RESUMEN
@#Objective To investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. Methods The clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. Results There were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). Conclusion All-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.
RESUMEN
Colorectal cancer is one of the common malignant tumors with high morbidity， and changes in lifestyle， dietary structure and environment in China in recent decades have been associated with an increase in the incidence of colorectal cancer. A large number of studies have shown that traditional Chinese medicine（TCM） can be used as a complementary and alternative treatment for colorectal cancer after conventional western medicine treatment. TCM physicians have accumulated a lot of clinical experience in the treatment of patients with stage Ⅰ-Ⅲ colorectal cancer， and have proved that TCM has unique efficacy， but there is still a lack of relevant clinical practice guidelines to standardize and guide the diagnosis and treatment of TCM. Based on this， according to the guideline development process of the World Health Organization Handbook for Guideline Development and the Clinical Evidence Grading Criteria on TCM Based on Evidence Body， under the framework of relevant laws， regulations and technical guidance documents， combined with the evidence of relevant domestic and foreign clinical research in recent years for evidence grading and opinion recommendation， and then the Guidelines for TCM Intervention After Conventional Western Medicine Treatment for Stage Ⅰ-Ⅲ Colorectal Cancer were developed by expert consensus. This guideline introduces the etiology， pathogenesis， syndrome differentiation and treatment of TCM intervention for colorectal cancer， which can provide guiding opinions for TCM clinicians and clinicians of integrated traditional Chinese and western medicine engaged in the prevention and treatment of colorectal cancer.
RESUMEN
@#Objective To compare and analyze the therapeutic effects of robot-assisted lobectomy and segmentectomy for stage ⅠA non-small cell lung cancer with a diameter≤2 cm. Methods A total of 181 patients with pathologically confirmed stage ⅠA non-small cell lung cancer (diameter≤2 cm) who underwent robot-assisted lobectomy and segmentectomy in our hospital from 2018 to 2021 were included. There were 74 males and 107 females with an average age of 57.50±10.60 years. They were divided into two groups according to the surgical procedure: a segmentectomy group (85 patients) and a lobectomy group (96 patients). Results There was no statistically significant difference between the two groups in terms of clinical data such as age, gender, smoking history, basic disease, pathological type, tumour diameter, operative time, postoperative 24 h drainage volume and overall complications (P>0.05). The intraoperative blood loss (33.88±16.26 mL vs. 39.27±19.48 mL, P=0.046), groups of dissected lymph nodes (4.76±1.19 vs. 5.52±1.46, P=0.000), number of dissected lymph nodes (14.81±7.23 vs. 18.06±7.70, P=0.004) and postoperative 72 h drainage volume (561.65±225.31 mL vs. 649.84±324.34 mL, P=0.037) of patients in the segmentectomy were less than those in the lobectomy group. The chest drainage time (5.49±3.92 d vs. 7.60±4.96 d, P=0.002) and postoperative hospital stay time (7.47±4.16 d vs. 9.67±5.50 d, P=0.003) were shorter than those in the lobectomy group. There was no conversion to thoracotomy or perioperative death in the two groups. The postoperative follow-up rate was 100.0% with a longest follow-up time of 48 months. The 3-year recurrence-free survival rates of the segmentectomy group and lobectomy group were 87.7% and 92.4%, respectively (P=0.465). Conclusion The da Vinci robot-assisted lobectomy and segmentectomy are safe and feasible surgical procedures for patients with stage ⅠA non-small cell lung cancer (diameter≤2 cm), with a similar 3-year recurrence-free survival rate. The lobectomy group has more lymph nodes dissected, while the segmentectomy group is superior to the lobectomy group in terms of intraoperative blood loss, postoperative 72 h chest drainage volume, chest drainage time and postoperative hospitalization time.
RESUMEN
Objective To explore the risk factors for vascular invasion and its influence on prognosis of resectable gastric cancer patients by analyzing the clinicopathological features. Methods We retrospectively analyzed the data of 1077 patients with stage Ⅰ-Ⅲ gastric cancer who underwent surgical resection. According to whether vascular invasion occurred, they were divided into LVI positive group (n=672) and LVI negative group (n=405). Logistic univariate and multivariate analyses were used for the relation between clinical pathological features and LVI. Survival analysis was used to study the relation between vascular invasion and survival rate in patients with stage Ⅰ gastric cancer. Results Univariate analysis showed that tumor size, type of differentiation, depth of invasion, lymph node metastasis, TNM stage, Lauren classification, nerve invasion and the increase of CEA, CA125 and CA199 were risk factors for vascular invasion (P < 0.05). Multivariate analysis showed that poor differentiation, deep invasion, lymph node metastasis, nerve invasion and elevated CA724 were independent risk factors for vascular invasion. The 5-year survival rate of stage Ⅰ gastric cancer patients with vascular invasion was significantly lower than that without vascular invasion (P < 0.01). Conclusion Gastric cancer patients with poor differentiation, deep invasion, lymph node metastasis, nerve invasion and elevated CA724 are more prone to vascular invasion. Patients with stage I gastric cancer at risk of vascular invasion should be treated more aggressively.
RESUMEN
Non-small cell lung cancer (NSCLC) is one of the most severe malignant tumors worldwide. Lobectomy and systematic nodal dissection remain the standard treatment for stageⅠNSCLC. Stereotactic body radiotherapy (SBRT) has become the standard treatment for medically inoperable patients. Though the prognosis of stage Ⅰ NSCLC patients is generally good, there are still about 20% of patients with local recurrence and distant metastasis. There is significant heterogeneity in the prognosis and failure phenotype of patients, which cannot be precisely distinguished by the pathological TNM classification system. Identification of the risk factors for the prognosis of patients with stage Ⅰ NSCLC is a key step to realize the treatment from experience to precision. Screening the high-risk patients will facilitate to individually develop the adjuvant therapy strategy after surgery or SBRT and improve the overall curative effect. There are many factors that are significantly related to the prognosis of stage Ⅰ NSCLC including individual factors such as gender, age, and systemic inflammatory biomarkers; treatment-related factors such as the extent of surgical resection of the primary tumor and lymph nodes, the choice of different radiation rays, and different dose fractionation; and tumor-related factors such as imaging information, pathology information; and molecular biology information. This review will analyze the treatment failure phenotype and prognostic factors of stageⅠ NSCLC in various perspectives such as individual-, tumor- and treatment-related factors.
Asunto(s)
Humanos , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/patología , Fenotipo , Pronóstico , Insuficiencia del TratamientoRESUMEN
Objective:To compare the short-term outcomes of segmentectomy for stage ⅠA non-small cell lung cancer by two surgical methods.Methods:A retrospective analysis was performed on 101 patients with stage ⅠA non-small cell lung cancer and undergoing segmentectomy admitted to the Department of Thoracic Surgery of The General Hospital of the Northern Theater Command from July 2016 to July 2020, including 50 patients who underwent Da Vinci robotic segmentectomy and 51 patients who underwent video-assisted thoracoscopic segmentectomy during the same period. By collecting the clinical data of the patients, the operation time, intraoperative blood loss, lymph node dissection stations, lymph node dissection number, drainage volume on the first day after the operation, total drainage volume on the third day after the operation, postoperative chest catheter insertion time, postoperative hospitalization days, and postoperative complication rate were compared and analyzed.Results:Patients in both groups successfully completed pulmonary segmental resection, and there were no cases of conversion to thoracotomy and perioperative death.Compared and analyzed the postoperative clinical results of the two groups, the intraoperative blood loss [(34.40±12.96) ml vs.(85.10±26.41)ml, P=0.000], the number of lymph node dissection stations(4.72±1.20 vs. 3.60±1.40, P=0.000) and the number of lymph node dissection(15.14±5.91 vs. 10.76±5.26, P=0.000) showed statistically significant differences, and RATS group was superior to VATS group.There were no statistically significant differences in operation time[(153.90±21.88) min vs.(155.39±25.04) min, P=0.751], drainage volume on the first day after surgery[(217.80±76.94) ml vs.(210.98±86.98) ml, P=0.678], total drainage volume three days after surgery[(612.60±169.93) ml vs.(595.10±203.90) ml, P=0.641], duration of chest drainage tube after operation[(5.36±2.33) days vs.(5.18±2.54) days, P=0.706], postoperative hospitalization days[(7.50±2.35) days vs.(7.47±2.93) days, P=0.956]and postoperative complication incidence. Conclusion:Da Vinci robot segmentectomy is a safe and effective surgical method, with less bleeding and more lymph node dissection stations and number than video-assisted thoracoscopic segmentectomy for stage ⅠA non-small cell lung cancer.
RESUMEN
OBJECTIVE: To investigate short-term and long-term efficacy of PGLA thread-embedding therapy in the treatment of stage Ⅰ post-stroke shoulder-hand syndrome. METHODS: A total of 60 patients with stage Ⅰ post-stroke shoulder-hand syndrome were randomly divided into control group and treatment group, with 30 patients in each group. The patients in the control group were given acupuncture combined with rehabilitation training, and those in the treatment group were given PGLA thread-embedding therapy combined with rehabilitation training. Conventional acupuncture was performed once a day, and thread-embedding therapy was performed once every 5 days. Both groups were treated for 30 days. Clinical outcome, Visual Analogue Scale (VAS) score, hand edema score, and Fugl-Meyer Assessment (FMA) score were compared within and between groups immediately and at 1 month after treatment. RESULTS: The treatment group had a significantly higher overall response rate than the control group immediately and at 1 month after treatment (93.33%/86.67% vs 73.33%/56.67%, P<0.05). Both groups had significant reductions in VAS score and hand edema score and a significant increase in FMA score immediately and at 1 month after treatment (P<0.05), and the treatment group had significantly greater improvements than the control group (P<0.05). CONCLUSION: PGLA thread-embedding therapy has a better clinical effect than conventional acupuncture in the treatment of stage Ⅰ post-stroke shoulder-hand syndrome.
RESUMEN
The prognosis of lung cancer is closely related to the clinical stage when it is found. In China, the five-year survival rate of lung cancer is only 15%, while the five-year survival rate of stage ⅠA lung cancer reaches 80% to 90%. Therefore, early detection, diagnosis and treatment of lung cancer are particularly important, which can significantly reduce the mortality of lung cancer and improve the fiveyear survival rate. With the application of low-dose spiral CT screening for early stage lung cancer, the diagnosis rate of stage ⅠA lung cancer gradually increases, thus promoting the research and progress of the diagnosis and treatment of early stage lung cancer. This paper summarizes the progress of the current new diagnosis and treatment technology of stage ⅠA lung cancer.
RESUMEN
Objective To evaluate the evolution of the effective and safe diagnostic and surgical approaches for patients with cervical cancer of stage Ⅰ A1 during ten years.Methods A retrospective cohort study of 721 cases diagnosed with cervical cancer of stage Ⅰ A1 from 2005 to 2014 was conducted by reviewing the archived medical records.Results Of patients with cervical cancer of stage Ⅰ A1,396 cases (54.9％) had no symptoms and follow-up materials.The transformation of treatment and curative effect were evaluated with Pearson chi square test,Spearman correlation analysis as well as Fisher's exact probability.Pathology of biopsy clarified the diagnosis for 82 cases (11.4 ％),and pathologic results of conization made the definite diagnosis for 640 cases (89.9 ％) (P＜0.01).Laparoscopy grew to be the main trend of surgical approach for cervical cancer of stage Ⅰ A1 instead of laparotomy from 2010 to 2014 compared with 2005 to 2009 (P＜0.01).Non-radical surgery became more popular to the cohort from 2010 to 2014 (P＜0.01).Thirty-five cases (4.9％) were lost to follow-up.There was no dead case and a case of recurrence.Conclusions Conization was very important to clarify the diagnosis for cervical cancer of stage Ⅰ A1.Laparoscopic hysterectomy was a safe and effective treatment for cervical cancer of stage Ⅰ A1 patients.
RESUMEN
Objective The objective of this study was to study the dosimetric characteristics and advantages of Non-coplanar IMRT techniques stereotactic body radiation therapy(SBRT)in the early stage of NSCLC.Methods Ten patients were selected with early stage of NSCLC.Treatment planning designed 9 fields coplanar IMRT and 9 fields Non-coplanar IMRT,respectively.Non-coplanar plans include five coplanar fields and four non-coplanar fields.Two group patients' plans compared V2.5,V5,V20,V25 of the whole lung,the average exposure doses of the whole lung,and the average exposure doses of the contralateral lung.The comparison of the other OARs include:spinal cord Dmax,heart Dmax,esophagus Dmax,trachea Dmax,chest wall Dmax and V30 of chest wall.At the meantime,we compared the conformal index of PTV(CI)and the homogenization index of PTV(HI).Results Non-coplanar plans reduced V20 of the whole lung(P=0.001),the average exposure dose of the contralateral lung(P=0.001),but V5 of the whole lung non-coplanar plans were increased than that in coplanar plans(P=0.002).Non-coplanar technology reduce max dose of spinal cord,esophagus,trachea,chest wall and V30 of chest wall(P=0.026,0.001,0.026,0.008,0.016).Heart Dmax of the non-coplanar plans was high in coplanar plans with no statistical significance difference(P=0.296).The conformal index of PTV of the non-coplanar plans was better(P=0.036),there was no difference in the homogenization index of PTV(P=0.254).Conclusion The stereotactic body radiation therapy of the early stage of NSCLC,the non-coplanar technology can effectively reduce exposure doses of the lung tissue and the other most OARs,also improve the conformal index of the PTV.The non-coplanar technology have possibility in reducing complications when compared with the coplanar technology and therefore has certain dosimetry advantage.
RESUMEN
Background and purpose: With characteristic but non-specific features, subsolid pulmonary nodules (SSPN) is closely associated with early lung cancer. This study aimed to estimate the imaging value of SSPN in stageⅠA lung cancer, and summarized the radiological features of various SSPNs, retrospectively. Methods:The clinical data and imaging data of 405 patients with solitary pulmonary nodules (SPNs) from Apr. 2008 to Apr. 2014 at Fudan University Shanghai Cancer Center were collected. According to ground-glass opacity (GGO) proportion, SPNs were divided into 3 groups:pure ground-glass opacity (pGGO), mixed ground-glass opacity (mGGO) and solid nodule (SN). The malignant ratios were calculated based on the postoperatively pathological results. Besides, SSPNs were classiifed into stageⅠA lung cancer group and benign lesions group aiming at identifying the differentiating computed tomography (CT) features. Results:Of the enrolled 405 SPN patients, there were 367 SSPNs (including 124 pGGOs and 243 mGGOs) whose incidence in stageⅠA lung cancer group was signiifcantly higher than those in benign group [95.9%(257/268) vs 80.3%(110/137), P<0.001]. The total malignant ratio of SSPN was 70.0%(257/367), mGGO had a higher malignant ratio (72.0%) than those of pGGO (66.1%) and SN (28.9%). The malignant SSPNs were frequently detected in upper lobe of middle-aged women with a higher incidence of irregular edge, spiculation, lobulation and pleural retraction than benign group (P<0.05). Conclusion:SSPN is one of the signiifcantly malignant indicators, and mGGO has the highest malignant tendency. Senility, female, irregular edge, spiculation, lobulation, pleural retraction and pulmonary upper lobe distribution are demonstrated the signiifcant discriminators from benign lesions.
RESUMEN
Objective To assess early and medium outcomes of pathologic N2 disease unexpectedly detected in patients undergoing total video-assisted thoracic surgery lobectomy for non-small cell lung cancer.Methods Between Sep.2006 and Dec.2010,348 patients with Non-small cell lung cancer underwent total video-assisted thoracic surgery lobectomy,and within them,35( 10.1％ ) were found to have pathologic N2 disease after operation.We retrospectively reviewed the clinical and pathologic features of patients with unexpected N2 disease after video-assisted thoracic surgery lobectomy and their early and medium outcomes,including survival and recurrence pattern.Results No perioperative mortality was noted.26 patients received a lobectomy directly,and the other 9 patients after a wedge resection.All the patients had R0 resection.The medium operation time was 190 minutes and medium blood loss was 200ml.The medium stations and numbers of dissected N2 lymph nodes in operation were 4 and 10,respectively.And the medium stations and numbers of metastatic N2 Lymph nodes were 1 and 2,respectively.Among patients with pathologic N2 disease,18 (51.4％) had single-station involvement.The median duration of chest tube placement was 8 days.The median length of hospital stay was 11 days.15 complications occurred in 12 (34.3％) patients.All of the patients underwent adjuvant chemotherapy with platinum postoperatively.The median follow-up time was 23 months.The 1 - and 2-year overall survival (OS) was 80.9％ and 67.9％,and the medium OS was not reached.During follow-up,16 (45.7％) patients had a recurrence.The pattern of recurrence was locoregional in 5,distant in 11.The 1 - and 2-year disease-free survival (DFS) was 71.9％ and 44.2％,and the medium DFS was 20 months (95％,8.1 to 31.9 months).Divided the patients with pathologic N2 disease into two groups considering single-station involvement or not,the 1-and 2-year OS and DFS for the single-station group and for the multiple-station group were 87.7％,78.9％ ; 88.9％,49.4％and 67.6％,59.1％ ; 55.3％,39.5％.The medium DFS for both the two groups was 23 and 16 months respectively.Conclusion For non-small cell lung cancer with N0 disease confirmed by an exactly preoperative staging workups,if it is feasible in technology,a total video-assisted thoracic surgery lobectomy should be recommended.Even if N2 lymph node metastasis is unexpectedly detected postoperatively,the metastasis was mostly micro- or single-station involved,and a similar outcome with conventional thoracotomy can be achieved.
RESUMEN
ObjectiveTo evaluate the efficacy, feasibility and safety of CT guided percutaneous 125Ⅰ seeds implantation in elderly patients of stage Ⅰperipheral non-small cell lung cancer ( NSCLC ).MethodsClinical data of 16 elderly peripheral stage Ⅰ NSCLC patients ( 10 squamous carcinoma and 6adenocarcinoma;13 stage ⅠA and 3 stage ⅠB ) who received radioactive 125Ⅰ seeds implantation because of refusal or being unsuited to operation or external radiotherapy were retrospectively analyzed. Prescribed dose was 140 - 160 Gy. Under CT guidance, 125Ⅰ seeds were implanted percutaneously into tumors for interstitial radiotherapy according to treatment plan system. ResultsMean number of 125Ⅰ seeds each patient received was21.1. 12 complete response (CR) and 4 partial response (PR) were achieved. Total response rate ( CR + PR) was 100％. 100％ patients completed 10 to 56 months of follow-up, 15, 13, 8 and 6 patients completed 1-, 2-, 3-and 4-years'follow-up, respectively. The median local progression free time was 14months. The 1-,2-,3-and 4-year overall survival rate were 60％, 54％, 50％ and 33％, respectively (median:14 months). 7 cases died of non-tumor disease and 5 died of metastasis. No severe complications were observed. ConclusionsCT guided 125Ⅰ seeds implantation is a safe, reliable and effective radical treatment method for elderly stage Ⅰ peripheral NSCLC patients, who refuse to or are unsuitable to operation or external radiotherapy.
RESUMEN
Objective: To investigate the relationship of nm23 and VEGF expression with hilar lymph node micrometastasis and the prognosis of stage Ⅰ non-small cell lung cancer (NSCLC). Methods: Immunohisto-chemistry was used to detect nm23 and VEGF protein expression in primary cancer tissue and cytokeratins in 86 hilar lymph nodes from 40 patients with stage Ⅰ NSCLC. Kaplan-meier method and Log rank test were used to analyze the 5-year survival. Results: The rate of positive hilar lymph node micrometastasis was 12.5% for stage Ⅰ NSCLC. Lymph node micrometastasis was not statistically correlated with gender, age, histologic type, differentiation, primary tumor size or VEGF protein expression (P>0.05). But it was reversely associated with nm23 protein expression in primary cancer tissue of NSCLC (P<0.05). The 5-year overall survival of pa-tients with well-differentiated NSCLC, positive nm23 expression and negative lymph node micrometastasis was better than those with moderately and poorly differentiated NSCLC, negative nm23 expression and posi-tive lymph node micrometastasis (P<0.05). Lymph node micrometastasis and nm23 protein expression were identified as two independent prognostic factors for stage Ⅰ NSCLC by univariate Cox regression analysis.Conclusion: nm23 protein expression in pdmary cancer tissue of stage Ⅰ NSCLC is closely associated with hi-lar lymph node micrometastasis, nm23 protein and hilar lymph node micrometastasis are two independent prognostic factors for stage Ⅰ NSCLC. Patients with nm23 protein deletion and positive lymph node microme-tastasis have a poor prognosis.
RESUMEN
Purpose:To evaluate the efficiency of mediastinal lymph nodes dissection (MLND) and to determine a reasonable extent of dissection in the treatment of patients with clinical stageⅠ A non small cell lung carcinoma (NSCLC). Methods:From January 1988 to June 1995, one hundred and forty seven patients with clinical stageⅠ A NSCLC were treated by surgery. All the patients were divided into three groups according to the type of procedure, that is, resection without MLND, resection with selective MLND and systematic MLND. According to their clinical characteristics patients in each group were matched and assigned once again, and 93 cases were enrolled. Survival rates were calculated by Kaplan meier method and survival curves were prepared and survival difference was compared by Log rank test. Results:Survival rates at 5 year of no MLND, selective MLND and systematic MLND groups were 22.6%, 48.4%, and 51.6%, respectively. Survival rates of two MLND groups were higher than that of no MLND group. Log rank test presented significantly statistical difference between them ( P