Study on the prognosis of the T1a non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND AND OBJECTIVE</b>The new edition of the TNM staging for lung and pleural tumours has been finished, which put weight on the extent of primary tumor as one of the important prognosises. But little study has performed on the primary tumor extent < or = 2 cm. The aim of this study is to explore the prognosis of patients with tumor extent < or = 2 cm in stage I of non-small cell lung cancer, which helps us to choose the best treatment for these patients.</p><p><b>METHODS</b>Retrospective study on the clinical response and survival time of whom underwent complete surgical resection and diagnosed as T1a of stage I NSCLC from 1998 to 2004 was analyzed. Data was analyzed by SPSS 17.0 software.</p><p><b>RESULTS</b>Overall survival rate was 80.8%. By the study, age (P = 0.241), gender (P = 0.175), history of smoking (P = 0.845), pathologic type ( P =0.265), and systematic mediastinal lymphadenectomy (SML )(P = 0.918) or not, postoperative adjuvant chemotherapy or not ( P = 0.616) and visceral pleural invasion (P = 0.827) were not the prognosises of these patients. Only the tumor differentiation such as poorly differentiated was the important prognosis ( P = 0.01).</p><p><b>CONCLUSION</b>In the tumor extent < or = 2 cm of stage I non-small cell lung cancer, the visceral pleural invasion maybe not influence the patients survival. The tumor differentiation is one of the important prognostic factors.</p>

Trachea-bronchoplasty in the surgical treatment of locally advanced non-small cell lung cancer / 中国肺癌杂志

<p><b>BACKGROUND</b>Some of the locally advanced non-small cell lung cancer (NSCLC) need different trachea-bronchoplasty operative styles in order to make the widest possible to resect the tumor and remain normal pulmonary function. The aim of this study is to explore the surgical problem during trachea-bronchoplasty operation.</p><p><b>METHODS</b>There were 2206 patients with NSCLC underwent surgical treatment from January 2003 to June 2005 in this hospital. Of the 2206 cases, 100 patients accepted the trachea-bronchoplasty, whose clinic data were analyzed. There were 42 cases of squamous cell carcinoma, 23 adenosquamous carcinoma, 11 adenocarcinoma, 5 mucoepidermoid carcinoma, 4 adeoid cystic carcinoma, 3 carcinoid and 12 undetermined. Thirty-four cases were in stage IB, 23 in stage IIB, 23 in stage IIIA and 20 in stage IIIB. There were 42 cases of right upper sleeve lobectomy, 1 right lower sleeve lobectomy, 24 left upper sleeve lobectomy, 4 left lower sleeve lobectomy, 8 sleeve bilobectomy, 17 carinal reconstruction, 4 sleeve lobectomy plus pulmonary artery angioplasty.</p><p><b>RESULTS</b>Complete resection (R0) of the cancer was performed in 97 patients and uncomplete resection (margin positive, R1) was performed in 3 patients. Postoperative complication happened in 5 cases (the occurrence rate was 5%): Pneumonia in 2 cases, pleura cavity infection in 1 case, broncho-pleura fistula in 1 case, alveoli-pleura fistula in 1 case. One patient died of pulmonary infection, the operative mortality was 1%. The postoperative inpatient time was from 4 days to 27 days, with median of 11 days.</p><p><b>CONCLUSIONS</b>Trachea-bronchoplasty is suitable for some patients of the locally advanced NSCLC and consistent to the tumor surgical treatment principle. A satisfactory cure effect can be obtained for undergoing such operative style. The key point of successful operation is the operating skill to manage trachea, bronchi and pulmonary vessels.</p>

Application of video-assisted mini-thoracectomy for the diagnosis and treatment of peripheral pulmonary nodules / 中国微创外科杂志

Objective To evaluate the reliability of video-assisted mini-thoracectomy(VAMT) for the diagnosis and treatment of patients with pulmonary peripheral nodules.Methods A total of 55 patients with pulmonary peripheral nodules(1 case of multiple nodules and 54 cases of solitary nodule) underwent VAMT.The surgery included wedge resection in 23 patients and lobectomy with lymph node dissection in 32 patients(The lobectomy was performed by using conventional combined with thoracoscopic instruments.A self-made lymph node clamp was applied for lymph node dissection).Results The operation was successfully accomplished under thoracoscopy in all the 55 patients.The operation time was 35~180 min(mean,109 min) and the intraoperative blood loss was 50~400 ml(mean,122 ml).No blood transfusion was required.Postoperative complications included air leakage in 1 patient(discharge on the 32 postoperative day) and delayed wound healing in 1 patient(discharge on the 19 postoperative day).The length of postoperative hospital stay of the other 53 patients was 4~11 days(mean,8.3 days).Final pathological diagnosis showed 15 cases of benign lesions,38 cases of primary lung carcinoma,1 case of atypical adenomatous hyperplasia,and 1 case of metastatic lung cancer.The benign lesions were cured by wedge resection.Anatomic lobectomy with lymph node dissection was performed in 32 patients with primary lung cancer.Of other 6 patients with terminal lung cancer,4 patients were conservatively treated because of an extensive dissemination and 2 patients received a palliative wedge resection because of poor pulmonary functions.Conclusions Video-assisted mini-thoracectomy is helpful for the diagnosis and treatment of pulmonary peripheral nodules.Its long-term effects for clinical early-stage lung cancer need further follow-up investigations.

Effects of chemotherapy on operation for lung cancer / 中国癌症杂志

Purpose:To investigate the effects of chemotherapy on the patient's operation for lung cancer.Methods:One hundred patients were randomized into two groups. ①Preoperative chemotherapy group, the patients accepted chemotherapy first, then underwent operation, 59 cases;②postoperative chemotherapy group, the patients accepted the chemotherapy after operation, 41 cases. Most of the patients accepted the MVP chemotherapy regimen (1-6 course). All patients underwent operation of lobectomy or pneumonectomy. During the operation, the change of thorax structure was observed. Some indexes, which include operation time, blood loss during operation and postoperative drainage volume of first day, were recorded. The data were analysed with SPSS software.Results:①It is indicated that preoperative chemotherapy induce thoracic tissue fibrosis, which include pleura, the tissue around tumor and lymph nodes. The tissue fibrosis of pulmonary artery was most notable, which increase the risk and difficulty of operation .The serious grade of tissue fibrossis was related to the courses of chemotherapy. ②The operation time of preoperative chemotherapy group was longer than that of postoperative chemotherapy group ( P 0 05).④There was no significant difference in postoperative drainage volume in the two groups.Conclusions:①Chemotherapy increases the patients′ operation risks for lung cancer;②Fibrosis is an underlying risk factor for blood loss, it is necessary to pay more attention to careful hemostasia during the operation. ③To decrease the risks of postoperative complication, sufficient interval after chemotherapy, preoperative preparation and proper management after operation are the key factors.

Clinical study of major pulmonary resection by video-assisted mini-thoractomy for patients with lung cancer / 中国癌症杂志

Background and purpose:VATS lobectomy has gained popularity for lung cancer around the world.Complete anatomic resections and node dissections are routinely being performed at many centers under VATS,but some thoracic surgeons are concerned regarding the safety,benefit and radical resection of this operative method.Our study is to evaluate the reliability and feasibility of pulmonary resection by video-assisted mini-thoractomy(VAMT) for patients with lung cancer.Methods:72 patients with lung cancer received either lobectomy and systemic lymph node dissection by video-assisted mini-thoracotomy(VAMT group;n=32) or conventional thoracotomy(conventional group;n=40),lobectomy was performed by conventional or thoracoscopic instruments,specific lymph node clamps were applied for lymph node dissection.Results:VAMT was successfully performed without significant postoperative complication and blood transfusion.No significant differences were observed in the two groups with respect to the length of operation and the total groups of dissected lymph nodes.This study showed that VAMT is a minimally invasive surgery without impairing of the outcome and needed less operative blood loss and shorter postoperative hospitalization compared to conventional thoracotomy.Conclusions:Major pulmonary resection by video-assisted minithoractomy for patients with lung cancer is safe,reliable and less invasive,it is consistant with the surgical standard of lung cancer.Its long-term benefit needs to be clarified after further follow-up.

Analysis of prognostic factors in patients with non-small cell lung cancer treated by surgery and chemotherapy / 中国癌症杂志

Background and Purpose:Lung cancer is the most malignant tumour in the world.Its incidence is growing and NSCLC is predominent(80%) in lung cancer.Most patients with lung cancer were diagnosed in late stages.The tumour could be shrunk by neoadjuvant chemotherapy when the case with stage Ⅲ NSCLC was considered not possible for radical operated neoadjuvant chemotherapy may lead to the following,operation could be improved,micrometastasis could be annihilated and survival could be extended.Objective of this paper was to analyse the prognostic factors for survival in patients treated by surgery and chemotherapy for NSCLC.Methods:98 cases of neoadjuvant chemotherapy combined with surgery for NSCLC,stageⅠ~Ⅲ,were collected retrospectively in our hospital from 1995 to 1997.35 cases were stageⅠ.21 cases were stage Ⅱ.42 cases were stage Ⅲ.83 cases had 1 cycle of chemotherapy pre-operatively.15 cases had 2 cycles chemotherapy pre-operatively.Regimes of chemotherapy were MVP,MOP and MAP et al.Response rate(RR) of chemotherapy was:45 cases had partial response(PR) and 53 cases were stable disease(SD).Operative mode was lobectomy and pneumectomy with lymph nodes dissection.Pathologic type was squamous,adeno,adeno-squamous and others.All the patients were treated by chemotherapy for two or three cycles after surgery except for the patients in stageⅠin 1996~1997.After being followed-up for more than 5 years,data were examined using life table,KaplanMeier method,Log Rank statistic and Cox-mantel test.The possible factors affecting survival were tested with univariate and multivariate analysis.Results:The median followed-up time of 98 cases for NSCLC was 41.2 months.36 cases were alive.62 cases were dead.The 1-,3-,5-year survival rate of 98 cases for NSCLC was 88.78%、49.63% and 18.46%.The 5-year survival rates of stageⅠ、ⅡandⅢ were 33.23%、20.26% and 5.52% respectively(P=0.0002).The 5-year survival rates of N_(0)、N_(1)、N_(2) were 35.49%、19.08% and 4.90% respectively(P=0.0004).In the 98 cases of NSCLC,better prognosis was correlated with earlier stage.The prognosis was better if the period from last chemotherapy before operation to operation was no more than 1 month. The prognosis of lobectomy,lung hila activity,thorax lymph nodes negativity and squamous cancer was better.The prognosis was poorer if the tumor had invaded big vessels,viscera,chest wall,pericardium and quantity bleeding during≥400ml.The prognosis was better if the tumor was fibrotic.The prognosis of 2 cycles of chemotherapy pre-operatively might be better than 1 cycle.The prognosis of tumor necrosis was poorer and the prognosis of chemotherapy post-operatively was better.Conclusions:The main prognostic factors affecting survival in patients treated by surgery and chemotherapy for NSCLC was stage,the period from last chemotherapy before operation to operation,operation mode,lung hila activity,thorax lymph nodes,site of tumor invasion,bleeding quantity,pathologic type,tumor fibrosis and necrotis,cycles chemotherapy pro-operation and chemotherapy post-operation.

Extended operation for non-small lung cancer invading left atrium and great vessels and trachea carina / 中国癌症杂志

Purpose:To evaluate the clinical effects and indications of surgical treatment of non small lung cancer invading the left atrium and great vessels and trachea carina. Methods:From August 1998 to Auguest 2003, we performed operations on patients with non-small lung cancer invading the left atrium in 3 cases, invading the descending aorta in 1 case, invading trachea carina in 3 cases; all the patients have been examined to exclude distant metastasis, including nuclear bone scan to exclude bone metastasis; there were 2 cases of left pneumonectomy and one of right pneumonectomy invading the left atrium, there were 3 cases of right sleeve pneumonectomy invading the trachea carina. For the cases invading the descending aorta, we performed the operation with atrium-aorta bypass, Pathology examination: all of the cases were squamous lung cancer, staging of T 4N 0M 0 for 6 cases,T 4N 2M o for 1 case. Results:No complication, follow up: 6 cases survived more than 1 year,1 case survived more than 9 months;4 cases were alive for more than 3 years, 1 case invading the atrium died in 30 months because of brain metastasis,1 case invading the carina died in 15 months because of pulmonary infection. Conclusions:For localized advanced non-small lung cancer invading the aorta and invading the carina and the atrium, if we selected the patient correctly and with a good surgical technique with complete radical resection of the tumor ,we can acquire good results.

Analysis of causes and management of bronchus-pleural fistula after pneumonectomy of lung cancer / 中国癌症杂志

Purpose: To evaluate the causes and management of bronchial pleural fistula after pneumonectomy. Methods: Retrqspective analysis for Bronchus-pleural fistula( BPF) of 16 cases after pneumonectomy of 820 cases of lung cancer in our hospital. BPF occurred in right peumonectomy( 13/320) is more than in left pneumonectomy(3/500) . BPF occurred in the positive stump of bronchus ( 10/41) more than in negative stump of bronchus (6/779) ; BPF occurred in preoperative chemotherapy cases( 5/110) more than in non-preoperative chemotherapy cases( 11/710), No BPF occurred in the 70 cases in which the bronchial stump was covered by autogenous tissue. The management principle in early stage is thoracocentesis and wash with antibiotics; after identification of the infection in thoracic cavity or BPF, closed drainage for thorax was done. If the results of drainage are not very good, open drainage is necessary. Results: 2 cases were discharged with completely healing, (the cavity of 1 case was washed again and again with 5% NaHC03and urokinase , another case was operated again to cover the BPF using muscle flaps 3 days after the first operation), 8 cases were discharged with closed drainage, 4 cases were discharged with open drainage changing the wound covering every day, the BPF did not heal for a long time after open drainage in 1 case, 1 case died of function failure of body organs. Conclusions: BPF is related to management of the bronchial stump and radical resection for tumor, It is a useful method to cover the bronchial stump with autogenous tissues to decrease BPF's, especially for right pneumonectomy and preoperative chemotherapy or radiotherapy cases. The management principle of BPF is thoracocentesis for early cases, especially washing with antibiotics and 5% NaHC03and urokinase repeatedly, closed drainage when necessary is also a good method for curing empyema and BPF.