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Objective To determine the long-term impacts of major pulmonary complications ( MPCs) and identify the in-dependent risk factors in those non-small cell lung cancer(NSCLC)patients who underwent VATS lobectomy.Methods A ret-rospective study was developed to analyze the pulmonary complications of 574 non-small cell lung cancer patients who under-went VATS lobectomy in Peking University Hospital , the complications were graded according to TMM classification criteria . The effects of PCs on the long-term prognosis were analyzed by using the Kaplan-Meier method.Multivariate logistic regression analysis was used to determine the risk factors of MPCs.Results Of 574 patients, 106 had PCs, including 50(8.7％) MPCs, Postoperative pulmonary complications were associated with significantly longer drainage time (P<0.001) and hospital stays(P<0.001).Perioperative mortality was significantly increased in patients with PCs (4.0％ vs 0.6％; P =0.021). Those who develop a MPC had a reduced 3-year DFS and 5-year DFS(61.3％ vs.77.4％、42.2％ vs.69.3％;P=0.003), as well as the reduced 3-year OS and 5-year OS(78.5％vs.88.2％、62.4％ vs.79.2％;P=0.047).MPCs were independ-ent prognostic factors of patients with lung cancer .Multivariate logistic regression analysis showed that the independent risk fac-tors for MPCs were age, male, ASA grade.Conclusion Major pulmonary complications after VATS lobectomy are associated with a poorer long-time outcome.The independent risk factors for MPCs are age, male, and ASA grade.
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Objective To develop an easy-to-use nomogram to assist clinicians in predicting major postoperative morbidity in those non-small-cell lung canccr patients who underwent VATS lobectomy.Methods A perspective multi-center study was developed to analyze the major postoperative complications of 612 non-small-cell lung cancer patients who underwent VATS lobectomy.Muhivariable logistic regression was used to model postoperative morbidity and built the nomogram to accurately predict the major complications.Results There were 606 (99％) survivors and 6 (1％) mortality.A total of 32 patients suffered from major complications.Using logistic regression to predict major complications,preoperative model for ASA score,age ≥70 years and operation time ＞ 150 nin were found to be the significant predictors(P ＜ 0.05) of morbidity and were included in our model.Conclusion We propose a nomogram to enable clinicians to better estimate morbidity in patients with VATS lobectomy.
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Objective The aim of this study is to evaluate the efficacy and safety of preoperative Computed Tomography (CT)-guided microcoil localization for pulmonary ground-glass opacity.Methods We performed CT-guided Microcoil localization in 30 patients with 32 pure ground glass opacities between December 2012 and September 2013.All 30 patients underwent CT-guided micmcoil localization under local anesthesia with a 21G needle percutaneous lung biopsy.All patients accepted video-assisted thoracic surgery after the localization the same day or the next day.Results We located 32 pure ground glass opacitiesin 30 patients.The mean lesion diameter was 0.94 cm,the average depth from the visceral pleura was 0.71 cm,all leisons were successfully located by microcoil,asymptomatic pneumothorax was observed in seven patients,pulmonary hematoma was observed in two patients,pain was observed in one patient,dislodgement was found in one patient during the operation.None of these cases needed surgical treatment.Pathologic diagnoses of the target leisions were as follows:adenocarcinoma in situ (n =17),adenocarcinoma(n =9),atypical hyperplasia(n =4),inflammation (n =2).After the placement of preoperative CT-guided microcoil localization for pulmonary ground-glass opacity,all the 32 pulmonary pure ground-glass opacities resection success rate was 100％.Conclusion Preoperative CT-guided microcoil localization for pulmonary pure ground-glass opacity is a safe and effective way to improve the accuracy of surgical resection.
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Objective To evaluate the long term effect of video-assisted thoracoscopic thymectomy for myasth,enia gravis and the influence of concomitant thymoma.Methods 47 cases of myasthenia gravis were retrospectively reviewed who had received video-assisted thoracoscopic thymectomy from Apr.2001 through Oct.2009.The patients were separated to two groups with or without thymoma.Influence of oncologic factors was carefully studied.Results There were 20 males and 27 females with a mean age of 36.6 yrs.According to the typing system of the Myasthenia Gravis Foundation of America ( MGFA),the patients belonged to type Ⅰ 18 cases,type Ⅱ a 14 cases,type Ⅱ b 14 cases,and Ⅲa 1 case.22 patients were in the group with thymoma,and the other 25 in the group without thymoma.Until the deadline of follow-up time of Jun.2011,only two cases in non-thymomatous group were lost.Follow-up time was 20 to 122 months,mean 57 months.The complete stable remission rate(CSR),pharmacologic remission(PR),minimal manifestations(MM),worse(W),exacerbation(E) and died of myasthenia gravis(D) in non-thymomatous group were 78.3％,13.0％,4.3％,0,0 and 4.3％.In thymomatous group the values were 50.0％,22.7％,13.6％,4.5％,9.1％ and 0.Conclusion Video-assisted thoarcoscopic thymectomy has a satisfactory long term effect for myasthenia gravis.Thymomatous group has no different in overall effectiveness with that of non-thymomatous group although a probably lower complete stable remission rate is prompted.
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ObjectiveSummarize 500 cases of non-small cell lung cancer (NSCLC) that has accepted complete videoassisted thoracoscopic (VATs) lobectomy procedure in People's Hospital of Peking University,to report the mid-term follow-up results,and to evaluate the safety and effectiveness of VATs lobectomy.MethodsBetween September 2006 and September 2011,500 cases of non-small cell lung cancer that has accepted complete thoracoscopic lobectomy in the People's Hospital of Peking University were reviewed (267 male,233 female).Median patient age was 62.3 years.The average maximal diameter of solid tumors was 2.65cm.There are 496 cases of initial treat patients and 4 cases of operation after radiation and chemotherapy.This group consisted of lobectomies of left upper lobe ( n =129),left lower lobe ( n =73 ),right upper lobe ( n =163 ),right middle lobe x( n =47 ),right lower lobe( n =89 ).The operation procedure was complete VATs lobectomy combined with systematic lymph node resection ( at least 3 groups of lymph nodes in the mediastinum area),including 480 cases of purely lobectomy,13 cases of compound lobectomy (pulmonary lobe + pulmonary lobe,or pulmonary lobe + pulmonary segment),3 cases of segmentomy,2 cases of pneumonectomy,1 case of sleeve lobectomy and 1 case of bilateral lobectomy.ResultsAll procedures were carried out smoothly without serious complication,except 1 case of death of an advanced age patient due to multi-organ failure after the operation period.The average surgical duration was 198.1 min,and average blood loss was 214.6ml.There are 5 cases of postoperative hemorrhage,identified as pulmonary artery residual ooze blood,in which 4 cases of bleeding were stopped through re-operation,and 1 case was improved through conservative treatment.The median lymph nodes dissection was 5.7 group and median number of resected lymph nodes was 16.9.The median postoperative chest tube drainage duration was 7.8 day,and median postoperative hospital stay was 10.2 day.There were 45 cases (9.0％) of conversion to open thoracotomy and 87 cases ( 17.4％ ) of slight complications,including 32 cases of cardiac abnormalities,such as continuous arrhythmia,28 cases of air leakage beyond seven days,9 cases of pulmonary infections or atelectasis,6 cases of chylothorax,and 16 cases of other complications.The results of pathology show 363 cases of adenocarcinoma,85 cases of squamous carcinoma,12 cases of adenosquamous carcinoma,28 broncho-alveolar cell carcinoma,6 cases of large cell lung cancer and 6 cases of other lung cancer.The 1-year disease free survival (DFS) was 90.2％ and 1-year overall survival (OS) was 94.3％.The 3-year DFS was 76.4％ and 3-year OS was 81.3％.ConclusionCompletely video-assisted Thoracoscopic lobectomy procedure was a safe and effctive procedure for patients with non-small cell lung cancer.
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ObjectiveTo review the experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumors,to investigate the technical features and difficulties of thoracoscopic approach.MethodsFrom May 2001 to June 2011,58 patients underwent thoracoscopic resection of posterior mediastinal tumors in our institution,including 36 males and 22 females.The average age of the patients was 38.7 years.The average tumor size was 4.9 cm.16 patients had neurogenic or pulmonary symptoms at the time of diagnosis,while the other 42 were asymptomic.24 lesions were located in the left side,33 lesions in the right side,1 lesion in bilateral sides.All procedures generally required 3 ports,and intracapsular enucleation was preferred,supplying vessels were ligated by hemoclips or Hem-o-lock clips; the nerves of origin were cut off at both edges of the tumor.For bulky tumor,dense adhesion,and massive bleeding,open conversions were performed by extending the incision anteriorly to 6-10 cm.ResultsAll procedures were successfully performed without death event occurring.The average operating time was 127.2 min.The average intraoperative blood loss was 206.4 ml.3 cases requied blood transfusion.The average chest tube duration was 2.72 days.The average postoperative stay was 5.19 days.53 procedures were performed entirely under thoracoscopy to achieve gross-total resection.Conversions to an open procedure were necessitated in 5 patients (8.6％).7 patients experienced post-operative complications,with 4 Horner syndromes.There were 25 neurilemomas,23 neurofibromas,8 ganglioneuromas,1 paraganglioma,and 1 malignant paraganglioma.No local recurrence was seen after an average follow-up of 44.9 months.ConclusionVideo-assisted thoracoscopic removes of the posterior mediastinal tumors are safe,reliable and minimally invasive for selected patients with mastered throcoscopic skills.intracapsular enucleation is a safe procedure with reduced risk,while tumors larger than 6cm and located in the apex are with increased risk.
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Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of thoracic sarcoidosis.Methods The study was retrospective,from September 2009 to June 2011,35 patients with suspected sarcoidosis,with enlarged hilar or mediastinal lymph nodes on computed tomography ( ≥1.0 cm),underwent EBUS-TBNA.Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months clinical and radiologic follow-up.Results EBUS-TBNA was performed on a total of 87 lymph node stations in 35 patients.Of the enlarged lymph nodes,64 (73.6％) were located in the mediastinal region and the remaining 23 ( 26.4％ ) around the hilar or interlobar area.A final diagnosis of sarcoidosis was made for 28 (80％) of the patients.In patients with a final diagnosis of sarcoidosis,EBUS-TBNA demonstrated noncaseating epithelioid cell granulomas in 25 ( 89.3％ ) of the patients.EBUS was well tolerated by all of the patients with no complications.Conclusion EBUS-TBNA is a safe procedure with a high yield for the diagnoses of thoracic sarcoidosis of stage Ⅰ or Ⅱ.
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Objective To review the experience d EBUS-TBNA for staging of lung cancer and the value in diagnosing thoracic diseases in our single center.Methods The data of 343 patients who underwent EBUS-TBNA from September 2009 to August 2011 in our institution were retrospectively reviewed.There were 219 males and 124 females with an average age of (59.4 ± 13.6 ) years.Based on their primary indication,patyients were divided into three categories:group A:with known or strongly suspected lung cancer and enlarged mediastinal lymph nodes on chest radiographic examination ( short axis ≥ 1.0cm) ; group B:with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin; and group C:with pulmonary parenchymal mass located close to the central airways.Results The average short axis diameter of the thoracic lesions was ( 1.94 ± 1.01 ) cm ( range from 0.5 to 8.0cm),and 2.66 punctures were performed per lesion.In group A ( n =208 ),151 patients were confirmed to have mediestinal lymph nodes metastasis while 51 showed negative results.Four patients were diagnosed as tuberculosis and two were confirmed to be stage Ⅱ sarcoidosis.37 in the 51 patients with negative EBUS-TBNA underwent thoracoscopic or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 32 patients did not have lymph nodes metastases.The diagnostic sensitivity,specificity,accuracy,positive predictive and negative predictive of EBUS-TBNA for the mediastiral staging of lung cancer were 96.8％ (151/156),100.0％ (32/32),97.3％ ( 183/188 ),100％ ( 151/151 ) and 86.5％ (32/37),respectively.In group B ( n =94),22 patients had malignancy and 72 had benign diseases.Thirteen patients received operative validation in the 23 cases which were diagnosed as proliferative lymph nodes by EBUS-TBNA,and by further operation two and three patients were confirmed as malignancy and other benign diseases respectively.The sensitivity,negative predictive value ( NPV ) and accuracy of EBUS-TBNA in distinguishing malignant mediastinal diseases was 88.0％ (22/25)、100％ (73/73) 、95.9％ (70/73)and 97.9％ (92/94),respectively.In group C( n =41 ),malignant diagnosis was achieved in 33 patients,while 4 patients confirmed as malignancy by further operations in the other 8 negative cases.The diagnostic sensitivity and accuracy of EBUS-TBNA for the diagnosis of unknown pulmonary parenchymal mass were 89.2％ (33/37) and 90.2％ (37/41),respectively.All the procedures were uneventful and no complication occurred.Conclusion EBUS-TBNA is a highly effective and safe procedure in the diagnosis of thoracic diseases and staging.of lung cancer.
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Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of mediastinal lesions around the trachea.MethodsThe study was retrospective, between September 2009 to July 2010, 34 consecutive patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin underwent EBUS-TBNA.Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months clinical and radiologic follow-up.ResultsOf the 34 patients, EBUS-TBNA achieved definitive diagnosis in 28 patients (82.4％), 10 were diagnosed as malignancies, 18 were diagnosed as benign.The sensitivity, specificity,and accuracy of EBUS-TBNA in distinguishing benign from malignant mediastinal lesions were 90.9％, 100％, and 97.1％,respectively.EBUS was well tolerated by all of the patients with no complications.ConclusionEBUS-TBNA of mediastinal lesions around the trachea is a minimally invasive safe diagnostic technique with high yield.
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Objective To evaluate the value of autofluorescence bronchoscope (AFB) in airway examination in central type lung cancer. Methods From Sep 2009 to Mar 2010 ,29 patients ( 23 men , 6 women , median age 62.2 years , range from 34 to 81 years) underwent AFB procedure. There were 3 lesions located at trachea, 1 at right main bronchus, 9 at right upper lobe, 1 at right median bronchus, 1 at right middle lobe, 4 at right lower lobe, 1 at left main bronchus, 9 at left upper lobe.There were 21 preliminary diagnostic cases and 8 postoperative surveillance cases. All procedure was performed under combination of local anaesthesia and general anaesthesia. All patients underwent white light bronchoscopy followed by AFB procedure.All of the suspicious abnormal sites were recorded and biopsied for pathological examination. Results All procedures were safely performed without death or serious complications. 100 specimens were obtained for pathologic examination. Malignant lesion was diagnosed in 39 and non-malignancy in61. All malignant sites were detected by AFB, however WLB missed 12 sites.The sensitivity of AFB and WLB for malignancy were 100% and 69.2%, respectively. In 21 preliminary diagnostic cases,AFB detected all malignancy sites, but WLB missed 23 sites, in which 9 were malignant sites. In 8 rechecked patients, AFB detected all malignancy sites, but WLB missed 7 sites, in which 3 were malignant sites. Conclusion Autofluorescence bronchoscopy could be more accurate in judging the extent of the tumor invasion, more sensitive in finding multiple lesions in airway, more sensitive in detecting early cancer recurrence in postoperative surveillance patients.
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Objective To determine the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer. Methods The study was retrospective, a total of 52 patients underwent EBUSTBNA for known or suspected lung cancer. All patients were detected enlarged mediastinal lymph nodes on CT scan ( ≥ 1.0cm). Results Of the 52 patients, 41 patients were found with N2 or N3 disease on EBUS-TBNA. 11 patients with negative EBUS-TBNA underwent thoracoscopy or thoracotomy for pulmonary resection and mediastinal lymph node dissection, 9 patients were confirmed N0 by pathology, whereas 2 patients had metastatic lymph node. The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of EBUS-TBNA for the mediastinal staging of lung cancer were 95.3%, 100%, 96.2%, 100%, and 81.8%, respectively. The procedure was uneventful, and there were no postoperative complications. Conclusion EBUS-TBNA is an effective and safe technique for mediastinal staging in lung cancer patients.
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0bjective Evaluate the clinical factors affecting the definite pathological diagnosis of solitary pulmonary odules(SPN).Methods From Jan 2000 to July 2009,390 patients(212 men,178 women,median age 57.1 years,range from 17 to 86 years)got definite pathological diagnosis of solitary pulmonary nodules in our Institute were investigated.All following clinical data were collected:age,gender,course of disease,symptoms,history and quantity of smoking,history of tumor,family history of tumor,site,diameter,calcification,spicular sign,border,lobulated,traction of pleural,vascular convergence sign,lymph nodes of mediastinum,adhesion,depression of pleural,pleural effusion.Results The surgical procedures included 20 tumor enucleation,153 wedge resection,and 217 lobectomy.There were 130 benign lesions,including hamartoma(n=33),arteriovenous istula(n=1),cyst(n=2),interstitial pneumonia(n=1),tuberculoma(n=49),lymphoproliferative(n=2),fungal ball(n=3),neurofibroma(n=1),inflammatory pseudotumor(n=27),sclerosing hemangioma(n=9),bronchiectasis(n=2).260 were malignant lesions,including Alveolar cell carcinoma(n=23),Metastatic carcinoma(n=20),Carcinoid(n=4),Squamous cell carcinoma(n=40),adenecarcinoma(n=164),Small cell carcinoma(n=9).Single factor analysis and Logistic regression analysis show that there were significant differences in age, diameter,border,calcification and depression of pleural in judgement character of SPN.In addition,there were no differences in gender,course of disease,symptoms,history and quantity of smoking,history of tumor,family history of tumor,site,spicu lar sign,lobulated,traction of pleural,vascular convergence sign,lymph nodes of mediastinum,adhesion and pleural effusion.Conclusion Age of patient,and diameter,border,calcification,pleural depression of the tumor were significant risk factors in judgment character of SPN.
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Objective To optimize operative techniques of completely video-assisted thoracoscopic lobectomy by reviewing the experience of Peking University People's Hospital. Methods From September 2006 to August 2010, 408 patients (214 males,194 females) with median age of 58.6 years (range from 15 to 86 years) underwent completely thoracoscopic lobectomy. All procedures were conducted under general anesthesia with double lumen intubation. The thoracoscope was introduced through 7th or 8th intercostals space on the mid-axillaries line. The 4 cm long utility incision was made on the 4th or 5th intercostals space anterior axillary's line without rib-spreading. A third retraction incision located on the 7th or 8th intercostals space sub-scapular line. The surgeon stands on the ventral side of patient using an electrocautery hook and a suction device through the utility incision. Anatomic lobectomy was performed with systemic mediastinal lymph node dissection for lung cancer patients. Results All procedures were carried out smoothly with no case of serious complication. There was 1 case death because of respiratory failure of pulmonary fungal infection during the operative period. The average surgical duration was 195 minutes, and average blood loss was 249 ml with no blood transfusion required. There were 35 cases (8.6%) of conversion to open thoracotomy, including interference by lymph nodes, bleeding, inflammatory adhesion of Artery and large size tumors.The results of pathology show 322 cases of malignant disease and 86 cases of benign disease. Conclusion To grasp the core technique of completely thoracoscopic lobotomy may make the procedure undergone smoothly, and may shorten the learning curve.
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Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for CT-positive mediastinal lymph nodes. Methods From September 2009 to December 2009, 28 patients with confirmed or suspected non-small-cell lung cancer with CT scan demonstrating enlarged ( ≥ 1 cm) mediastinal lymph nodes underwent EBUS-TBNA. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were evaluated. Results 28 patients with 40 lymph nodes were studied. 27 patients had been performed successfully with enough specimens. No complications happened in the group. Mediastinal metastases were confirmed by EBUS-TBNA in 20 patients. 8 patients with benign mediastinal nodes as detected by EBUS-TBNA underwent surgery and mediastinal lymph node dissection, which confirmed N2 disease in 2 patients. Overall diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA in the detection of mediastinal metastasis were 92.9%, 90.9%,100%, 100%, 75% respectively. Conclusion EBUS-TBNA is a safe and effective technique for CT-positive mediastinal lymph nodes on CT scan.