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Rev. Assoc. Med. Bras. (1992) ; 67(7): 1015-1020, July 2021. tab, graf
Article in English | LILACS | ID: biblio-1346939


SUMMARY OBJECTIVE: Pulmonary metastasectomy for the treatment of metastatic colorectal cancer is essential, but high ranked evidence of survival benefit is lacking. Here, we aimed to examine the prognostic factors after pulmonary metastasectomy in patients with colorectal cancer. METHODS: This is a single-center, retrospective hospital-based observational case series study. We reviewed data for 607 patients with metastatic colorectal cancer (mCRC) who were treated and observed from 2012 to 2019. Of the 607 patients with mCRC, 87 were with solitary lung metastases. Of the 87 patients, 39 were not appropriate for metastasectomy, while 15 patients recognized as suitable candidates by the multidisciplinary thoracic tumor board rejected metastasectomy. Consequently, only 33 patients were included in the final analysis. RESULTS: Rectum was detected as the primary site in 16 (48.5%) patients. Over 80% of patients had metachronous lung metastases, with a median of 29.0 months from initial diagnosis. Video-assisted thoracic surgery with wedge resection was performed in 20 (60.6%) patients. Over 90% of patients had solitary metastasis resected, with 97% of R0 resection. Median tumor size was 23.0 mm (min: 10; max: 90). Adjuvant treatment was given to 31 (93.9%) patients, while neoadjuvant treatment was given only to 8 (25%) patients. Of the 33 patients, there were 25 (75.7%) relapses. The most frequent site of relapse was lung in 15 (45.5%) patients. Interestingly, there were only 4 (12.2%) patients who had a relapse in the liver after lung metastasectomy. We found that median disease-free survival (DFS) and overall survival (OS) were 43.0 (13.0-73.0) and 55.0 (31.6-78.4) months, respectively. CONCLUSIONS: Pulmonary metastasectomy was associated with significantly long-time survival rates in mCRC (43 months of DFS and 55 months of OS). The second relapse occurred in 25 (75.7%) patients, with isolated lung metastases in nearly half of the patients (45.5%). Therefore, lung metastases in mCRC were unique and a multidisciplinary team including a thoracic surgeon should manage these patients.

Humans , Colorectal Neoplasms/surgery , Metastasectomy , Lung Neoplasms/surgery , Prognosis , Survival Rate , Retrospective Studies , Disease-Free Survival , Thoracic Surgery, Video-Assisted , Neoplasm Recurrence, Local
Säo Paulo med. j ; 139(3): 293-300, May-June 2021. tab
Article in English | LILACS | ID: biblio-1252238


ABSTRACT Lung cancer is a type of neoplasia with one of the highest incidences worldwide and is the largest cause of mortality due to cancer in the world today. It is classified according to its histological and biological characteristics, which will determine its treatment and prognosis. Non-small cell lung cancer accounts for 85% of the cases, and these are the cases that surgeons mostly deal with. Small cell lung cancer accounts for the remaining 15%. Surgery is the main method for treating early stage lung cancer, and lobectomy is the preferred procedure for treating primary lung cancer, while sublobar resection is an alternative for patients with poor reserve or with very small tumors. Surgeons need to be trained to use the resources and techniques available for lung resection, including less invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS), and need to be familiar with new oncological approaches, including curative, adjuvant or palliative treatments for patients with lung cancer.

Humans , Carcinoma, Non-Small-Cell Lung/surgery , Surgeons , Lung Neoplasms/surgery , Pneumonectomy , Thoracic Surgery, Video-Assisted
Rev. Assoc. Med. Bras. (1992) ; 67(1): 39-44, Jan. 2021. tab, graf
Article in English | LILACS | ID: biblio-1287789


SUMMARY OBJECTIVE: The aim of this retrospective study was to investigate the correlation of transiently elevated postoperative serum cancer antigen 125 levels and prognosis in patients with non-small cell lung cancer. METHODS: A total of 181 non-small cell lung cancer patients with normal levels of preoperative serum cancer antigen 125 were statistically summarized in this study. RESULTS: Out of the analyzed patients, 22 (12.2%) showed elevation of serum cancer antigen 125 within one month after surgery. Serum cancer antigen 125 level decreased to normal at three months postoperation. Serum cancer antigen 125 was positively correlated with pro-brain natriuretic peptide in non-small cell lung cancer postoperative patients (p=0.00035). Univariate analysis did not find significant difference in disease progression survival between those who experienced cancer antigen 125 elevation in the early postoperation and those who did not (p=0.646). CONCLUSIONS: In conclusion, transient elevation of cancer antigen 125 is associated to pro-brain natriuretic peptide increase after pulmonary surgery in non-small cell lung cancer patients.

Humans , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Prognosis , Carcinoembryonic Antigen , Retrospective Studies , CA-125 Antigen
Rev. Col. Bras. Cir ; 48: e20202890, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287893


ABSTRACT Objective: to report the preoperative localization of pulmonary nodules with the placement of a guidewire oriented by Computed Tomography. Methods: the nodules were marked using a needle in the shape of a hook or another in the shape of a Q, guided by tomography. The choice of the location for the marking was the shortest distance from the chest wall to the nodule. The marking procedure was performed under local anesthesia and a tomographic control was obtained immediately at the end. Patients were referred to the operating room. Surgical resection occurred less than two hours after the needle placement. Results: between February 2017 and October 2019, 22 patients aged 43 to 82 years (mean 62.1) were included. The nodules had diameters that varied from 4 to 30 mm and the distance between the nodules and the pleural surface varied from 2 to 43 mm. The location and resection of the nodules were successfully performed in all cases. The guidewire was displaced in five cases. Five patients presented pneumothorax, with the space between the visceral and parietal pleura varying from 2 to 19 mm. In nine patients, an intraparenchymal hematoma of 6 to 35 mm in length was observed without signs, symptoms, or hemodynamic and ventilatory repercussions. The histopathological study was conclusive in all patients. Conclusions: the localization of pulmonary nodules through guidewires proved to be safe, reliable, and feasible in this series of cases. There was no need for surgical intervention to treat complications.

RESUMO Objetivo: relatar a marcação pré-operatória de nódulos pulmonares com o posicionamento de um fio-guia orientado por Tomografia Computadorizada. Métodos: os nódulos foram marcados utilizando-se agulha em formato de anzol ou outra em formato de Q, orientada por tomografia. A escolha do local para a realização da marcação foi o de menor distância da parede torácica até à lesão. O procedimento de marcação foi realizado sob anestesia local e controle tomográfico foi obtido imediatamente ao término da marcação. Os pacientes foram encaminhados ao centro cirúrgico. A ressecção cirúrgica ocorreu em tempo inferior a duas horas após a marcação. Resultados: entre fevereiro de 2017 e outubro de 2019, 22 pacientes, com faixa etária entre 43 e 82 anos (média 62,1) foram incluídos. Os nódulos apresentavam diâmetros que variaram de 4 a 30mm e, a distância entre os nódulos e a superfície pleural variou de 2 a 43mm. A localização e a resseção dos nódulos foram realizadas com sucesso em todos os casos. Houve deslocamento do fio-guia em cinco casos. Cinco pacientes apresentaram pneumotóraces, com o espaço entre as pleuras visceral e parietal variando de 2 a 19mm. Em nove pacientes, foi observado hematoma intraparenquimatoso com 6 a 35mm de extensão sem sinais, sintomas ou repercussão hemodinâmica e ventilatória. O estudo histopatológico foi conclusivo em todos os pacientes. Conclusões: a marcação de nódulos pulmonares por meio de fios marcadores se mostrou segura, confiável e factível nesta série de casos. Não houve necessidade de intervenção para o tratamento de complicações associadas ao método.

Humans , Adult , Aged , Aged, 80 and over , Solitary Pulmonary Nodule , Multiple Pulmonary Nodules , Lung Neoplasms/surgery , Lung Neoplasms/diagnostic imaging , Preoperative Care , Retrospective Studies , Thoracic Surgery, Video-Assisted , Lung , Middle Aged
J. bras. pneumol ; 47(1): e20190426, 2021. tab, graf
Article in English | LILACS | ID: biblio-1143154


ABSTRACT Objective: To evaluate the evolution of clinical and epidemiological data, as well as data related to diagnosis, staging, treatment, and survival, among patients undergoing curative surgery for lung cancer at a tertiary referral center in the city of São Paulo, Brazil. Methods: This was a retrospective study of cases in the International Association for the Study of Lung Cancer database. We selected only cases of patients undergoing curative surgery between January of 2011 and April of 2018. We determined overall and disease-free survival at 36 months and compared the data between two periods (2011-2014 and 2015-2018). Results: Comparing the two periods (N = 437 cases), we observed trends toward increases in the number of female patients, as well as in the proportions of former smokers (44.09% vs. 53.59%), of patients diagnosed with adenocarcinoma (52.21% vs. 59.72%), and of patients diagnosed at an earlier pathological stage, together with a decrease in 30-day mortality (4.05% vs. 2.39%). There were significant increases in the proportions of cases diagnosed at an earlier clinical stage (p = 0.002) or incidentally (p = 0.003). Although lobectomy was the main surgical technique employed, there was a proportional increase in segmentectomies (2.67% vs. 7.11%; p = 0.026). Overall and disease-free survival rates were 79.4% (95% CI: 74.0-83.9%) and 75.1% (95% CI: 69.1-80.1%), respectively. The difference in overall survival between the periods lost statistical significance when adjusted for pathological stage, the only factor that affected survival (log-rank: p = 0.038 to p = 0.079). Conclusions: The clinical and epidemiological evolution presented in this study corroborates global trends. The decrease in 30-day mortality was probably due to better patient selection and improved surgical techniques.

RESUMO Objetivo: Avaliar a evolução de dados clínicos e epidemiológicos, assim como dados sobre diagnóstico, estadiamento, tratamento e sobrevida em pacientes submetidos a tratamento cirúrgico curativo de câncer de pulmão em uma instituição terciária na cidade de São Paulo (SP). Métodos: Estudo retrospectivo baseado nos casos inseridos no banco de dados da International Association for the Study of Lung Cancer submetidos à cirurgia curativa entre janeiro de 2011 e abril de 2018. Determinamos a sobrevida global e livre de doença em 36 meses e comparamos os dados em dois períodos (2011-2014 e 2015-2018). Resultados: Comparando-se os dois períodos (N = 437 casos), houve uma tendência de aumento no número de pacientes do sexo feminino, ex-tabagistas (44,09% vs. 53,59%), com diagnóstico de adenocarcinoma (52,21% vs. 59,72%) e em estádio patológico mais precoce, assim como queda da mortalidade em 30 dias (4,05% vs. 2,39%). Houve aumento significativo de casos em estádio clínico mais precoce (p = 0,002) e diagnosticados incidentalmente (p = 0,003). A lobectomia foi a principal técnica cirúrgica; entretanto, houve aumento de segmentectomias (2,67% vs. 7,11%; p = 0,026). As sobrevidas global e livre de doença foram de 79,4% (IC95%: 74,0-83,9%) e 75,1% (IC95%: 69,1-80,1%), respectivamente. Houve perda de significância estatística na sobrevida global entre os períodos quando ajustada por estadiamento patológico, o único fator a impactar a sobrevida (log-rank: p = 0,038 para p = 0,079). Conclusões: A evolução clínica e epidemiológica apresentada neste estudo corrobora tendências mundiais. A diminuição da mortalidade em 30 dias provavelmente ocorreu devido a melhor seleção de pacientes e melhora da técnica cirúrgica.

Humans , Female , Lung Neoplasms/surgery , Lung Neoplasms/pathology , Brazil/epidemiology , Survival Rate , Retrospective Studies , Tertiary Care Centers , Neoplasm Staging
Neumol. pediátr. (En línea) ; 16(4): 172-176, 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1362265


El sarcoma sinovial primario de pulmón (SSPP) localizado en bronquio, es una entidad no reportada en la edad pediátrica. Se presenta el caso de un niño de siete años con antecedente de aparentes neumonías recurrentes derechas de siete meses de evolución; en la evaluación por neumología pediátrica se destaca en las radiografías de tórax, la presencia de atelectasias recurrentes en lóbulo medio e inferior derecho, por lo que se realiza broncoscopia, donde se observa una masa obstruyendo el 100% de la luz del bronquio fuente derecho y se sospecha tumor carcinoide. Se realiza extirpación de masa endobronquial con fines diagnósticos y terapéuticos, incluyendo resección segmentaria bronquial y anastomosis término-terminal. El respectivo análisis inmunohistoquímico muestra hallazgos sugestivos de sarcoma sinovial monofásico. Se descarta compromiso tumoral extrapulmonar, por lo que se diagnostica como tumor primario de bronquio. Se administraron 7 ciclos de quimioterapia y 31 sesiones de radioterapia. Actualmente en control, sin evidencia de metástasis, tumores residuales o recidivas.

Primary Synovial Sarcoma of Lung (PSSL) located in the bronchus is an unreported entity in pediatric age. We present the case of a 7-year-old child with a history of apparent recurrent right pneumonia of 7 months of evolution; in the evaluation by pediatric pulmonology, the presence of recurrent atelectasis in the middle and lower right lobe is highlighted on chest X-rays, so bronchoscopy is performed, where a mass is observed obstructing 100% of the right bronchus lumen and carcinoid tumor is suspected. Endobronchial mass resection is performed for diagnostic and therapeutic purposes, including bronchial segmental resection and termino-terminal anastomosis. The respective immunohistochemical analysis shows suggestive findings of monophasic synovial sarcoma. Extrapulmonary tumor involvement is ruled out, so it is diagnosed as a primary bronchial tumor. 7 cycles of chemotherapy and 31 sessions of radiation therapy are given. Currently in control, with no evidence of metastasis, residual tumors, or recurrence.

Humans , Male , Child , Sarcoma, Synovial/surgery , Sarcoma, Synovial/diagnosis , Lung Neoplasms/surgery , Lung Neoplasms/diagnosis , Bronchoscopy , Radiography, Thoracic , Sarcoma, Synovial/pathology , Lung Neoplasms/pathology
J. bras. pneumol ; 47(4): e20210025, 2021. tab, graf
Article in English | LILACS | ID: biblio-1286952


ABSTRACT Objective: To report the experience of a routine follow-up program based on medical visits and chest CT. Methods: This was a retrospective study involving patients followed after complete surgical resection of non-small cell lung cancer between April of 2007 and December of 2015. The follow-up program consisted of clinical examination and chest CT. Each follow-up visit was classified as a routine or non-routine consultation, and patients were considered symptomatic or asymptomatic. The outcomes of the follow-up program were no evidence of cancer, recurrence, or second primary lung cancer. Results: The sample comprised 148 patients. The median time of follow-up was 40.1 months, and 74.3% of the patients underwent fewer chest CTs than those recommended in our follow-up program. Recurrence and second primary lung cancer were found in 17.6% and 11.5% of the patients, respectively. Recurrence was diagnosed in a routine medical consultation in 69.2% of the cases, 57.7% of the patients being asymptomatic. Second primary lung cancer was diagnosed in a routine medical appointment in 94.1% of the cases, 88.2% of the patients being asymptomatic. Of the 53 patients who presented with abnormalities on chest CT, 41 (77.3%) were diagnosed with cancer. Conclusion: Most of the cases of recurrence, especially those of second primary lung cancer, were confirmed by chest CT in asymptomatic patients, indicating the importance of a strict follow-up program that includes chest CTs after surgical resection of lung cancer.

RESUMO Objetivo: Relatar a experiência de um programa de acompanhamento de rotina baseado em consultas médicas e TC de tórax. Métodos: Estudo retrospectivo envolvendo pacientes acompanhados após ressecção cirúrgica completa de câncer de pulmão de células não pequenas entre abril de 2007 e dezembro de 2015. O programa de acompanhamento consistiu em exame clínico e TC de tórax. Cada visita de acompanhamento foi classificada como uma consulta de rotina ou fora da rotina, e os pacientes foram considerados sintomáticos ou assintomáticos. Os desfechos do programa de acompanhamento foram ausência de evidência de câncer, recidiva ou segundo câncer de pulmão primário. Resultados: A amostra foi composta por 148 pacientes. A mediana do tempo de acompanhamento foi de 40,1 meses, e 74,3% dos pacientes realizaram menos TCs do que as recomendadas em nosso programa de acompanhamento. Recidiva e segundo câncer de pulmão primário foram encontrados em 17,6% e 11,5% dos pacientes, respectivamente. A recidiva foi diagnosticada em uma consulta médica de rotina em 69,2% dos casos, sendo 57,7% dos pacientes assintomáticos. O segundo câncer de pulmão primário foi diagnosticado em consulta médica de rotina em 94,1% dos casos, sendo 88,2% dos pacientes assintomáticos. Dos 53 pacientes que apresentaram anormalidades na TC de tórax, 41 (77,3%) foram diagnosticados com câncer. Conclusões: A maioria dos casos de recidiva, principalmente os de segundo câncer de pulmão primário, foi confirmada por TC de tórax em pacientes assintomáticos, indicando a importância de um programa de acompanhamento rigoroso que inclua TC de tórax após ressecção cirúrgica de câncer de pulmão.

Humans , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms/surgery , Lung Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Retrospective Studies , Follow-Up Studies , Neoplasm Recurrence, Local/diagnostic imaging
Rev. Col. Bras. Cir ; 48: e20202872, 2021. tab, graf
Article in English | LILACS | ID: biblio-1250708


ABSTRACT Objective: in Latin America, especially Brazil, the use of a robotic platform for thoracic surgery is gradually increasing in recent years. However, despite tuberculosis and inflammatory pulmonary diseases are endemic in our country, there is a lack of studies describing the results of robotic surgical treatment of bronchiectasis. This study aims to evaluate the surgical outcomes of robotic surgery for inflammatory and infective diseases by determining the extent of resection, postoperative complications, operative time, and length of hospital stay. Methods: retrospective study from a database involving patients diagnosed with bronchiectasis and undergoing robotic thoracic surgery at three hospitals in Brazil between January of 2017 and January of 2020. Results: a total of 7 patients were included. The mean age was 47 + 18.3 years (range, 18-70 years). Most patients had non-cystic fibrosis bronchiectasis (n=5), followed by tuberculosis bronchiectasis (n=1) and lung abscess (n=1). The performed surgeries were lobectomy (n=3), anatomic segmentectomy (n=3), and bilobectomy (n=1). The median console time was 147 minutes (range 61-288 min.) and there was no need for conversion to open thoracotomy. There were no major complications. Postoperative complications occurred in one patient and it was a case of constipation with the need for an intestinal lavage. The median for chest tube time and hospital stay, in days, was 1 (range, 1-6 days) and 5 (range, 2-14 days) respectively. Conclusions: robotic thoracic surgery for inflammatory and infective diseases is a feasible and safe procedure, with a low risk of complications and morbidity.

RESUMO Objetivo: na América Latina, especialmente no Brasil, a adoção da plataforma robótica para cirurgia torácica está aumentando gradativamente nos últimos anos. No entanto, apesar da tuberculose e doenças pulmonares inflamatórias serem endêmicas em nosso país, faltam estudos que descrevam os resultados do tratamento cirúrgico robótico das bronquiectasias. Este estudo tem como objetivo avaliar os resultados cirúrgicos da cirurgia robótica para doenças inflamatórias e infecciosas, determinando a extensão da ressecção, complicações pós-operatórias, tempo operatório e tempo de internação hospitalar. Métodos: estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de bronquiectasia e submetidos à cirurgia torácica robótica em três hospitais brasileiros entre janeiro de 2017 e janeiro de 2020. Resultados: foram incluídos 7 pacientes. A média de idade foi 47 + 18,3 anos (variação, 18-70 anos). A maioria dos pacientes apresentou bronquiectasia não fibrose cística (n=5), seguida de bronquiectasia tuberculosa (n=1) e abscesso pulmonar (n=1). As cirurgias realizadas foram lobectomia (n=3), segmentectomia anatômica (n=3) e bilobectomia (n=1). O tempo médio do console foi de 147 minutos (variação de 61-288 min.) e não houve necessidade de conversão para toracotomia. Complicação pós-operatória ocorreu em um paciente, tratando-se de obstipação com necessidade de lavagem intestinal. A mediana do tempo de drenagem torácica e internação hospitalar, em dias, foi de 1 (variação, 1-6 dias) e 5 (variação, 2-14 dias), respectivamente. Conclusões: a cirurgia torácica robótica para doenças inflamatórias e infecciosas é um procedimento viável e seguro, com baixo risco de complicações e morbidade.

Humans , Adult , Aged , Thoracic Surgery , Robotic Surgical Procedures , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications/epidemiology , Brazil , Retrospective Studies , Treatment Outcome , Thoracic Surgery, Video-Assisted , Length of Stay , Middle Aged
Chinese Journal of Lung Cancer ; (12): 683-689, 2021.
Article in Chinese | WPRIM | ID: wpr-922246


BACKGROUND@#Computed tomography (CT) three-dimensional reconstruction technology is increasingly used in preoperative planning of patients with ground glass nodule (GGN), but how to accurately locate the nodule and ensure the safe resection edge is still a difficult problem for clinicians. The purpose of this study was to investigate the accuracy, convenience and safety of CT three-dimensional reconstruction combined with intraoperative natural collapse localization in total thoracoscopic segmental pneumonectomy.@*METHODS@#A total of 45 patients with radiographic findings of pulmonary GGN admitted from July 2019 to December 2019 were selected as the study group. All patients received thin-slice CT scan and underwent preoperative three-dimensional reconstruction. After anesthesia, the small thoracic operation opening and the airway of the patients were quickly opened, and the lung was rapidly and naturally collapsed by pressure difference. GGN were positioned according to the natural marker line, and marked with 3-0 prolene line. After specimen removal, the distance between the GGN and the suture mark, the distance between the GGN and the incision margin were measured, and the incision margin was routinely examined. The general clinical data, pathological data and postoperative complications were counted and compared with 45 consecutive patients who were located with hookwire positioning needle in the same period.@*RESULTS@#The average localization time of non-invasive GGN with natural lung collapse during operation was 6.9 min, and the localization accuracy was 90.6%. There were 2 cases of extensive pleural adhesion and 1 case of emphysema. Postoperative pathology was confirmed as lung adenocarcinoma, and the examination of incision margin was negative. No GGNs were scanned again after surgery, and the precise resection rate of lung segment was 100.0%.@*CONCLUSIONS@#CT three-dimensional reconstruction combined with GGN localization of natural lung collapse during operation can shorten the time of searching for GGN during operation and guarantee the safety of the incision margin. It is a more economical and convenient localization method and makes pulmonary segment resection more accurate.

Humans , Imaging, Three-Dimensional , Lung/surgery , Lung Neoplasms/surgery , Pulmonary Atelectasis , Retrospective Studies , Solitary Pulmonary Nodule , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
Chinese Journal of Lung Cancer ; (12): 677-682, 2021.
Article in Chinese | WPRIM | ID: wpr-922245


BACKGROUND@#With the wide application of computed tomography (CT) in the screening of early lung cancer, more and more ground glass nodules (GGNs) have been found. Early intervention is helpful to improve the survival rate of lung cancer patients. Radiofrequency ablation (RFA) is an alternative option to manage primary or metastatic lung malignancies. The purpose of this study is to review the safety and clinical efficacy for lung GGN treated by RFA.@*METHODS@#From June 2016 to March 2021, 24 patients with a total of 28 lung GGNs in our hospital underwent 28 sessions of RFA. There were 13 males and 11 females with an average age of (69.4±11.1) years. The size of GGN receiving RFA was (1.30±0.56) cm; The ablation range was (2.50±0.63) cm and ablation time was (15.00±8.68) min.@*RESULTS@#The procedure of all RFAs went smoothly, no perioperative deaths occurred and no serious complications during the operation. The median follow-up was 25 months. One case died of myocardial infarction 2 months after operation. All 28 GGNs showed no evidence of local progression and the local control rate was 100.0%. Kaplan-Meier analysis showed that the 1-year and 2-year overall survival rates were 95.8% and 95.8%; the tumor specific survival rates were 100.0% and 100.0%, respectively.@*CONCLUSIONS@#RFA is a safe, effective and minimally invasive technique for the treatment of lung GGNs.

Aged , Aged, 80 and over , Female , Humans , Lung , Lung Neoplasms/surgery , Male , Middle Aged , Radiofrequency Ablation/adverse effects , Tomography, X-Ray Computed
Chinese Journal of Lung Cancer ; (12): 690-697, 2021.
Article in Chinese | WPRIM | ID: wpr-922242


BACKGROUND@#With the extensive development of minimally invasive surgery for pulmonary nodules, preoperative localization becomes more and more critical. There are some defects in traditional localization methods, so it is necessary to improve. The aim of this study was to compare and analyze the safety and effectiveness of two new methods, namely four-hook needle and memory alloy coil, in the localization of pulmonary nodules.@*METHODS@#A retrospective analysis of 152 patients was performed. 76 cases were in four-hook needle group, and 76 cases were in memory alloy coil group. Pulmonary nodules were located before operation, and then video-assisted wedge resection was performed. The average procedure time, localization complications and nodule resection time were counted.@*RESULTS@#The target pulmonary nodules were successfully removed in both groups. In four-hook needle group, 76 patients found localization devices, all the pulmonary nodules were successfully removed, and one case was transferred to open the chest for wedge resection of pulmonary nodules due to severe thoracic adhesion. All 76 patients in memory alloy coil group were successfully resected with pulmonary nodules, and one patient underwent compromising enlarged resection because no lesion was found after the specimen was removed during the operation. There was no significant difference in the incidence of pneumothorax and pulmonary hemorrhage, the success rate of localization and nodule wedge resection time between the two groups. The average time of localization in four-hook needle group was (13.66±3.11) min, lower than that of memory alloy coil group (15.51±3.65) min, and the difference was statistically significant (P=0.001). In memory alloy coil group, when the distance from the nodule to the pleura was ≥1.5 cm and <1.5 cm, the average localization time was (17.20±4.46) min and (14.91±3.15) min, respectively, and there was a statistical difference between the two distance (P=0.044).@*CONCLUSIONS@#Four-hook needle and memory alloy coil have good safety and effectiveness, and the localization time of four-hook needle is shorter. When using memory alloy coil, the effect of the method is better for pulmonary nodules with a distance less than 1.5 cm to pleura.

Alloys , Humans , Lung Neoplasms/surgery , Multiple Pulmonary Nodules , Retrospective Studies , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
Chinese Journal of Lung Cancer ; (12): 838-846, 2021.
Article in Chinese | WPRIM | ID: wpr-922152


BACKGROUND@#Postoperative complications are an important cause of death after lung resection. At present, the adoption of video assisted thoracoscopic surgery (VATS) for lung cancer in China is increasing every year, but the prediction model of postoperative complications of VATS for lung cancer is still lack of evidence based on large sample database. In this study, Thoracic Mortality and Morbidity (TM&M) classification system was used to comprehensively describe the postoperative complications of VATS major lung resection in our center, and the prediction model of complications was established and verified. The model can provide basis for the prevention and intervention of postoperative complications in such patients, and accelerate the recovery of patients.@*METHODS@#The clinical data of patients underwent VATS major lung resection in our center from January 2007 to December 2018 were collected retrospectively. Only patients with stage I-III lung cancer were included. The postoperative complications were registered strictly by TM&M classification system. The patients were divided into two groups according to the operation period: the early phase group (From 2007 to 2012) and the late phase group (From 2013 to 2018). The baseline data of the two groups were matched by propensity score matching. After matching, binary logistic regression analysis was used to establish the prediction model of complications, and bootstrap internal sampling was used for internal verification.@*RESULTS@#A total of 2,881 patients with lung cancer were included in the study, with an average age of (61.0±10.1) years, including 180 major complications (6.2%). Binary Logistic regression analysis of 1,268 matched patients showed: age (OR=1.04, 95%CI: 1.02-1.06, P<0.001), other period (OR=0.62, 95%CI: 0.49-0.79, P<0.001), pathological type (OR=1.73, 95%CI: 1.24-2.41, P=0.001), blood loss (OR=1.001, 95%CI: 1.000-1.003, P=0.03), dissected lymph nodes (OR=1.022, 95%CI: 1.00-1.04, P=0.005) were independent risk factors for postoperative complications. The ROC curve indicates that the model has good discrimination (C-index=0.699), and the C-index is 0.680 verified by bootstrap internal sampling for 1,000 times. The calibration curve shows a good calibration of the prediction model.@*CONCLUSIONS@#TM&M system can comprehensively and accurately report the postoperative complications of thoracoscopic lung cancer surgery. Age, operative period, pathological type, intraoperative bleeding and dissected lymph nodes were independent risk factors for postoperative complications of VATS major lung resection for lung cancer. The established complication prediction model has good discrimination and calibration.

Aged , Humans , Lung , Lung Neoplasms/surgery , Middle Aged , Morbidity , Nomograms , Pneumonectomy , Postoperative Complications/etiology , Retrospective Studies , Thoracic Surgery, Video-Assisted
Chinese Journal of Lung Cancer ; (12): 756-763, 2021.
Article in Chinese | WPRIM | ID: wpr-922143


BACKGROUND@#Segmentectomy has gradually become one of the standard surgical methods for small pulmonary nodules with early lung cancer on imaging. This study aimed to investigate the perioperative outcomes of patients who underwent uniport video-assisted thoracoscopic surgery (VATS) segmentectomy for identifying the intersegmental boundary line (IBL) by the near-infrared fluorescence imaging with intravenous indocyanine green (ICG) method or the modified inflation-deflation (MID) method and assess the feasibility and effectiveness of the ICG fluorescence (ICGF)-based method.@*METHODS@#We retrospectively analyzed the perioperative data in total 198 consecutive patients who underwent uniport VATS segmentectomy between February 2018 and August 2020. With the guidance of preoperative intelligent/interactive qualitative and quantitative analysis-three dimensional (IQQA-3D), the targeted segment structures could be precisely identified and dissected, and then the IBL was confirmed by ICGF-based method or MID method. Clinical effectiveness and postoperative complications of the two methods were evaluated.@*RESULTS@#An IBL was visible in 98% of patients by the ICGF-based group, even with the low-doses of ICG. The ICGF-based group was significantly associated with the shorter IBL clear presentation time [(23.59±4.47) s vs (1,026.80±318.34) s] (P0.05).@*CONCLUSIONS@#The ICGF-based method could highly accurately identify the IBL and make anatomical segmentectomy easier and faster, and therefore has the potential to be a feasible and effective technique to facilitate the quality of uniport VATS segmentectomy.

Feasibility Studies , Humans , Indocyanine Green , Ion Transport , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications , Retrospective Studies , Thoracic Surgery, Video-Assisted
Chinese Journal of Lung Cancer ; (12): 862-866, 2021.
Article in Chinese | WPRIM | ID: wpr-922139


Lung cancer is the most common malignant tumor in the world, among which non-small cell lung cancer (NSCLC) accounts for about 85% of the total number of lung cancers. The 5-year overall survial (OS) of radical surgery NSCLC patients ranged from 92% in stage Ia1 to 26% in stage IIIb, and the continuously decreasing survival time made it a strong clinical need for precise adjuvant therapy to eradicate molecular residual disease (MRD). At present, circulating tumor DNA (ctDNA) as a molecular indicator of MRD has gradually moved from the laboratory to the clinic. The latest consensus proposes that ctDNA with abundance ≥0.02% can be stably detected in the peripheral blood of perioperative NSCLC patients, which is based on the possibility of ctDNA as an MRD indicator. MRD detection technology supports the possibility of monitoring after radical treatment of NSCLC, and ctDNA can predict the recurrence of the disease earlier than the imaging monitoring after treatment of NSCLC, providing valuable time for timely adjustment of adjuvant therapy. In the studies on early postoperative adjuvant therapy of NSCLC, different guidelines differ on whether appropriate adjuvant therapy should be carried out, while MRD can be used as a more accurate predictor to guide postoperative adjuvant therapy, so that patients can benefit from the disease treatment.

Biomarkers, Tumor , Carcinoma, Non-Small-Cell Lung/surgery , Circulating Tumor DNA , Humans , Lung Neoplasms/surgery , Neoplasm Recurrence, Local , Neoplasm, Residual , Small Cell Lung Carcinoma
Chinese Medical Journal ; (24): 2700-2709, 2021.
Article in English | WPRIM | ID: wpr-921204


BACKGROUND@#There is limited information about thymosin α1 (Tα1) as adjuvant immunomodulatory therapy, either used alone or combined with other treatments, in patients with non-small cell lung cancer (NSCLC). This study aimed to evaluate the effect of adjuvant Tα1 treatment on long-term survival in margin-free (R0)-resected stage IA-IIIA NSCLC patients.@*METHODS@#A total of 5746 patients with pathologic stage IA-IIIA NSCLC who underwent R0 resection were included. The patients were divided into the Tα1 group and the control group according to whether they received Tα1 or not. A propensity score matching (PSM) analysis was performed to reduce bias, resulting in 1027 pairs of patients.@*RESULTS@#After PSM, the baseline clinicopathological characteristics were similar between the two groups. The 5-year disease-free survival (DFS) and overall survival (OS) rates were significantly higher in the Tα1 group compared with the control group. The multivariable analysis showed that Tα1 treatment was independently associated with an improved prognosis. A longer duration of Tα1 treatment was associated with improved OS and DFS. The subgroup analyses showed that Tα1 therapy could improve the DFS and/or OS in all subgroups of age, sex, Charlson Comorbidity Index (CCI), smoking status, and pathological tumor-node-metastasis (TNM) stage, especially for patients with non-squamous cell NSCLC and without targeted therapy.@*CONCLUSION@#Tα1 as adjuvant immunomodulatory therapy can significantly improve DFS and OS in patients with NSCLC after R0 resection, except for patients with squamous cell carcinoma and those receiving targeted therapy. The duration of Tα1 treatment is recommended to be >24 months.

Carcinoma, Non-Small-Cell Lung/surgery , Chemotherapy, Adjuvant , Humans , Immunomodulation , Lung Neoplasms/surgery , Neoplasm Staging , Propensity Score , Retrospective Studies , Thymalfasin
Article in English | WPRIM | ID: wpr-921073


INTRODUCTION@#Surgical resection of the primary and metastatic tumour is increasingly recommended in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases. This systematic review was conducted to examine the current evidence on the role of lung metastasectomy (LUM) in CRC.@*METHODS@#Three databases were systematically searched, to identify studies that compared survival outcomes of LUM, and factors that affected decision for LUM.@*RESULTS@#From a total of 5,477 records, 6 studies were eventually identified. Two papers reported findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival benefit in patients who underwent LUM compared to those who did not. When compared against patients who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent LUM were also more likely to have a single pulmonary tumour, and metachronous disease.@*CONCLUSION@#The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective reviews, and the single randomised clinical trial performed was not completed. More prospective studies are required to understand the true effect of LUM on outcomes in metastatic CRC.

Colorectal Neoplasms/surgery , Humans , Liver Neoplasms/surgery , Lung Neoplasms/surgery , Metastasectomy , Pneumonectomy , Prognosis , Randomized Controlled Trials as Topic , Retrospective Studies , Survival Rate
Article in Chinese | WPRIM | ID: wpr-887894


Objective To investigate the application value of indocyanine green(ICG)in the localization of small pulmonary nodules in video-assisted thoracoscopic surgery(VATS). Methods We retrospectively analyzed the clinical data of 45 patients with small nodules(diameter<1 cm)who received preoperative localization with ICG and underwent VATS wedge resection from October 2020 to February 2021.The data for analysis included patients age,nodule diameter,distance from the parietal pleura,nodule density,success rate of localization,time of localization,incidence of complications,and pathological findings. Results The success rate of localization was 100%.The average nodule size was 6.3 mm,and the nodules were(10±11)mm from the parietal pleura.After localization of 59 nodules,13(22.0%)cases were found to have mild pneumothorax,and 4(6.7%)cases were found to have mild hemorrhage.The success rate of operation was 100%,and 43(72.9%)cases were confirmed adenocarcinoma by postoperative pathology. Conclusion ICG has a high success rate and good safety in the localization of small pulmonary nodules in VATS.

Humans , Indocyanine Green , Lung Neoplasms/surgery , Retrospective Studies , Solitary Pulmonary Nodule/surgery , Thoracic Surgery, Video-Assisted , Tomography, X-Ray Computed
Rev. cuba. cir ; 59(4): e996, oct.-dic. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1149844


RESUMEN Introducción: La evaluación del mediastino en los pacientes que reciben tratamiento quirúrgico por cáncer del pulmón tiene sus orígenes en la necesidad de definir la extensión anatómica de cada estación nodal, lo cual es indispensable para la categorización patológica de los nódulos linfáticos. Objetivo: Evaluar la utilidad de la linfadenectomía mediastinal en el tratamiento quirúrgico del cáncer pulmonar. Métodos: Se realizó un estudio analítico de carácter prospectivo en el período comprendido entre enero de 2015 al 31 de agosto de 2018. El universo estuvo conformado por 96 pacientes con algún tipo de linfadenectomía mediastinal en el tratamiento quirúrgico del cáncer pulmonar dentro del período señalado. Se utilizaron métodos estadísticos, teóricos y empíricos. Resultados: La edad promedio fue 58,69 ± 9,343, el sexo masculino fue el más afectado y el adenocarcinoma el tipo histológico que predominó. La etapa clínica y patológica mayoritaria fue la III A y la lobectomía superior derecha la intervención más realizada. Se efectuaron un total de 76 disecciones ganglionares sistemáticas, seguidas por 18 muestreos ganglionares y 2 biopsias. Las linfadenectomías realizadas provocaron cambios de estadios en 46 pacientes. El análisis del valor predictivo positivo y negativo, así como de la sensibilidad y la especificidad fueron altos, así como las complicaciones escasas. Conclusiones: La linfadenectomía mediastinal como parte del tratamiento quirúrgico en el cáncer pulmonar constituye un pilar fundamental en la estadificación patológica del TNM, al mostrar una exactitud diagnóstica alta(AU)

ABSTRACT Introduction: Evaluation of the mediastinum in patients receiving surgical treatment for lung cancer has its origins in the need to define the anatomical extension of each node station, which is essential for the pathological categorization of lymph nodes. Objective: To evaluate the usefulness of mediastinal lymphadenectomy in the surgical treatment of lung cancer. Methods: A prospective and analytical study was carried out in the period from January 2015 to August 31, 2018. The universe consisted of 96 patients with some type of mediastinal lymphadenectomy in the surgical treatment of lung cancer within the indicated period. Statistical, theoretical and empirical methods were used. Results: The average age was 58.69 ± 9.343. The male sex was the most affected. Adenocarcinoma was the histological type that predominated. The most manifested clinical and pathological stage was III A. Right upper lobectomy was the most performed intervention. A total of 76 systematic lymph node dissections were performed, followed by 18 lymph node samples and two biopsies. The lymphadenectomies performed caused stage changes in 46 patients. The analysis of positive and negative predictive value, as well as sensitivity and specificity, were high. There were few complications. Conclusions: Mediastinal lymphadenectomy as part of the surgical treatment in lung cancer constitutes a fundamental procedure for the pathological staging of TNM, as it shows high diagnostic accuracy(AU)

Humans , Male , Middle Aged , Adenocarcinoma/etiology , Predictive Value of Tests , Lung Neoplasms/surgery , Lymph Node Excision/methods , Prospective Studies , Sensitivity and Specificity