Pneumonectomy for Non-small Cell Lung Cancer: Predictors of Operative Mortality and Survival / 中国肺癌杂志

Surgery is the most effective way to cure non-small cell lung cancer currently. Although sleeve lobectomy, with less reduction of respiratory function and a lower mortality rate, would not compromise oncological results in well-selected patients with central lung cancer, pneumonectomy is still necessary when complete resection could not be achieved by other surgical procedures. Cardiopulmonary complications are the most common complication after pneumonectomy. Fully understanding the related complications after pneumonectomy can help surgeons make a diagnosis timely, and further take relevant measures to reduce the adverse effects of postoperative complications on patients. What's more, in order to avoid postoperative complications and improve the prognosis of patients as much as possible, it is necessary to fully understand the risk factors to minimize the risk and to make the patients benefit from pneumonectomy as much as possible.

Autogenous pericardial angioplasty for thymic malignancies: techniques and short-term survival analysis / 中华胸心血管外科杂志

Objective:To evaluate the techniques and short-term outcomes of pericardial autologous angioplasty for the reconstruction of mediastinal large vessels in the treatment of locally advanced malignant thymoma.Methods:We retrospectively analyzed the clinical data of 6 patients with locally advanced malignant thymoma who received autologous pericardial transplantation for mediastinal great vascular reconstruction in the same treatment group of Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University from April 2017 to October 2018.Results:The operative time of malignant thymoma patients receiving autologous pericardial vascular reconstruction was(192.3±32.5)min, intraoperative blood loss was(105.0±27.5)ml, thoracic drainage time was(4.5±1.5)days, and postoperative hospital stay was(5.3±2.5)days. The postoperative quality of life of the patients was satisfactory. Angiography showed that the reconstructed vessels of the left inus vein were occluded in 1 patient 10 months after the operation, and the reconstructed vessels were unobstructed in the other patients. The average follow-up time of the patients was 34.3 months after surgery. One patient developed chest wall metastasis 23 months after surgery, and his condition was stable after receiving local radiotherapy. The other 5 patients did not occur local recurrence or distant metastasis.Conclusion:The application of autologous pericardium for the reconstruction of mediastinal great vessels in the treatment of malignant thymoma is a safe and effective method, and its clinical application prospect is worth expecting.

Comparison of short-term and long-term outcomes between thoracoscopic pneumonectomy and open pneumonectomy for non-small cell lung cancer: a study based on propensity score matching / 中华外科杂志

Objective@#To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.@*Methods@#The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively.@*Results@#Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(QR): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups.@*Conclusion@#Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.

Comparison of short-term and long-term outcomes between thoracoscopic pneumonectomy and open pneumonectomy for non-small cell lung cancer: a study based on propensity score matching / 中华外科杂志

Objective@#To compare the short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.@*Methods@#The clinical data of patients with non-small cell lung cancer who underwent pneumonectomy in the Department of Thoracic Surgery, Qingdao University Hospital from January 2008 to December 2016 were collected. Totally 142 patients (55 in the thoracoscopic group and 87 in the open group) were included in the study. A total of 29 pairs of patients were successfully matched by propensity score matching (PSM). Perioperative outcomes and overall survival were compared between the two groups using t test, χ2 test, Kaplan-Meier curve and Log-rank test, respectively.@*Results@#Camparion with open group, the thoracoscopic group had longer operative time ((209.7±70.2) minutes vs. (171.3±43.5) minutes, t=2.50, P=0.02), more mediastinal lymph node dissection (M(QR): 17(9) vs. 11(10), W=388, P=0.02) and shorter postoperative hospital stay (7.0(3.5) vs. 9.0(3.0), W=285, P=0.03). There was no significant difference in estimated blood loss, postoperative drainage time, dissected lymph node number, dissected lymph node station and perioperative complications. After PSM, there were no signifificant differences found in 3-year survival (71.4% vs. 48.1%, P=0.10) and 3-year disease-free survival (67.4% vs. 47.2%, P=0.13) between the two groups.@*Conclusion@#Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer with more mediastinal lymph node dissection and accelerating recovery, and equivalent long-term prognosis when compared with open approach.

Advances of sublobar resection for early non-small cell lung cancer / 国际外科学杂志

The curative treatment of choice for stage Ⅰ or Ⅱ non-small cell lung cancer (NSCLC) patients is usually surgical resection and the two surgical resection methods are lobectomy and sublobar resection.At present,the standard resection for early stage NSCLC is lobectomy.But more and more researches involve the sublobar resection for early stage NSCLC and its effect has been controversial.The research of how to improve the outcomes of sublobar resection is also emerging endlessly.The present paper reviews the effect of sublobar resection and the factors of impacting on its curative effect.

Clinical efficacy of exclusive right-thoracic approach in esophageal surgery / 中华消化外科杂志

Objective To investigate the indications and clinical efficacy of an exclusive right-thoracic approach in esophageal surgery.Methods The clinical data of 35 patients with esophageal disease who underwent an exclusive right-thoracic approach operation from June 2008 to June 2010 at the Affiliated Hospital of Qingdao University were retrospectively analyzed.Of the 35 patients,21 were with esophageal cancer,and their ages were above 70 years,the partial pressure of oxygen of arterial blood (PaO2),maximal voluntary ventilation and forced vital capacity of the first second were (70 ± 9) mm Hg (1 mm Hg =0.133 kPa),51％ ± 9％ and 57％ ± 11％,respectively.Fourteen patients were with benign esophageal disease or low grade malignancy,and their PaO2 maximal voluntary ventilation and forced vital capacity of the first second were (96 ± 13) mm Hg,83％ ± 11％ and 91％± 14％,respectively.Exclusive right-thoracic approach was selected for all the patients,and surgical procedure was selected according to the location of the lesions.Patients were followed up by out-patient examination or phone call till April 2012.Results All the operations were carried out successfully,21 patients with esophageal cancer underwent partial esophagus resection and stomach-esophagus intrathoracic anastomosis through a right-thoracic approach.Of the 14 patients with benign esophageal disease or low grade malignancy,2 patients were with esophageal leiomyoma,3 with esophageal stromal tumor and 1 with esophageal leiomyomatosis underwent partial esophagus resection + intrathoracic anastomosis ; 7 patients with esophageal leiomyoma and 1 with esophageal stromal tumor underwent tumor extirpation.The operation time and operative blood loss were (3.4 ± 1.8)hours and (160 ± 44)ml,respectively.The number of lymph node dissected of the 21 patients with esophageal tumor was 14 ± 5,including 1.1 ± 0.7 lymph nodes dissected near the left gastric artery.No anastomosis fistula and perioperative death were detected,and the duration of hospital stay was (10 ± 4)days.The postoperative PaO2,maximal voluntary ventilation and forced vital capacity of the first second were (66 ± 10)mm Hg,50％± 11％ and 51％ ± 13％ for patients with esophageal cancer,and (94 ± 13) mm Hg,80％ ± 13％ and 87％ ± 16％ for patients with benign esophageal disease or low grade malignancy.All the patients were followed up for 1-2 years,no eating obstruction was detected,and the postoperative 1-and 2-year survival rate were 82.9％(29/35) and 77.1％ (27/35),respectively.Of the 8 patients with esophageal cancer who died postoperatively,1 died of cardiovascular diseases and 7 died of tumor recurrence and metastasis.Conclusion Exclusive rightthoracic appraoch could be used for patients with benign esophageal disease,low-grade malignancy and old esophageal cancer patients with poor pulmonary function.