Experience of Thoracotomy and Robot-assisted Bronchial Sleeve Resection after Neoadjuvant Chemoimmunotherapy for Local Advanced Central Lung Cancer / 中国肺癌杂志

BACKGROUND@#Immunoneoadjuvant therapy opens a new prospect for local advanced lung cancer. The aim of our study was to explore the safety and feasibility of robotic-assisted bronchial sleeve resection in patients with locally advanced non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy.@*METHODS@#Data of 13 patients with locally advanced NSCLC that underwent bronchial sleeve resection after neoadjuvant chemoimmunotherapy during August 2020 and February 2021 were retrospectively included. According to the surgical methods, patients were divided into thoracotomy bronchial sleeve resection (TBSR) group and robot-assisted bronchial sleeve resection (RABSR) group. Oncology, intraoperative, and postoperative data in the two groups were compared.@*RESULTS@#The two groups of patients operated smoothly, the postoperative pathology confirmed that all the tumor lesions achieved R0 resection, and RABSR group no patient was transferred to thoracotomy during surgery. Partial remission (PR) rate and major pathological remissions (MPR) rate of patients in the TBSR group were 71.43% and 42.86%, respectively. Complete pathological response (pCR) was 28.57%. They were 66.67%, 50.00% and 33.33% in RABSR group, respectively. There were no significant differences in operative duration, number of lymph nodes dissected, intraoperative blood loss, postoperative drainage time and postoperative hospital stay between the two groups, but the bronchial anastomosis time of RABSR group was relatively short. Both groups of patients had a good prognosis. Successfully discharged from the hospital and post-operative 90-d mortality rate was 0.@*CONCLUSIONS@#In patients with locally advanced central NSCLC after neoadjuvant chemoimmunotherapy can achieve the tumor reduction, tumor stage decline and increase the R0 resection rate, bronchial sleeve resection is safe and feasible. Under the premise of following the two principles of surgical safety and realizing the tumor R0 resection, robot-assisted bronchial sleeve resection can be preferred.

Clinical Effect of Pedicled Pericardial Fat Flap in Prevention of Bronchial Pleural Fistula in Bronchial Sleeve Lobectomy / 中国肺癌杂志

BACKGROUND@#Bronchial sleeve lobectomy is essential surgical approach to treat centralized lung cancer. It is the best reflected the principle of lung cancer surgery, "remove tumor completely while minimize pulmonary function loss". Bronchial pleural fistula (BPF) is not common but very severe complication of bronchial sleeve lobectomy, that is usually fatal. Present article is to explore clinical effect on prevention of bronchial pleural fistula (BPF) in bronchial sleeve lobectomy, by wrapping brachial anastomosis with pedicled pericardial fat flap.@*METHODS@#Clinical data of 39 non-small cell lung cancer (NSCLC) patients who underwent surgical resection during January 2016 to May 2019 in Lung Cancer Center of West China Hospital, Sichuan University were collected and retrospectively analyzed. All of the patients underwent bronchial sleeve lobectomy and a brachial anastomosis wrapping with pedicled pericardial fat flap.@*RESULTS@#All patients recovered well and were discharged within 6 d-14 d after operation. No BPF occurred, nor other severe complications, such as reoperation needing intrathoracic bleeding, several pneumonia and respiratory failure, and life threatening cardiac arrhythmia. Only one patient (1/39) had several anastomotic stenosis and consequential atelectasis of residual lung in operative side 6 months after surgery.@*CONCLUSIONS@#Wrapping bronchial anastomosis with pedicled pericardial fat flap in bronchial lobectomy for centralized NSCLC is a simple and effective approach to prevent BPF, thus safety of the operation could be significantly improved.

Analysis of influencing factors of lymph node metastasis in patients with central and peripheral types of squamous cell lung cancer / 天津医药

Objective To analyze the factors related to the metastasis of lung squamous cell carcinoma in patients with central and peripheral types of lung squamous carcinoma, and provide evidence-based basis for preoperative preparation, intraoperative lymph node treatment choice and postoperative treatment. Methods Clinical data of 142 patients with lung squamous carcinoma who performed operation in Tianjin Medical University Cancer Institute and Hospital from January 2014 to December 2015 were retrospectively analyzed. There were 83 cases of central lung squamous cell carcinoma and 59 cases of peripheral lung squamous carcinoma in these 142 patients. Single factor and multiple factor Logistic regression analysis were used to analyze the clinical data in patients with different type groups, including gender, age, smoking history and smoking index, preoperative CYFRA21-1 level, preoperative predictive lymph nodes metastasis, tumor diameter, tumor type (keratotic and non-keratotic), pleura invasion, tumor embolism and postoperative lymph node metastasis. Results There were 47 cases with lymph node metastasis in 147 patients, including 31 cases of central type metastasis, and 16 cases of peripheral type metastasis. Single factor analysis showed that gender, smoking history, smoking index, preoperative lymph node metastasis assessment, tumor diameter, and non-keratotic type were related to the metastasis of central type of lung squamous cell carcinoma. Pleural invasion and non-keratotic type were associated with peripheral type of pulmonary squamous cell carcinoma. Multivariate Logistic regression analysis showed that more smoking, large tumor diameter and non-keratotic type were independent risk factors for lymph node metastasis of central type of lung squamous cell carcinoma. The non-keratotic type was an independent risk factor for lymph node metastasis of peripheral pulmonary squamous carcinoma. Conclusion Non-keratotic type of squamous cell carcinoma is related to lymph node metastasis especially N1 lymph node metastasis. It is suggested that such patients should be actively treated and colsely followed up after the operation. Patients with more smoking may be more likely to have N2 lymph node metastasis.

Clinical analysis of treatment of airway stenosis caused by advanced central lung cancer with bronchoscopic endobronchial ultrasound guided intratumoral injection of Cisplatin (10 cases) / 中国内镜杂志

Objective To explore the clinical application value of bronchoscopic endobronchial ultrasound (EBUS) guided intratumoral injection of Cisplatin in treatment of airway stenosis caused by advanced central lung cancer. Methods The clinical data of 10 cases of airway stenosis caused by advanced central lung cancer between Nov 2015 and Jan 2017 were analyzed retrospectively. Results 10 cases airway stenosis caused by advanced central lung cancer received EBUS guided intratumoral injection of Cisplatin treatment. Assessed by bronchoscopic, there were 8 cases of patients showed favorable effects after the treatment; Assessed by CT scan, 6 cases showed effects;And 8 cases relieved dyspnea. Conclusion EBUS guided intratumoral injection of Cisplatin in treatment of airway stenosis caused by advanced central lung cancer have some effect.

Effect of KMG for bronchi arterial chemoembolization combined with RFA for the central lung cancer / 实用放射学杂志

Objective To investigate the curative effect of kelp micro gelation (KGM) for bronchi arterial chemoembolization (BACE) combined with radiofrequency ablation (RFA) for central lung cancer.Methods 60 patients pathologically confirmed as the central lung cancer were enrolled and performed with BACE+KGM after the tumor-feeding artery was confirmed.RFA was performed under local anesthesia 1 month later.1 month,3 months and 6 months after the treatments CT scan was performed to show the changes of the tumor.Tumor markers were detected by blood test 1 month before and after the treatments.Up to the end of this study.Improvements of clinical symptoms and complications were also evaluated.Results Among the 60 patients under the treatment of BACE+KMG+RFA,10 patients had a complete remission(CR),33 patients in partial remission (PR),11 patients in stable (SD) and 6 patients in progress (PD).1 month after the treatments,VEGFA,VEGFB,VEGFC,CEA,CA125 and CA19-9 were significantly decreased,with the overall reactive rate (ORR) of 71.67％,disease control rate (DCR) of 90.00％,18.33％ of no change,10.00 ％ progressing and the 2 year survival rate was 93.33 ％.Conclusion BACE+KMG combined RFA is an effective treatment for central lung cancer with better short-term and long-term effect,improving the life quality and survival time of patients significantly.

Application of flexible fiberoptic bronchoscope used in central lung cancer diagnosis / 中国医学装备

Objective:To investigate the diagnostic value of fiber bronchoscopy for central lung cancer.Methods: The clinical data of 137 patients with central lung cancer were retrospectively analyzed. The diagnostic coincidence rate and the performance of the bronchoscopy were analyzed and compared with the traditional CT imaging examination.Results: The coincidence rate of diagnosis(90.51%) was higher than that of CT (75.91%) (x2=10.450,P<0.05). The diagnostic coincidence rate of flexible fiberoptic bronchoscope of squamous cell carcinoma, undifferentiated carcinoma and adenocarcinoma was 92.86%%, 92.68% and 66.67% respectively. The most common type of the fibrous branch was hyperplasia (61.31%) by flexible fiberoptic bronchoscope.Conclusion:In the diagnosis of central lung cancer, the fiber bronchoscopy has important value of MRI and CT can not be replaced.

Usefulness of Photodynamic Therapy in the Management of Early Central Lung Cancer: A Report of Three Cases / 결핵및호흡기질환

In photodynamic therapy, a chemical photosensitizer is activated by light of a specific wavelength., Photodynamic therapy has been combined with bronchoscopy in patients who are ineligible for surgical resection in order to treat patients with early central lung cancer. Here, we describe 3 patients with early central lung cancer who were treated effectively using photodynamic therapy. Our experience shows that this approach is a useful modality in the therapy of these types of tumors.

Differential Diagnosis of Endobronchial Tuberculosis and Central Lung Cancer with CT / 实用放射学杂志

Objective To study CT diagnosis and differential diagnosis of endobronchial tuberculosis and central lung cancer.Methods CT features and differential diagnosis in 48 cases with pulmonary lesions confirmed by clinical and pathology were analyzed retrospectively.Results Of 48 cases,21 cases were endobronchial tuberculosis and 27 cases were central lung cancer including 20 cases of squamous cell carcinoma and 7 cases of small-cell lung cancer.On CT,showing bronchiartia,nodules inside the lumen,the bronchial walls thickened,bronchus involved longer,not accompanied with masses around the affected bronchus,atelectasis and obstructive pneumonia with the bronchiectasis or cavities and calcification,which were strongly promised the endobronchial tuberculosis.And it pointed out the central lung cancer if bronchiartia was shorter,the bronchial walls were thickened clearly and accompanied with masses around the affected bronchus and atelectasis with homogeneous density.Conclusion CT is of certain value in diagnosis and differential diagnosis of endobronchial tuberculosis and central lung cancer.

Evaluation of Tracheobronchial Tree Invasion by Central Lung Cancer Using MSCT Image Post-processing Techniques / 实用放射学杂志

Objective To assess the value in detecting the tracheobronchial tree invasion by central lung cancer (CLC)using MSCT axial images and 4 kinds of images post-processed techniques.Methods 38 cases with CLC identified by fibrobrochoscopy or operation were scanned using MX8000 scanner with slice thickness of 3.2 mm, overlapping interval of 1.6 mm, pitch of 1.0. Multiplanar reformation(MPR), shaded surface display(SSD), volume rendering (VR) and virtual endoscopy(VE) were performed in all cases. Two radiologists assessed the invasion of tracheobronchial tree by CLC together.The imaging findings were compared with the data of surgery in 12 cases who were undergone operation.Results 38 cases of CLC, 0 grade to Ⅳ grade were assessed in 0,8,14,11 and 5 cases respectively by MSCT axial images, while in 0,10,11,12 and 5 cases by MSCT post-processing images. The concordance rate was 75% for MSCT axial images(n=9), and 100% for MSCT post-processing images(n=12) among 12 cases performed operation(? 2 test,? 2=6.0,P