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@#The precise localization of pulmonary nodules has become an important technical key point in the treatment of pulmonary nodules by thoracoscopic surgery, which is a guarantee for safe margin and avoiding removal of too much normal lung parenchyma. With the development of medical technology and equipment, the methods of locating pulmonary nodules are also becoming less trauma and convenience. There are currently a number of methods applied to the preoperative or intraoperative localization of pulmonary nodules, including preoperative percutaneous puncture localization, preoperative transbronchial localization, intraoperative palpation localization, intraoperative ultrasound localization, and localization according to anatomy. The most appropriate localization method should be selected according to the location of the nodule, available equipment, and surgeon鈥檚 experience. According to the published literatures, we have sorted out a variety of different theories and methods of localization of pulmonary nodules in this article, summarizing their advantages and disadvantages for references.
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@#Objective To investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). Methods Patients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. Results Initially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.
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@#Uniportal video-assisted thoracic surgery (UniVATS) is a significant approach of mini-invasive surgery for lung cancer. UniVATS was first used for treatment of lung cancer in 2010. The European consensus and the Chinese consensus were published in 2019 and 2020 respectively. The latest Chinese consensus included the definition of UniVATS, indications for lung cancer treatment, safety and feasibility, surgical skills, learning curve, short-term and long-term results, providing suggestions for the standardization of uniportal video-assisted thoracic surgery, which are essential to improve the quality of surgery and reduce the incidence of related complications. The Chinese consensus also summarized the current status of subxiphoid UniVATS and non-intubated UniVATS for lung cancer. Considering the technical difficulties and challenges, the application of both technologies in clinical treatment has certain limitation. This article aims to give an interpretation of the results of the Chinese consensus and the similarities and to compare the differences with the European consensus, and to provide a reference for the majority of thoracic surgery colleagues.
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@#Objective To explore the risk factors for lymph node metastasis in patients with T2 stage non-small cell lung cancer. Methods The clinical data of 271 patients with non-small cell lung cancer who underwent surgical treatment in our hospital from 2014 to 2017 were collected, including 179 males and 92 females, with an average age of 62.73±0.58 years. The patients were divided into N0, N1, and N2 groups according to the lymph node metastasis status. The clinical data of the patients in different groups were compared. Results The body mass index (BMI, P=0.043), preoperative lymph node enlargement (P<0.001), and tumor diameter (P<0.001) were significantly different among groups. The BMI (OR=1.131, 95%CI 1.001-1.277, P=0.048) and preoperative lymph node enlargement (OR=3.498, 95%CI 1.666-7.342, P=0.001) were independent risk factors for N2 lymph node metastasis, and tumor diameter was an independent risk factor for both N1 (OR=1.538, 95%CI 1.067-2.218, P=0.021) and N2 (OR=1.814, 95%CI 1.196-2.752, P=0.005) lymph node metastasis. Conclusion Patients with high BMI or enlarged lymph nodes before surgery have a high risk for N2 lymph node metastasis, and those with large tumor diameter have a high risk for both N1 and N2 lymph node metastasis.
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@#Surgery is an essential method of comprehensive treatment for lung cancer, but it also impairs patients’ cardiopulmonary function. A subset of patients who undergo surgery may suffer from postoperative complications, and even death. Preoperative pulmonary rehabilitation is a part of enhanced recovery after surgery, and can improve patients' cardiopulmonary function, reduce postoperative complication rate and shorten hospital stay. It has been already demonstrated a great value in lung cancer surgery. In this review, we summarized the three important components of preoperative pulmonary rehabilitation, including smoking cessation, chest physical therapy, and preoperative exercise training. Moreover, this review outlined the development of pulmonary rehabilitation for lung malignancies, aiming to promote its application and standardization.