The rule of lymph node metastasis of adenosquamous carcinoma of the lung / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the rule of lymph node metastasis of adenosquamous carcinoma of the lung.</p><p><b>METHODS</b>The data of 361 surgically treated patients with adenosquamous carcinoma of the lung from October 1965 to June 2003 were collected and retrospectively reviewed. The classification of regional lymph node stations and TNM stage were determined according to the UICC criteria (1997). The route and patterns as well as influencing factors of lymph node metastasis were analyzed by SPSS 10.0 software. The median follow-up period was 5.5 years (range, 1.4 to 23.4 years).</p><p><b>RESULTS</b>The analysis of the route of mediastinal lymph node metastasis in the 361 cases showed that the tumor originated in the left upper lobe firstly metastasized to station 5 (A-P window), tumor in the right upper lobe to the station 4 (lower paratracheal), then secondly to station 7 (subcarinal), lastly to station 3 from the tumor in the left upper lobe or to the station 2 from the tumor in the right upper lobe. It was found that the tumors originated from the lower lobe, firstly metastasized to station 7, secondly to station 9 or 4 from the right lobe; or station 5 from left lower lobe, lastly to station 3 or 2 in the mediastinum. For the tumor in the middle lobe, mainly metastasized to station 7, 4 and 2. The skip mediastinal lymph node metastasis but N1 negative most commonly metastasized to station 7, then to station 4 from the tumor in the right lung and 5 from the tumor in the left lung. The prognosis of patients with a single skipping metastasis to mediastinal lymph node (N1-, SMLN) was better than that in the other patients with mediastinal lymph node metastases.</p><p><b>CONCLUSION</b>The lung cancer growing in a different location has a different route and skipping metastasis to mediastinal lymph nodes. The patterns of lymph node metastasis affect prognosis. The prognosis of patients with single skipping metastasis to mediastinal lymph nodes but negative pulmonary hilar lymph node is better than that in the other patients with multiple station mediastinal lymph node metastases. The "N1-, SMLN" pattern ought to be considered as a special lymph nodal metastasis with better prognosis.</p>

Surgical therapeutic strategy for non-small cell lung cancer with (N2) mediastinal lymph node metastasis / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the surgical therapeutic strategy for non-small cell lung cancer (NSCLC) with (N2) mediastinal lymph node metastasis.</p><p><b>METHODS</b>The clinical data of 325 patients with N2 NSCLC treated surgically between 1961 and 1995 were analysed.</p><p><b>RESULTS</b>The over-all 5-year survival rate was 19.6%. Survival was higher in patients with radical resection than with palliative resection, with squamous-cell carcinoma than with adenocarcinoma, with sleeve lobectomy and pneumonectomy than with regular lobectomy, with 1 to 3 mediastinal metastatic lymph nodes than those over 4, and with adjuvant therapy (chiefly postoperative radiotherapy) than without. All these differences were statistically significant (P < 0.05). There was no 5-year survivor in patients with T3 or T4 tumor, nor in those with distant metastasis.</p><p><b>CONCLUSION</b>It is suggested that surgery is the best choice for N2 NSCLC patients with T1 or T2 tumor, with non-adenocarcinoma, and with metastatic mediastinal lymph nodes less than 4 in number. Surgery is probably not a good choice in those with T3 tumor varieties. At operation, radical resection of the tumor and systematic removal of all hilar and mediastinal lymph nodes are essential for disease staging and survival improvement. Adjuvant therapy may improve long-term survival and is especially indicated in patients with residual tumor and/or metastatic mediastinal lymph nodes over 3 in number.</p>

Surgical management of upper mediastinal lymph nodes metastases from thyroid carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the significance of upper mediastinal lymph nodes dissection for thyroid carcinoma patients.</p><p><b>METHODS</b>The clinical data of 79 thyroid carcinoma patients who underwent the upper mediastinal lymph node dissection (between January 1984 and December 1998) were retrospectively analysed. There were 45 male and 34 female with a median age of 47 years (range 10 to 74 years). Follow-up was ended on December 31, 2003.</p><p><b>RESULTS</b>Histopathologically, there were 58 (73.4%) papillary carcinoma, 14 (17.7%) medullary carcinoma, and 7 (8.9%) follicular carcinomas. Four of them had poorly-differentiated carcinoma. Upper mediastinal lymph node dissection was carried out in 62 patients through trans-cervical approach, in 10 through an inverted T-shaped incision, and in 7 through a midline sternotomy. Seventy-six patients had 93 neck lymph node dissection procedures, and 47 patients developed paratracheal lymph node metastasis. The overall 5- and 10-year cumulative survival rate was 64.6% and 63.1%, respectively. Mediastinal lymph node recurrence developed only in 10 patients after initial upper mediastinal lymph node dissection. Nine patients died of upper mediastinal lymph node metastasis. Postoperative complications were observed in 11 patients without perioperative death.</p><p><b>CONCLUSION</b>Upper mediastinal lymph node metastasis is most frequently found in papillary thyroid carcinoma. Surgical dissection of upper mediastinal metastatic lymph nodes through either cervical incision or mediastinotomy is safe and effective with low rate of perioperative complications. It may improve the life quality and survival of thyroid carcinoma patients.</p>

Diagnosis and surgical treatment of metachronous second primary lung cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience of the diagnosis, surgical treatment and prognosis of metachronous second primary lung cancers.</p><p><b>METHODS</b>Between January 1983 and April 2004, 32 patients with metachronous second primary lung cancers were operated in our department. Clinical data of all these patients were reviewed retrospectively.</p><p><b>RESULTS</b>The initial procedures for their first primary lung cancers were lobectomy or pneumonectomy. Lobectomy or completion pneumonectomy for the second primary lung cancers were performed in 17 cases, limited pulmonary resection was done in 14 cases and exploration was in 1 case. The postoperative morbidity and mortality were 12% (4/32) and 3% (1/32), respectively. The 1-, 3-, and 5-year survival rate after second operation were 66% (19/29), 32% (9/28) and 19% (4/21), respectively.</p><p><b>CONCLUSIONS</b>The incidence of metachronous second primary lung cancers has been increasing gradually during recent years. The closely follow-up for patients undergoing resection for their first primary lung cancers is most important factor for improvement of the diagnosis of metachronous second primary lung cancers. Limited resection and incomplete lymph node dissection might be the factors contributing to the poor prognosis.</p>

Postoperative respiratory failure in patients with cancer of esophagus and gastric cardia / 中华肿瘤杂志

<p><b>OBJECTIVE</b>We retrospectively analyzed the cause and death risk of 114 postoperative respiratory failure patients found in 3519 patients with esophageal cancer and 1495 patients with carcinoma of gastric cardia surgically treated between January 1992 and May 2003.</p><p><b>METHODS</b>To analyze the reasons causing postoperative respiratory failure in surgically treated esophageal or gastric cardia cancer patients, and the correlation between the death risk of postoperative respiratory failure and preoperative pulmonary function tests, postoperative complications, operation modes, history of preoperative accompanying diseases and so on using Binary Logistic Regression analysis and Chi-square tests (chi(2)) in SSPS statistics software.</p><p><b>RESULTS</b>In this series, postoperative respiratory failure developed in 97 of 3519 (2.76%) esophageal cancer patients and 17 of 1495 (1.14%) gastric cardia cancer patients, which were mainly caused by severe respiratory tract infection (37.7%, 43/114) and operative complications (35.1%, 40/114) such as: anastomotic leakage or perforation of thoracic stomach, extensive bleeding during operation, chylothorax, etc, totally accounting for 72.8% (83/114). In contrast with lung cancer patients, most of the postoperative respiratory failure (69.3%) occurred in the patients who had perioperative complications but almost always normal preoperative pulmonary function tests. Other reasons to cause postoperative respiratory failure were: extubation in unconscious patients at the end of general anesthesia; over-infusion during operation; pulmonary artery embolism; severe arrhythmia and so on. All patients except 2 were treated in ICU by mechanic ventilation through intubation and/or tracheotomy. Eighty patients (70.2%) were intubated and/or had tracheotomy within 3 days postoperatively. Seventy patients (61.4%) were rescued successfully, whereas 44 cases (38.6%) died of postoperative respiratory failure and/or other postoperative complications. Univariate analysis and multivariate analysis by binary logistic regression indicated that: severe perioperative complications, more postoperative complications, poor preoperative pulmonary function, radical preoperative radiotherapy, intubation and/or tracheotomy after the second postoperative day and long period of mechanic ventilation were the major risk factors leading to death once the postoperative respiratory failure developed. The former 3 factors were independent risk factors leading to death with OR of 2.50, 2.37, 1.68, respectively. Age, sex, operation modes, history of preoperative accompanying disease, prophylactic antibiotics were not demonstrated as statistically significant risk factors correlated with death.</p><p><b>CONCLUSION</b>Severe perioperative complications and respiratory tract infection are the two major causes of postoperative respiratory failure in patients with cancer of esophagus and gastric cardia. Patients with severe perioperative complications or poor preoperative pulmonary function or association with more than two kinds of postoperative complications have much higher death risk than other patients when they develop postoperative respiratory failure. Careful manipulation during operation and effective perioperative management are the most important measures to avoid postoperative respiratory failure and high mortality.</p>

Diagnosis and surgical treatment for stage I non-small-cell lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the results of surgery and the diagnosis of stage I non-small-cell lung cancer (NSCLC).</p><p><b>METHODS</b>The survival of 274 stage I NSCLC patients who underwent surgery from 1991 to 1998 were statistically analyzed by the Kaplan-Meier method. Comparison of the differences in survival rates among groups were made according to the Logrank test. The follow-up time was at least 5 years with a follow-up rate of 97.8%.</p><p><b>RESULTS</b>The overall 1-, 3-, 5-year survival rates for patients with pathologic stage I lesion were 92.9%, 79.6% and 66.1%. The 5-year survival rates for patients with squamous-cell carcinoma, adenocarcinoma, adenosquamous and alveolar-cell carcinoma were 73.3%, 55.3%, 52.2%, 71.7%, respectively. The 1-, 3-, 5-year survival rates for T1N0 were 95.0%, 83.2%, 74.3% whereas those of T2N0 lung lesions were 90.8%, 75.9%, 59.9% (P < 0.05). The 1-, 3-, 5-year survival rates of regular lobectomy were 94.1%, 79.3%, 67.5% and of conservative resection (segmentectomy and wedge resection) were 76.5%, 50.0%, 38.3% (P < 0.05). There was no perioperative mortality. The postoperative complications were: intrathoracic hemorrhage (2 patients, successfully treated by second thoracotomy) and chylothorax (1 patient, healed after conservative treatment).</p><p><b>CONCLUSION</b>The 5-year survival rate of pathologic stage I non-small-cell lung cancer is 66.1%. The outcome of patients with squamous-cell carcinoma (73.3%) is similar to that of alveolar-cell carcinoma (71.7%) which, however, is better than that of adenocarcinoma (55.3%) or adenosquamouscarcinoma (52.5%). The overwhelming superiority in result of IA (T1N0) lesion (74.3%) over the IB (T2N0) disease (59.9%) is quite impressive. Regular lobectomy plus radical mediastinal lymph node dissection is the appropriate management for stage I non-small-cell lung cancer.</p>

Mediastinal lymph nodes micro-metastases in patients with clinical stage I-II lung cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate micro-metastasis in mediastinal lymph nodes (mLN) of patients with clinical stage I approximately II lung cancer and its clinical significance.</p><p><b>METHODS</b>A total of 181 mLN from 32 lung cancer patients in clinical stage I approximately II were collected during operation and their frozen sections at two different levels were examined immunohistochemically (IHC) with an anti-epithelial cell monoclonal antibody Ber-Ep4. Routine HE staining was done for comparison. The results were processed by Chi-square tests in SPSS 10.0 soft ware.</p><p><b>RESULTS</b>Fifteen of the 32 patients (46.9%) were found to have micro-metastasis in 21 of 181 mLN (11.6%) examined by immunohistochemical staining though routine histopathological examinations were negative. Of those 15 cases, micro-metastasis was detected in 9 only by IHC and in 6 both by IHC and HE stainings. The positive rate of micro-metastasis in N0, N1, and N2 stratified by routine pathology was 36.8% (7/19), 33.3% (2/6) and 85.7% (6/7), respectively (N0 vs N2, P < 0.05). When stratified according to clinical staging (cTNM), pathological staging (pTNM) and pathological staging on the basis of IHC (iTNM), the frequencies of N2 cases were 0, 18.8% and 46.9%, respectively (differences among the three groups: P < 0.01). Nine cases reported as N0(7) and N1(2) by routine histopathological examination were found to have micro-metastasis in mLN by IHC staining, therefore they were actually N2 cases.</p><p><b>CONCLUSION</b>IHC staining with a monoclonal antibody specific for epithelial cells (Ber-Ep4) is more sensitive in the detection of mediastinal micro-metastais than routine HE staining. Underestimation of the extent of mLN metastasis by cTNM and/or pTNM stagings frequently exists in patients with clinically early lung cancer.</p>

Comparison of clinical and surgico-pathological TNM stage of 2007 lung cancer patients / 中华肿瘤杂志

<p><b>OBJECTIVE</b>An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical (c-TNM) and postoperative surgico-pathologic staging (p-TNM) of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer.</p><p><b>METHODS</b>We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal ultrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated.</p><p><b>RESULTS</b>In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate (55.2%) of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9%, while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-IV stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-M0, providing the possibility of resectional surgery depending on the status of T and N.</p><p><b>CONCLUSION</b>For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.</p>

Influence of the number of lymph node metastasis on survival and significance of postoperative radiotherapy for esophageal carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the influence of the number of lymph node metastasis on survival and prophylactic postoperative radiotherapy after radical resection of thoracic esophageal carcinoma.</p><p><b>METHODS</b>Four hundred and ninety-five patients with thoracic esophageal squamous cell cancer who had undergone radical resection were randomly divided into surgery group alone (S, 275) and surgery plus radiotherapy group (S + R, 220). The patients were classified into three groups: Group A: 234 patients (47.2%) without lymph node involvement; Group B: 146 patients (29.5%) with 1 to 2 involved lymph nodes and Group C: 115 patients (23.2%) with >or= 3 involved lymph nodes.</p><p><b>RESULTS</b>1. The 5-year survival rate in Groups A, B and C for the same T stage (T3) was 52.6%, 28.8% and 10.9%, respectively (P = 0.0000); the 5-year survival rate in group C was 0% in S group and 19.3% in S + R group (P = 0.0336); 2. In the positive lymph node group, the metastatic rate of intra-thoracic and supraclavicular lymph node was 35.9% and 21.2% in S group and 19.7% and 4.4% in S+R group (P = 0.014 and P = 0.000). In the negative lymph node group, the metastatic rates of intra-thoracic lymph node was 27.8% in S group and 10.3% in S + R group (P = 0.003). The metastatic rate of intra-abdominal lymph node in Groups A, B and C was 3.9%, 9.4% and 17.5%, respectively (P = 0.0000). The occurrence of hematogenous metastasis was most frequent in group C (27.8%) with >or= 3 positive lymph nodes.</p><p><b>CONCLUSION</b>1. The number of metastatic lymph node is one of the important factors which affects the survival of thoracic esophageal carcinoma. 2. Chemotherapy might be given to the patients with three or more lymph nodes involved who have the possibility of developing hematogenous metastasis. Postoperative radiotherapy can reduce the occurrence of intra-thoracic and supraclavicular lymph node metastasis and improve the survival of patients with three or more lymph nodes involvement.</p>

Clinicopathological features and prognosis of thymic carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the clinicopathologic features of thymic carcinoma and assess its prognostic factors.</p><p><b>METHODS</b>A retrospective analysis was performed in 54 patients with thymic carcinoma who underwent surgical resection. Eighteen patients were treated by total resection of the tumor, 17 partial resection and 10 exploratory thoracotomy. The clinical stage was determined according to Masaoka's classification. The survival time and prognostic factors were evaluated by the log-rank and Cox multivariate analysis model.</p><p><b>RESULTS</b>The overall 5-year survival rate was 44.4%. Being located in anterior mediastinum and noncalcification in the tumor pathognomonically played an important role in the differential diagnosis. According to the multivariate analysis, tumor maximum diameter (OR = 1.84), histological subtype (OR = 1.70), completeness of resection (OR = 1.37), tumor invasion of peritumoral organs (OR = 1.32) and postoperative recurrence (OR = 1.26) were significant prognostic factors. Compared with other subtypes, carcinoid tumor had the characteristics of earlier lesion, better resection rate and better prognosis.</p><p><b>CONCLUSION</b>The most important prognostic variables for thymic carcinoma are tumor maximum diameter, histological subtype, completeness of resection, tumoral invasion and postoperative recurrence. Complete resection followed by chemoradiotherapy should be considered as favorable on the basis of a definitive pathologic diagnosis.</p>

Myasthenia gravis occurring after resection of thymoma / 中华外科杂志

<p><b>OBJECTIVE</b>The aim of this study was to analyses the clinicopathologic features of the patient with myasthenia gravis (MG) occurring after resection of thymoma.</p><p><b>METHODS</b>Data of 15 patients were collected. The follow-up range from 8 to 178 (average 76.7) months. A retrospective analysis was performed through comparison with data of all 112 cases without MG, which had not occurred MG during our average 5.5 years follow-up, operated for thymoma in same period. The statistics analysis adopted chi(2) and t test.</p><p><b>RESULTS</b>(1) According to Masaoka's classification of thymoma, stage I in 7 cases, stage II in 4, stage III in 4. Histologic Bernatz's classification: lymphocyte predominant type in 4, epithelial type in 3, mixed type in 7, unknown in 1. According to Osserman's classification of MG, grade I in 7, IIa in 4, IIb in 3, III in 1. The MG onset times was the postoperative narcotic waking duration-137 (average 33.9) months, and the average remission time was 30.9 (0.5 - 120) months. (2) 4 cases who occur MG as soon as pull up narcotic tube, all adopted nondepolarizing muscular relaxants. (3) MG was discovered in 3 cases (3/67) during postoperative radiotherapy until a average dosage of 36 Gy was received in average 24 days. (4) The tendency of occurring MG following resection was found in female patients with longer duration of disease, mixed type, larger and later stage thymoma as compared with the thymoma group.</p><p><b>CONCLUSIONS</b>The factors including the operation, relatively using overdose relaxation control, choosing unfavorable muscle relaxant and postoperative radiotherapy could induce postoperative MG. An intensive care should be put on the cases with the tendency of occurring postoperative MG.</p>

Clinical analysis of surgical treatment of primary tracheal tumors / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the clinical experiences in treating primary tracheal tumors by surgery.</p><p><b>METHODS</b>The clinical data concerning 70 surgically treated patients between 1968 and 2001 were retrospectively analyzed.</p><p><b>RESULTS</b>There were 39 sleeve tracheal resections, 13 carinal resections, 10 lateral tracheal wall resections, 5 local enucleations, and 1 pneumonectomy. The tumors in 2 patients were unresectable. The morbidity rate was 31% (22/70) and operative 30-day mortality for resection with primary reconstruction was 8% (4/52). The tumors were benign in 14 and malignant in 56 cases. The most common malignant tumors were adenoidcystic carcinoma (45%) and squamous cell carcinoma (23%). The cases of benign tracheal tumors were followed up for an average of 5.7 years. After resection for malignant tumors, the overall 5- and 10-year survival rates were 64% (21/33) and 54% (14/26), respectively.</p><p><b>CONCLUSIONS</b>Surgical resection is the most effective treatment of tracheal tumors. Tracheal resection and reconstruction is the treatment of choice for primary tracheal tumors. Benign tumors should be resected conservatively with preservation of tracheal parenchyma. The reduction of operative complications are key points of good surgical results.</p>

Expression of different RASSF1 transcripts and its clinical significance in lung carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the expression of three different RASSF1 transcripts and its clinical significance in lung carcinomas.</p><p><b>METHODS</b>The mRNA expression of RASSF1A, RASSF1B and RASSF1C was detected by RT-PCR in 51 human lung cancer tissues and 51 matched normal tissues.</p><p><b>RESULTS</b>1. The mRNA expression of three RASSF1 transcripts was detectable in all non-cancer tissues. However, high rate of expression loss of RASSF1A and RASSF1B existed in lung cancer tissues, which was 53.2% (2851) and 37.3% (19/51), respectively. RASSF1C was expressed in all of the tumor tissues. 2. Loss or abnormal down-regulation of RASSF1A was positively related with lymph node metastasis and TNM stage (P < 0.05) and 3. RASSF1B and RASSF1C mRNA expression was not correlated with TNM stage, histological type, differentiation grade or smoking index.</p><p><b>CONCLUSION</b>There is a significant expression difference among the three RASSF1 transcripts in lung carcinoma. RASSF1A, closely associated with lymph metastasis and TNM stage of lung carcinoma, should be a new tumor suppressor gene.</p>

Significance of CEA, SCC and Cyfra21-1 serum test in esophageal cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To study the clinical significance of serum CEA, SCC and Cyfra21-1 test in the diagnosis, prediction of prognosis and postoperative monitor of recurrence in esophageal cancer.</p><p><b>METHODS</b>The concentration of serum CEA and Cyfra21-1 was measured by electrochemiluminescence immunoassay (ECLIA) using Elecsys 2010, CEA kit and Cyfra21-1 kit. Serum SCC was measured by microparticle enzyme immunoassay (MEIA) using IMx System and SCC kit. Serum of 206 patients with esophageal cancer (203 squamous cell carcinoma, 2 small cell carcinoma and 1 adenosquamous carcinoma) was measured preoperatively, 71 of whom also measued 8 to 12 days after resection.</p><p><b>RESULTS</b>The cut-off value of CEA and Cyfra21-1 was < or = 3.25 ng/ml and < or = 2.61 ng/ml, which were determined by the data of 45 healthy Chinese measured during the same period. The positive ratios of serum CEA and Cyfra21-1 in 206 cases were 29.1% and 45.1%. The combined positive ratio of CEA and Cyfra21-1 was 57.3%. The CEA positive ratios, according to the pathological stage of 165 resectable patients, were 16.6% (stage I), 26.8% (II) and 30.8% (III). For Cyfra21-1, they were 27.8%, 37.5% and 50.5%. For CEA combined with Cyfra21-1, they were 38.9%, 50.0% and 63.7%. The mean value of CEA, SCC and Cyfra21-1 (especially SCC and Cyfra21-1) was found to be well correlated with the tumor volume, TNM stage and depth of tumor invasion. Patient with bulky tumor or advanced tumor (T4) usually had much higher mean value than those with early stage tumors. One week after radical resection, the level of the three tumor markers fell to normal level in 92.9% of 71 patients. The level of serum CEA and Cyfra21-1 varied greatly in a small part of the patients. Extremely elevated serum CEA and Cyfra21-1 usually indicated advanced lesion or tumor metastasis.</p><p><b>CONCLUSION</b>Preoperative and postoperative measurement of serum CEA, SCC and Cyfra21-1 (especially Cyfra21-1) is helpful in the diagnosis, prediction of prognosis and monitor of postoperative recurrence in patients with esophageal cancer.</p>

Clinical features of postoperative chylothorax for lung cancer and esophageal cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To define the clinical features of postoperative chylothorax for lung cancer (PCLC), and to compare them with those for esophageal cancer (PCEC).</p><p><b>METHOD</b>We retrospectively analysed clinical characteristics of 12 patients with chylothorax among 4 084 patients receiving resection of lung cancer, as well as 52 in 4 479 patients having resection of esophageal cancer since 1985 at our hospital.</p><p><b>RESULTS</b>The incidence of PCLC was 0.29% and that of PCEC was 1.16%. The percentage of diagnosis confirmed within 4 postoperative days was 33.3% for PCLC, and 76.9% for PCEC. The rate of typical chylous pleural effusion was 83.3% for PCLC, and 5.8% for PCEC. Symptoms and signs of PCLC were much milder than those of PCEC. The re-operation rate was 16.7% for PCLC, and 96.2% for PCEC. All patients were discharged uneventfully.</p><p><b>CONCLUSION</b>The incidence, causes, clinical manifestations, diagnosis, and treatment of PCLC is different from those of PCEC.</p>