Surgical Treatment of Refractory Chest Tumors Assisted by Cardiopulmonary Bypass / 中国肺癌杂志

BACKGROUND@#A retrospective review of the surgical treatment of refractory chest tumors involving the heart or large vessels with cardiopulmonary bypass (CPB).@*METHODS@#To summarize 11 cases of chest tumor patients who had undergone cardiopulmonary bypass surgery from January 2008 to May 2017 in our hospital, and analyze the general condition, clinical characteristics, treatment methods, postoperative hospitalization time, complications and follow-up results of all patients.@*RESULTS@#All 11 patients were operated with cardiopulmonary bypass. Total resection of tumors in 8 cases and most of the excision in 3 cases. 1 case of left atrial metastatic leiomyosarcoma were excised in the left atrium, and then the right lung resection was performed. 1 case of left lung central lung cancer resection through the median sternum incision. 2 cases underwent pulmonary artery repair at the same time, 3 cases underwent partial pericardiectomy and 3 cases underwent pulmonary wedge resection at the same time. All the patients were effectively relieved after the operation. No death rate in hospital and 30 days after operation. 3 cases of postoperative pulmonary infection were recovered after the treatment of antibiotics. 1 case of lymphoma relapsed 6 months after surgery and died one year later. 1 case of pericardial fibrosarcoma had local recurrence and extensive metastasis at 13 months after operation, and died after 15 months. 1 case of pulmonary leiomyosarcoma were found to have local recurrence 15 months after the operation and were relieved after chemotherapy. The remaining 8 patients survived, and no obvious recurrence and distant metastasis were found in the computed tomography (CT) examination.@*CONCLUSIONS@#The CPB assisted surgical treatment can be performed for patient of refractory chest tumors involving the heart or large vessels. It can improve the surgical resection rate of refractory chest tumors, effectively alleviate the effects on respiratory and circulatory functions, and significantly prolong the survival period of these patients.

Prognostic Analysis of Postoperative Children with Gigantic Thoracic Tumors / 医学研究杂志

Objective To investigate the clinical features and prognostic factors of children with gigantic thoracic tumors.Methods Clinical data were collected from the database of Cardiothoracic Surgery,Shanghai Children's Hospital between January 2009 and June 2015.The analyses were mainly focused on the clinical data of 76 cases of thoracic giant tumor that underwent surgical treatment,Univariate survival analysis was performed with Kaplan Meier method.Results Pathological results showed that 35 cases were benign tumors and 41 cases were malignant tumors.For benign tumors,the main pathological classification were ganglioneuroma in 12 cases,vascular tumors in 9 cases,germ cell tumors in 8 cases.For malignant tumors,the main pathological classification were neuroblastoma in 13 cases,ganglioneuroblastoma in 7 cases and lymphoma in 7 cases,etc.After surgical resection 31 cases of benign tumors were long-term survival.The 5 year survival rates of 70 patients with gigantic thoracic tumors was more than 75％,39 patients with malignant tumors were more than 50％.Single factor in Kaplan Meier analysis showed that gender,location of primary tumor were not associated with neurogenic tumor prognosis(P ＞ 0.05).The age of patients,tumor stage,tumor pathological type,whether chemotherapy are associated with prognosis of neurogenic tumors the difference has statistical significance (P ＜ 0.05).Conclusion Surgical resection is a prognostic factor for patients with benign thoracic giant tumor.The recurrence and metastasis rates of malignant tumor is high.Its prognosis is poor.The survival time of patients with postoperative chemotherapy or radiotherapy can be prolonged.The most common children gigantic thoracic tumors are neurogenic tumors,There is no correlation between the prognosis of neurogenic tumors and sex or primary site.While age,tumor stage,pathology and whether with chemotherapy are associated with neurogenic tumor prognosis.

Study of a novel diagnostic assay for thoracic malignant tumor based on DNA image cytometry / 临床与实验病理学杂志

Purpose To explore the effects of ploidy analysis on thoracic neoplasms based on DNA image cytometry (DNA-ICM), and to look for a meaningful novel diagnostic assay for tumor patients. Methods 4 402 patients who were diagnosed with thoracic disease were recruited in 2 years. By the DNA-ICM analysis, all the specimens were diagnosed as three types——positive, equivocal and negative ones. The results of701 specimens were compared with biopsy and clinical followup. Results DNA aneuploidy detected by DNA-ICM were65％ in confirmed malignant samples, 64％ in equivocal malignancy, and 8％ in non-malignant diseases. The comprehensive performance of DNA-ICM in malignancy was 73％, 93％, 71％, 94％ respectively for sensitivity, specificity, positive predictive value and negative predictive value. OR analysis found that the risk ratio of aneuploidy in malignancy was 23.236 compared to non-malignancy. Conclusion DNA-ICM can be applied in thoracic malignancy and have more potential values to be explored in oncology.

A study on the set-up accuracy by using body plate with vacuum cushion and thermoplastic mask technique in comparison with the conventional arm support technique in thoracic tumor radiotherapy / 中国癌症杂志

Background and purpose: Radiation therapy has entered the era of precise radiotherapy. Set-up error becomes important factor affecting the effects of radiotherapy. The aim of this study was to analyze the set-up accuracy of the in-house developed technique of body plate with vacuum cushion and thermoplastic mask (Group A) and the conventional technique of arm support (Group B) in thoracic tumor radiotherapy. Methods: A total of 19 patients with thoracic tumor were enrolled in this study and randomly separated into Group A and Group B. The patients of Group A underwent the secondary set-up: align the marker on vacuum cushion and patient's body to the room laser, cover the patient's body with thermoplastic mask and align the marker on the mask to the room laser. The patients of Group B were directly setup by aligning the marker on the patient's body to the room laser. The kilo-voltage cone beam computed tomography (KV-CBCT) was performed on each patient to collect the pre- and post-treatment CBCT images. The CBCT images were registered to the planning CT to analyze the translational error of Group A and Group B. Results: The pre-treatment set-up errors of Group A vs Group B were (1.06±0.58) vs (1.82±0.82) mm in left and right (LR) direction, (1.31±0.40) vs (2.18±1.20) mm in superior and inferior (SI) direction, and (1.28±0.66) vs (2.94±1.81) mm in anterior and posterior (AP) direction. The post-treatment set-up errors of Group A vs Group B were (0.86±0.54) vs (1.29±0.58) mm in LR direction, (1.07±0.58) vs (1.08±0.45) mm in SI direction, and (0.98±0.53) vs (1.56±0.63) mm in AP direction.Conclusion: The in-house developed immobilization technique of body plate with vacuum cushion and thermoplastic mask was more accurate and reproducible than the conventional immobilization technique of arm support in thoracic tumor radiotherapy.

Reconstrução da parede torácica após a ressecção de extensos tumores / Reconstruction of chest wall after resection of large tumors

INTRODUÇÃO: Nos estágios finais da reconstrução torácica, consequente a exéreses tumorais, são necessários procedimentos complexos e implantes. O que requer cuidados multidisciplinares, com a participação dos cirurgiões torácicos, plástico, radiologista e fisioterapeuta. O objetivo foi descrever as opções de reconstrução torácica após ressecção de neoplasia, realizado no Hospital Sarah Brasília. MÉTODO: Estudo retrospectivo de reconstrução torácica em tempo único, após excisão de tumor, fisioterapia respiratória com ventilação não invasiva e exercícios. RESULTADOS: Entre 2007 a 2012 foram operados 10 pacientes, sete homens e três mulheres; idade 10 a 31 anos; oito apresentavam tumores torácicos metastáticos (osteosarcoma, sinoviosarcoma, Fibrosarcoma epitelioide esclerosante e Rabdomiosarcoma) e dois originários da parede torácica (fibromatose e condrosarcoma). Observou-se boa evolução no pós-operatório imediato, com extubação ao final da cirurgia, retirada do dreno torácico entre 5° e 8° PO. As complicações foram: atelectasia (10%), recorrência tumoral (10%), e óbito em 3 (30%) casos . CONCLUSÃO: Foi possível a reconstrução torácica em tempo único utilizando tela de polipropileno, polimetilmetacrilato e retalhos musculares, com recuperação precoce da função pulmonar e baixo índice de complicações imediatas.

INTRODUCTION: Complex procedures and implants are required in the final stages of chest wall reconstruction after tumor excision. This process requires multidisciplinary care with participation from thoracic and plastic surgeons, a radiologist, and a physical therapist. The goal of this study was to describe the options for chest wall reconstruction after neoplasm resection at Hospital Sarah Brasilia. METHOD: A retrospective study of one-time chest wall reconstruction after tumor excision, respiratory physical therapy with noninvasive ventilation, and exercises was conducted. RESULTS: Between 2007 and 2012, 10 patients underwent surgery (seven men, three women; age range: 10-31 years); eight patients had metastatic thoracic tumors (e.g., osteosarcoma, synovial sarcoma, sclerosing epithelioid fibrosarcoma, and rhabdomyosarcoma) and two had tumors originating from the chest wall (fibromatosis and chondrosarcoma). The outcomes were good after the immediate postoperative period, with extubation occurring at the end of surgery and chest tube removal between the fifth and eighth postoperative day. Three cases (30%) involved complications of atelectasis (10%), tumor recurrence (10%), or death. CONCLUSION: One-time chest wall reconstruction using polypropylene mesh, polymethylmethacrylate, and muscle flaps was possible and was associated with early recovery of pulmonary function and a low rate of immediate complications.

O uso da ventilação mecânica não-invasiva nos cuidados paliativos de paciente com sarcoma torácico metastático: relato de caso / The use of noninvasive mechanical ventilation in the palliative care of a patient with metastatic thoracic sarcoma: case report

JUSTIFICATIVA E OBJETIVOS: Os cuidados paliativos se baseiam na prevenção e alívio do sofrimento, identificando, avaliando e tratando a dor e outros problemas físicos, psicossociais e espirituais. Quadros súbitos de dispnéia são freqüentes em pacientes oncológicos em fase terminal. Nestes casos, a ventilação mecânica não-invasiva pode ser uma boa opção no manuseio da dispnéia, promovendo conforto e permitindo o contato do paciente com seus familiares. O objetivo deste estudo foi apresentar os benefícios obtidos com a ventilação mecânica não-invasiva no paciente sob cuidados paliativos. RELATO DO CASO: Paciente com 29 anos, em pós-operatório imediato de cesariana, admitida na unidade de terapia intensiva (UTI) para tratamento de insuficiência respiratória aguda. À radiografia de tórax visualizava-se massa pulmonar a direita. Após investigação clínica e de imagem foi diagnosticado sarcoma torácico metastático em fase avançada, sendo indicadas pela equipe de Oncologia medidas e cuidados paliativos. Para alivio da dispnéia, a equipe multidisciplinar da UTI optou pelo uso de ventilação mecânica não-invasiva (modalidade CPAP + PSV), permitindo a interação da mãe com o bebê e familiares. CONCLUSÕES: No contexto de cuidados paliativos, a VMNI mostrou-se ser um método capaz de contribuir para o controle da dispnéia provendo conforto e alívio ao paciente.

BACKGROUND AND OBJECTIVES: Palliative care is based on prevention and relief of suffering, identifying, assessing and treating pain and other physical, psychological, social and spiritual problems. Sudden dyspnea is frequently observed in terminal oncologic patients. In these cases, noninvasive ventilation can be an adequate option to control dyspnea promoting comfort and allowing patient interaction with their relatives. The aim of this article was to present the benefits of noninvasive ventilation in the palliative care setting. CASE REPORT: The case of a 29 year old patient, admitted in intensive care unit (ICU), after cesarean section delivery, for clinical treatment of acute respiratory failure is reported. Chest X-ray showed pulmonary mass in the right lung. After clinical and image investigation, metastatic thoracic sarcoma was diagnosed and palliative cares were introduced. The ICU interdisciplinary team chose to use noninvasive ventilation (modality CPAP + PSV) to relieve dyspnea and discomfort, as well as to allow interaction with her baby and family. CONCLUSIONS: Palliative care with noninvasive ventilation contributed to increase comfort of the patient by controlling dyspnea.

Effects of two different nursing interventions on postoperative pain of patients with thoracic tumor / 中国实用护理杂志

Objective To explore the effects of two diffeerent nursing interventions on postoperative pain of patients with thoracic tumor. Methods Postoperative patients with thoracic tumor (126 cases) were ran-domly divided into the experimental group(64 cases) and the control group (62 cases). The experimental group combined stages of assessment methods with the three-step analgesic ladder for cancer pain which the WHO recommended. Timely and reasonable use of analgesic agents ensured control of pain effectively. The control group was given disposal only when patients complained pain. Sleep, effective cough of sputum, related indica-tors of vital signs and the time of first ambulation were observed in the two groups. Results The inci-dence of patients' abnormal respiratory rate, accelerated heart rate and decreased oxygen saturation levels in fingertip in the experimental group were significantly lower than those of the control group(P<0.05). Within 3 days after surgery, the proportion of the experimental group patients whose cough and expectoration re-flex score was good, without insomnia and with first ambulation was significantly higher than that of the control group (P<0.05). Conclusions Adoption of stages of assessment and initiative and effective pain control for patients with thoracic tumor of postoperative pain can significantly improve the quality of care, pro-mote the recovery of physiological function, and reduce the incidence of postoperative complications.

Cervico-Thoracic Intradural Extramedullary Lipoma

A 42-year-old female was admitted with an 11-month history of progressive spastic paraparesis and ataxic gait. Magnetic resonance imaging showed intraspinal space occupying lesion compressing the spinal cord posteriorly, located from C5 to T2 with iso to high signal intensity at T2-weighted images and high signal intensity at T1-weighted images. The patient underwent surgery for decompression of the affected spinal cord because of the progressive neurological deficit. At surgery, the lesion was intradural extramedullary lipoma composed with mature adipose tissue. Partial tumor removal to decompress the neural structures and laminoplasty to avoid postoperative instability and deformity were performed. Postoperatively, she demonstrated improvement in paraparesis and was able to walk without assistance. Though attempts to decrease the size of or even to totally remove a lipoma are not required to achieve satisfactory results and carry considerable risks of surgical morbidity, a careful and limited decompression of the affected spinal cord through a partial removal of the tumor and laminoplasty could result in a significant neurological improvement.

Reconstruction Of Superior Vena Cave and Its Branches in the Treatment of Malignant Mediastinal or Pulmonary Tumors Through Anterior Mediastinotomy / 中国医师杂志

Objective To explore the operative method for reconstruction of superior vena cave (SVC) and its branches in the treatment of patients with malignant mediastinal or pulmonary tumors through anterior mediastinotomy. Methods From 2001 to 2004 year, 22 patients with malignant mediastinal tumor or lung cancer received the resection of tumors and the reconstruction of the superior vena cave and its branches through anterior mediastinotomy. The operative efficacy was followed up in all patients. Results There was neither severe operative complications nor operative death in this group of patients, and 2 patients died of tumor recurrence in one year of post-operation, while others survived till now. Only one artificial graft occlusion occurred one month after operation. Conclusion The complete resection of malignant mediastinal or pulmonary tumors and the reconstruction of superior vena cave and its branches through anterior mediastinotomy is simple and reliable, and can remarkably improve the survival time of the short-term and long-term of the patients with malignant mediastinal or pulmonary tumor invading SVC.

Analysis of the reasons for postoperative complications and death of thoracic tumors / 中国癌症杂志

Purpose:To study the reasons for operative death and complications in cases of thoracic tumors,it was important for avoiding the operation risks and raising the survival rate. Methods:Analyzing the 3490 cases of thoracic tumors treated by surgery during 20 years in our hospital. Results:Among these cases,90 patients died and the operation death rate was 2.58%(90.3 400).In the 90 cases,there were lobectomy of lung cancer in 67,and the death rate was 1.72%(67/2 896);carcinoma of esophagus and gastric cardia in 19,the rate 3.91%(16/486);mediastinal tumors in 2,the rate 1.85%(2/108).The chief complications were cardiopulmonary diseases,stress ulcer,postoperative hemorrhage,stump fistula,anastomatic fistula,chylothorax and diaphragmatic hernia.Conclusions:The pulmonary,cardiavescular complications and anastomatic fistula were the major reasons for the operative death,but the first was pulmonary complication.

Ethical Issues in Clinical Practice of Thoracic Tumors / 中国医学伦理学

The conflicts among medical doctors,patients,medical administration,and health insurance corporations are becoming more and more serious.Additionally,novel medical techniques and methods are unprecedented challenges during the clinical activities for thoracic tumors.Here we emphasize that medical doctors who specialize in thoracic tumors should be proficient at managing these special and complex disorders.In order to effectively prevent and deal with a variety of ethical conflicts,all clinical practice should strictly abide by the principles of evidence-based medicine,and medical doctors should be held responsible for their patients from both technical and moral aspects.