Progress on three-dimensional visualization technology in precise lung resection / 中国胸心血管外科临床杂志

@#Three-dimensional (3D) visualization technology can well characterize lung nodules, accurately locate lung nodules, accurately identify lung anatomical structures, shorten operation time, reduce intraoperative and postoperative complications, and make thoracoscopic precise lung resection safer and more efficient. However, the mastery of 3D reconstruction technology in some hospitals still needs to be improved. Due to the time and economic cost of 3D printing, the development of this technology is restricted. With the application and improvement of 3D visualization technology in more centers in the future, the development of precise lung resection will be more extensive. This article reviewed the progress on 3D visualization technology in thoracoscopic precise lung resection.

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods     A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results     A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion     Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.

Clinical analysis of the feasibility and safety of single utility port robot-assisted lung resection / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility and safety of single utility port Da Vinci robot-assisted lung resection via anterior approach. Methods    The clinical data of 21 patients who underwent single utility port Da Vinci robot-assisted lung resection from February to March 2021 were retrospectively analyzed. There were 10 males and 11 females, with a median age of 50 (34-66) years. The operation time, blood loss, postoperative hospitalization time, postoperative complications and other indicators were analyzed. Results    All patients completed the operation successfully with no transition to thoracotomy or perioperative death. Overall surgery time was 103 (70-200) min, Docking time was 5 (3-10) min, operation time was 81 (65-190) min. The blood loss was 45 (20-300) mL. All patients had malignant tumors, the number of dissected lymph node station was 3 (1-6), and the number of lymph nodes was 5 (2-16). The postoperative indwelling time was 3 (2-5) d. The postoperative hospitalization time was 5 (3-7) d. The pain score for the first 3 days after surgery was 3±1 points. Conclusion    Single utility port robot-assisted lung resection via anterior approach is safe, less traumatic, more convenient and effective, which can be gradually promoted and applied to clinical trials.

Estadificación nodular linfática y supervivencia en pacientes operados por carcinoma pulmonar no microcítico / Lymphatic nodular staging and survival in patients operated due to non-small cell lung cancer

Introducción: En los pacientes con cáncer de pulmón resulta vital el tratamiento quirúrgico, pues posibilita una estadificación patológica minuciosa, así como un pronóstico y tratamiento acordes con la carga tumoral de cada paciente. Objetivo: Determinar la influencia del tipo de linfadenectomía mediastinal en la supervivencia de pacientes operados por cáncer pulmonar de células no pequeñas. Métodos: Se realizó un estudio descriptivo y longitudinal en el Servicio de Cirugía General del Hospital Provincial Clínico-Quirúrgico Docente Saturnino Lora de Santiago de Cuba, durante un período de 10 años (de 2009 a 2019), en 55 pacientes seleccionados aleatoriamente, quienes recibieron algún tipo de linfadenectomía del mediastino además de resección pulmonar. En el procesamiento estadístico, se utilizaron el número absoluto, el porcentaje y la media como medidas de resumen; también la prueba de independencia de la Χ2, para identificar la posible asociación entre variables, y el método de Kaplan-Meier, para precisar la supervivencia. Resultados: La técnica de linfadenectomía mediastínica más utilizada fue el muestreo ganglionar (47,3 %), con la cual también se obtuvo un mayor porcentaje (84,6) de resultados negativos en cuanto a invasión neoplásica, a diferencia de lo observado con la disección ganglionar sistemática, que reveló positividad de infiltración tumoral en un elevado número de pacientes (52,9 %). Asimismo, los pacientes operados mediante disección ganglionar sistemática mostraron mejor supervivencia a los 6 meses (100 %) y al año (87,5 %); a los 5 años las cifras de supervivencia con esta técnica fueron superiores a las obtenidas con todos los tipos de escisiones ganglionares practicadas. Conclusiones: Existió mayor probabilidad del diagnóstico de invasión linfática del mediastino y una mejor supervivencia en los pacientes tratados con disección ganglionar sistemática. Por ello, se recomienda protocolizar dicho tratamiento quirúrgico, lo cual pudiera estar avalado por un ensayo clínico que permita comparar grupos homogéneos que reciban cada tipo de linfadenectomía, respectivamente, a fin de recoger una evidencia científica relevante y concluyente.

Introduction: In the patients with lung cancer it is vital the surgical treatment, because it facilitates a meticulous pathological staging, as well as a prognosis and treatment according to each patient tumoral charge. Objective: To determine the influence of the mediastinal limphadenectomy type in the survival of patients operated due to non-small cells lung cancer. Methods: A descriptive and longitudinal study was carried out in the General Surgery Service of Saturnino Lora Teaching Clinical-Surgical Provincial Hospital in Santiago de Cuba, during 10 years (from 2009 to 2019), in 55 patients selected at random who received some type of mediastinum lymphadenectomy besides lung resection. In the statistical processing, the absolute number, percentage and the mean were used, as summary measures; also the chi-squared test to identify the possible association among variables, and the Kaplan-Meier method, to specify survival. Results: The most used medistinic lymphadenectomy technique was the ganglionar sampling (47.3 %), with which a higher percentage of negative results was also obtained (84.6) as regards neoplastic invasion, contrary to that is observed with the systematic ganglionar dissection that revealed metastasis positivity in a high number of the patients that received it (52.9 %). Likewise, patients operated by means of systematic ganglionar dissection showed a better survival 6 months later (100 %) and a year later (87.5 %); after 5 years the survival number with this technique was superior to all the types of ganglionar excisions practiced. Conclusions: There was a higher probability of the mediastinic lymphatic infiltration diagnosis and better survival in the patients treated with systematic ganglionar dissection. Reason why, it is recommended to protocolize this surgical treatment, which could be endorsed by a clinical trial that allows to compare homogeneous groups that receive each type of lymphadenectomy, respectively, in order to obtain an outstanding and conclusive scientific evidence.

Comparación de resultados de la Cirugía Torácica Convencional y la Uniportal en el Instituto Nacional de Oncología y Radiobiología / Comparison of results of Conventional and Uniportal Video-Assisted Thoracic Surgery in the National Institute of Oncology and Radiobiology

Introducción: La cirugía torácica videoasistida por un solo puerto (Uniportal VATS) se ha convertido hoy en uno de los abordajes más utilizados para resecciones pulmonares en muchos centros de cirugía torácica del mundo, en Cuba su introducción es bastante reciente y todavía se encuentra en fase inicial. Objetivo: Comparar los resultados obtenidos por cirugía torácica abierta y Uniportal VATS en pacientes intervenidos en el Instituto Nacional de Oncología y Radiobiología de La Habana (INOR) durante enero de 2016 a abril de 2017. Material y Métodos: Estudio observacional descriptivo de corte longitudinal retrospectivo con 60 pacientes atendidos en el INOR durante enero de 2016 a abril de 2017 a los cuales se les realizó cirugía torácica. Resultados: Veinticuatro pacientes fueron operados por Uniportal VATS y 36 a través de la toracotomía, primaron las lesiones del lado derecho, el procedimiento más realizado fue lobectomía. Los estadíos predominantes fueron IA y IB, la mayoría de los procedimientos fue realizada en tres horas o menos, 8 casos se convirtieron, 13 sufrieron complicaciones. La estadía media de los pacientes tratados con Uniportal VATS fue menor que los que recibieron la toracotomía abierta. Conclusiones: El abordaje Uniportal se caracterizó por ser seguro, tener una gran versatilidad, pocas complicaciones y por mejorar la recuperación postquirúrgica del paciente y acelerar su reincorporación a las actividades de la vida cotidiana(AU)

Introduction: Single-port Video Assisted Thoracic Surgery (Uniportal VATS) has currently become one of the most commonly used approaches for lung resections in many Thoracic Surgery Centers around the world. In Cuba, its introduction is quite recent and it is still in its initial phase. Objective: To compare the results obtained by open thoracic surgery and Uniportal VATS in patients who underwent surgery in the National Institute of Oncology and Radiobiology of Havana (INOR) from January 2016 to April 2017. Material and Methods: An observational descriptive longitudinal retrospective study was conducted in 60 patients who underwent Thoracic Surgery in the INOR during 2016 - April 2017. Results: A total of 24 patients were operated through Uniportal VATS and 36 underwent thoracotomy. The lesions predominantly affected the right side and lobectomy was the most performed surgical procedure. Stages IA and IB predominated. Most of the procedures were carried out in 3 hours or less, 8 cases were converted and 13 suffered from complications. The average postoperative length of stay in hospital for patients who underwent Uniportal VATS was reduced compared to those who underwent open thoracotomy. Conclusions: Uniportal VATS is characterized by being a safe procedure with few complications and great versatility. It improves postoperative recovery of patients and accelerates their return to daily life activities(AU)

Pleurodesis with an Autologous Blood Patch in the Treatment of Persistent Air Leak after Lung Resection / 中国医学科学院学报

Objective To evaluate the efficacy and risks of autologous blood patch pleurodesis in patients with persistent air leak(PAL)after lung resection. Methods A total of 97 patients with PAL after lung resection in Beijing Shijitan Hospital from October 2014 to October 2019 were retrospectively reviewed,including 53 treated by autologous blood patch pleurodesis and 44 by the conventional way.The therapeutic effect,adverse reactions and complications were analyzed. Results All the patients with PAL were cured with autologous blood patch pleurodesis.Most air leaks(81.1%)ceased within 48 hours after treatment,and the left 18.9% patients got cured after a repeat.The mean tube retention time and the mean in-hospital stay were 8.4 days and 10.0 days in the autologous blood patch pleurodesis group and 13.5 days and 15.3 days in the conventional treatment group.A prolonged drainage time(P=0.00)and in-hospital stay(P=0.00)were observed in the conventional treatment group.No severe complications were observed except two patients developed slight fever and cutaneous emphysema. Conclusion In our experience,the autologous blood patch pleurodesis is an effective way with low risk of adverse reactions in the treatment of PAL.

Predictive value of plasma cytokines for acute kidney injury following lung resection surgery: prospective observational study / Valor preditivo das citocinas plasmáticas para lesão renal aguda após cirurgia de ressecção pulmonar: estudo observacional prospectivo

Abstract Background and objectives: Patients undergoing lung resection surgery are at risk of developing postoperative acute kidney injury. Determination of cytokine levels allows the detection of an early inflammatory response. We investigated any temporal relationship among perioperative inflammatory status and development of acute kidney injury after lung resection surgery. Furthermore, we evaluated the impact of acute kidney injury on outcome and analyzed the feasibility of cytokines to predict acute kidney injury. Methods: We prospectively analyzed 174 patients scheduled for elective lung resection surgery with intra-operative periods of one-lung ventilation periods. Fiberoptic broncho-alveolar lavage was performed in each lung before and after one-lung ventilation periods for cytokine analysis. As well, cytokine levels were measured from arterial blood samples at five time points. acute kidney injury was diagnosed within 48 h of surgery based on acute kidney injury criteria. We analyzed the association between acute kidney injury and cardiopulmonary complications, length of intensive care unit and hospital stays, intensive care unit re-admission, and short-term and long-term mortality. Results: The incidence of acute kidney injury in our study was 6.9% (12/174). Acute kidney injury patients showed higher plasma cytokine levels after surgery but differences in alveolar cytokines were not detected. Although no patient required renal replacement therapy, acute kidney injury patients had higher incidence of cardiopulmonary complications and increased overall mortality. Plasma interleukin-6 at 6 h was the most predictive cytokine of acute kidney injury (cut-off point at 4.89 pg.mL-1). Conclusions: Increased postoperative plasma cytokine levels are associated with acute kidney injury after lung resection surgery in our study, which worsens the prognosis. Plasma interleukin-6 may be used as an early indicator for patients at risk of developing acute kidney injury after lung resection surgery.

Resumo Justificativa e objetivos: Os pacientes submetidos à cirurgia de ressecção pulmonar apresentam risco de desenvolver lesão renal aguda pós-operatória. A determinação dos níveis de citocinas permite detectar uma resposta inflamatória precoce. Investigamos a relação temporal entre o estado inflamatório perioperatório e o desenvolvimento de lesão renal aguda após cirurgia de ressecção pulmonar. Além disso, avaliamos o impacto da lesão renal aguda no desfecho e analisamos a viabilidade das citocinas para prever este tipo de lesão. Métodos: No total, foram analisados prospectivamente 174 pacientes agendados para cirurgia eletiva de ressecção pulmonar com períodos intraoperatórios de ventilação monopulmonar. Lavado bronco-alveolar com fibra óptica foi realizado em cada pulmão antes e após os períodos de ventilação monopulmonar para análise das citocinas. Os níveis de citocina foram medidos a partir de amostras de sangue arterial em cinco momentos. A lesão renal aguda foi diagnosticada dentro de 48 horas após a cirurgia, com base nos critérios para sua verificação. Analisamos a associação entre lesão renal aguda e complicações cardiopulmonares, tempo de internação em unidade de terapia intensiva e de internação hospitalar, reinternação em unidade de terapia intensiva e mortalidade a curto e longo prazos. Resultados: A incidência de lesão renal aguda no estudo foi de 6,9% (12/174). Os pacientes com lesão renal aguda apresentaram níveis mais altos de citocinas plasmáticas após a cirurgia, mas não foram detectadas diferenças nas citocinas alveolares. Embora nenhum paciente tenha precisado de terapia renal substitutiva, os com lesão renal aguda apresentaram maior incidência de complicações cardiopulmonares e aumento da mortalidade geral. A interleucina-6 plasmática em seis horas foi a citocina mais preditiva de lesão renal aguda (ponto de corte em 4,89 pg.mL-1). Conclusões: O aumento dos níveis plasmáticos de citocinas no pós-operatório está associado à lesão renal aguda após cirurgia de ressecção pulmonar no estudo, o que piora o prognóstico. A interleucina-6 plasmática pode ser usada como um indicador precoce para pacientes com risco de desenvolver lesão renal aguda após cirurgia de ressecção pulmonar.

Deep versus moderate neuromuscular block during one-lung ventilation in lung resection surgery / Bloqueio neuromuscular profundo versus moderado durante a ventilação monopulmonar em cirurgia de ressecção pulmonar

Abstract Background and objectives: Neuromuscular relaxants are essential during general anesthesia for several procedures. Classical anesthesiology literature indicates that the use of neuromuscular blockade in thoracic surgery may be deleterious in patients in lateral decubitus position in one-lung ventilation. The primary objective of our study was to compare respiratory function according to the degree of patient neuromuscular relaxation. Secondary, we wanted to check that neuromuscular blockade during one-lung ventilation is not deleterious. Methods: A prospective, longitudinal observational study was made in which each patient served as both treated subject and control. 76 consecutive patients programmed for lung resection surgery in Gregorio Marañon Hospital along 2013 who required one-lung ventilation in lateral decubitus were included. Ventilator data, hemodynamic parameters were registered in different moments according to train-of-four response (intense, deep and moderate blockade) during one-lung ventilation. Results: Peak, plateau and mean pressures were significantly lower during the intense and deep blockade. Besides compliance and peripheral oxygen saturation were significantly higher in that moments. Heart rate was significantly higher during deep blockade. No mechanical ventilation parameters were modified during measurements. Conclusions: Deep neuromuscular blockade attenuates the poor lung mechanics observed during one-lung ventilation.

Resumo Justificativa e objetivos: Os relaxantes neuromusculares são essenciais durante a anestesia geral para vários procedimentos. A literatura clássica de anestesiologia indica que o uso de bloqueio neuromuscular em cirurgia torácica pode ser prejudicial em pacientes posicionados em decúbito lateral com ventilação seletiva. O objetivo primário deste estudo foi comparar a função respiratória de acordo com o grau de relaxamento neuromuscular do paciente. O objetivo secundário foi verificar que o bloqueio neuromuscular durante a ventilação seletiva não é prejudicial. Métodos: Estudo observacional, prospectivo e longitudinal no qual cada paciente serviu como próprio controle. Foram incluídos 76 pacientes consecutivos, agendados para cirurgia de ressecção do pulmão no Hospital Gregorio Marañon ao longo de 2013, submetidos à ventilação seletiva em decúbito lateral. Os dados do ventilador e os parâmetros hemodinâmicos foram registrados em diferentes momentos de acordo com a resposta por sequência de quatro estímulos (bloqueio intenso, profundo e moderado) durante a ventilação seletiva. Resultados: As pressões de pico, platô e média foram significativamente menores durante os bloqueios intenso e profundo. Além disso, complacência e saturação periférica de oxigênio foram significativamente maiores nesses momentos. A frequência cardíaca foi significativamente maior durante o bloqueio profundo. Não houve alteração dos parâmetros da ventilação mecânica durante as mensurações. Conclusões: O bloqueio neuromuscular profundo atenua a mecânica pulmonar deficiente observada durante a ventilação seletiva.

Comparative Study of Resection by Traditonal Thoracotomy and the Thoracoscope for Senile Patients with Lung Cancer / 现代生物医学进展

Objective:To analyze the curative effects of resection by traditional thoracotomy and thoracoscopy for senile peripheral lung cancer.Methods:65 patients with peripheral lung cancer were randomly divided into traditional thoracotomy surgical group and thoracoscope group.Operation protocol are in accordance with established grouping scheme,compare two groups of patients with general attribute data.indicators related to the operation.Postoperative follow-up last to June 2016,Kaplan Meier-method is used to evaluate patients' 5 year overall survival (OS) and relapse-free survival (RFS).Results:The thoracoscope surgery group operating time significantly longer than thoracotomy group (p＜0.05).The time of intrathoracic drain in thoracoscope group was obviously shortened (p＜0.05).The loss of blood in thoracoscope group is less than thoracotomy group (p＜0.05).Postoperative complications such as VAS score decreased,and the hospitalization time is shorter than thoracotomy group (p＜0.05).But the thoracoscope hospitalization expenditure is more expensive than thoracotomy group (p＜ 0.05).RFS of thoracotomy group for five years was 65.27％,and the thoracoscope group was 67.13％:there was no statistically significant difference (p＞0.05).Thoracotomy patients OS for 5 years was 53.73％,the thoracoscope group was 55.34％,the difference was statistically significant (p＜0.05).Conclusion:Compared with the traditional thoracotomy surgery,blood loss is more than lung cancer resection under thoracoscope.Thoracoscope make the patient recover faster.

Clinical analysis for bronchopleural fistula after lung resections / 中南大学学报(医学版)

Objective:To explore the risk factors,preventive measures and therapeutic methods for bronchopleural fistula (BPF) after lung resections.Methods:A restrospective analysis for 11 patients with BPF after pneumonectomy from April 2012 to June 2016 in Department of Thoracic Surgery,Xiangya Hospital,Central South University was performed.Their clinical characteristics,treatment and prognosis were analyzed,and the risk factors and effective therapeutic strategies were summarized.Results:Among the 11 patients with BPF,10 cases were cured finally,and 1 case with conservative treatment was dead.The total mortality rate was 9.09％.The 10 patients treated with positive measures were all cured,including 5 cases with pulmonary lobectomy and pneumonectomy,4 cases with amplatzer and covered stent,and 1 case with fibrin glue.One case with conservative treatment was dead because of respiratory failure.Conclusion:It is important to intervene BPF as early as possible.Fibrin glue via bronchoscope for tiny BPF after lung resection is preferred to be considered.We recommend to take early positive operation (pulmonary lobectomy and pneumonectomy) after pulmonary resection if the BPF cannot be cured via bronchoscope whereas the patients' condition is allowed.The amplatzer or covered stent should be considered first for the patient with BPF after pneumonectomy.

Lung resection for extensive lung injury causing severe hemorrhage.

We have presented here a case of a twenty three year old male who successfully recovered of a massive right lung injury by rapid transport, insertion of inter costal drain, emergency thoracotomy for resection of upper and middle lobes and post operative intensive care.

A utilização dos testes de função pulmonar na avaliação pré-operatória / Pulmonary function testing in the preoperative evaluation

A avaliação pulmonar pré-operatória é realizada para estimar o risco de ocorrência de complicações pulmonares no pós-operatório. Esse risco varia na dependência do sítio operatório, da anestesia utilizada e do estado clínico dos doentes, sendo que a presença de pneumopatia crônica pode elevá-lo. Os testes de função pulmonar durante a avaliação pré-operatória têm múltiplas finalidades: diagnosticar e graduar a intensidade dos distúrbios, indicar o melhor tratamento, otimizando-o, fornecer valores de corte que podem diferenciar risco aceitável de risco alto para complicações e eventualmente induzir a mudança de estratégia operatória ou descartar essa modalidade de tratamento. Inicialmente espirometria e gasometria arterial eram os únicos exames disponíveis para tal, mas, atualmente, podemos contar com outros exames como a medida da capacidade de difusão pulmonar para o monóxido de carbono, pressões respiratórias máximas, teste de exercício cardiopulmonar e testes de exercício de campo. O objetivo desta revisão é apresentar os testes de função pulmonar utilizados rotineiramente na avaliação pré-operatória e como eles são capazes de contribuir com essa avaliação.

Preoperative pulmonary evaluation is performed to estimate risk of postoperative pulmonary complications. Risk depends on the operative site, type of anesthesia and clinical status of patient. Chronic lung disease may increase this risk. Pulmonary function testing during the preoperative evaluation has multiple purposes: establish the diagnosis and severity of disorders, indicate the most appropriate treatment, provide cutoff values that can establish high risk for complications. In this case it is possible to change operative strategy or offer another treatment option. Initially spirometry and blood gases analysis were the only tests available for that, but now we can rely on other tests such as measurement of diffusing capacity for carbon monoxide, respiratory muscle strength, cardiopulmonary exercise testing and field testing. The aim of this review is to present the pulmonary function tests usually used in preoperative evaluation and how they are able to contribute in this field.

Efficacy of Systemic Postoperative Pulmonary Rehabilitation After Lung Resection Surgery

OBJECTIVE: To investigate the efficacy of systemic pulmonary rehabilitation (PR) after lung resection in patients with lung cancer. METHODS: Forty-one patients undergoing lung resection were enrolled and classified into the experimental (n=31) and control groups (n=10). The experimental group underwent post-operative systemic PR which was conducted 30 min/day on every hospitalization day by an expert physical therapist. The control group received the same education about the PR exercises and were encouraged to self-exercise without supervision of the physical therapist. The PR group was taught a self-PR program and feedback was provided regularly until 6 months after surgery. We conducted pulmonary function testing (PFT) and used a visual analog scale (VAS) to evaluate pain, and the modified Borg Dyspnea Scale (mBS) to measure perceived respiratory exertion shortly before and 2 weeks, 1, 3, and 6 months after surgery. RESULTS: A significant improvement on the VAS was observed in patients who received systemic PR >3 months. Significant improvements in forced vital capacity (FVC) and mBS score were observed in patients who received systemic PR >6 months (p<0.05). Other PFT results were not different compared with those in the control group. CONCLUSION: Patients who received lung resection suffered a significant decline in functional reserve and increases in pain and subjective dyspnea deteriorating quality of life (QoL). Systemic PR supervised by a therapist helped improve reduced pulmonary FVC and QoL and minimized discomfort during the postoperative periods in patients who underwent lung resection.

Single-Port Thoracic Surgery: A New Direction

Single-port video-assisted thoracic surgery (VATS) has slowly established itself as an alternate surgical approach for the treatment of an increasingly wide range of thoracic conditions. The potential benefits of fewer surgical incisions, better cosmesis, and less postoperative pain and paraesthesia have led to the technique's popularity worldwide. The limited single small incision through which the surgeon has to operate poses challenges that are slowly being addressed by improvements in instrument design. Of note, instruments and video-camera systems that are narrower and angulated have made single-port VATS major lung resection easier to perform and learn. In the future, we may see the development of subcostal or embryonic natural orifice translumenal endoscopic surgery access, evolution in anaesthesia strategies, and cross-discipline imaging-assisted lesion localization for single-port VATS procedures.

Effect of the Neutrophil Elastase Inhibitor on Acute Lung Injury after Pulmonary Resection for Lung Cancer: A Preliminary Study / 대한구급학회지

BACKGROUND: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are the leading causes of death after lungresection. Neutrophil elastase is thought to be an important mediator in the pathogenesis of ALI. Sivelestat is a new neutrophil elastase inhibitor which may improve the outcome in patients with ALI/ARDS after lung resection. The objective of this study was to determine whether or not sivelestat can reduce mortality in patients with ALI after pulmonary resection for lung cancer. METHODS: This study was a retrospective case-control study of twenty three patients who developed ALI/ARDS within seven days of lung resection for lung cancer. The control group (n = 12) received standard care, while the sivelestat group (n = 11) received a continuous infusion of sivelestat (0.2 mg/kg/hr) for seven days in addition to standard care. RESULTS: There was no significant difference in the baseline characteristics between the control and sivelestat groups, except for heart rate. Six of twelve patients (50%) in the control group survived, while seven of twelve patients (64%) survived in the sivelestat group (p = 0.34). There was also no significant difference between the two groups in the progression to ARDS. In the sivelelestat group, survivors had lower APACHE II and SOFA scores than the patients in the control group. CONCLUSIONS: There was no additional effect of a neutrophil elastase inhibitor in the treatment of ALI after pulmonary resection for lung cancer.

The Role of RVEF in Evaluation of Pulmonary Resection Risk in the Elderly Patients / 中国医师杂志

Objective To explore the relationship between preoperative right ventricular ejection fraction(RVEF) and postoperative complications in the elderly patients with lung resection. Methods RVEF was assessed in 118 consecutive aged patients before pulmomary resection by echocardiography, 64 of whom received RVEF measurement again 3 weeks after operation. Results Preoperative RVEF in patients with postoperative complications was obviously lower than that in patients without ones. The frequency of postoperative complications in patients with different preoperative RVEF(

The present studying status of pulmonary function supervisory before and after lung resection / 肿瘤研究与临床

To formulize simply about the development, test methods and major aspect of supervisory of pulmonary function test for lung resection. Including the development, test methods, major aspect of supervisory of pulmonary function test and the use of it. And also including lung function criterion for lung resection, the studying and using present status of evaluation for the operation risks. Pulmonary function test is the routine before operation and with important significance. Although the present pulmonary function criterion for lung resection is a comparative aspect for reference, it has important value to refer.

The Significance of Exercise Test as a Predicting Index for the Complications from Lung Resection in Patients of Lung Cancer / 대한내과학회지

OBJECTIVES: Even resectable case under TNM staging criteria in lung cancer, poor pulmonary function makes surgical candidates inoperable and lung resection in patients with diminished cardiopulmonary reserve function is associated with increased perioperative morbidity and mortality, We planned to examine which can be the most important predicted determinants in asssessing preoperative routine check-up and/or exercise test in prospect of postoperative short-term complications. METHODS: Twenty two patients, taken lung resection under the diagnosis of an operable lung cancer were evaluated prospectively about not only the staging work-up, but also oxygen consumption and carbon dioxide production with treadmill test, and stair climbing. Control subjects were selected randomly from the thirty healthy person visiting health care center and examined general check-up together with spirometry and exercise test. The postoperative complications occurred within three months were included followings' arrhythmia requiring therapy, pneumonia, atelectasis, air-leak and/or pneumothorax, and death from the above reasons, RESULTS: Lung cancer group showed a significant decrease in FEV1, Bruce stage on treadmill test, and maximal oxygen consumption compared with normal control group. Comparison within groups according to complication showed significantly increased smoking history and significantly decreased FEV1 and FEV1 ppop in complicated group. In complicated group, the ratio of VO2max/VO2max, predicted was also decreased significantly, while the ICU day increased significantly. In complicated group, three cases among four with normal to mild pulmonary insufficiency on spirometry showed quite low VO2max level, CONCLUSION: These findings suggest that heavy smoking and diminished preoperative FEV1 in operable lung cancer are regarded as high risk factors, and it needs special concerns about postoperative complications when the ICU days is increasing. VO2max is thought to be an useful measurement in expecting postoperative complications, especially in cases of relatively good pulmonary function and further study will be needed for the more subjects in near future.