Effect of Calcified Lymph Nodes on Thoracoscopic Lobectomy in Chronic Obstructive Pulmonary Disease Patients with Lung Cancer / 中国医学科学院学报

Objective To observe the effect of calcified lymph nodes on video-assisted thoracoscopic surgery (VATS) lobectomy in the chronic obstructive pulmonary disease (COPD) patients with lung cancer. Methods A retrospective analysis was conducted on the COPD patients with lung cancer who underwent VATS lobectomy in the Department of Thoracic Surgery in the First Affiliated Hospital of Hebei North University from May 2014 to May 2018.The patients were assigned into a calcified lymph node group and a control group according to the presence or absence of calcified lymph nodes in CT,and the size,morphology,and calcification degree of the lymph nodes were recorded.The operation duration,intraoperative blood loss,chest tube retention time,hospitalization days,and overall complication rate were compared between the two groups. Results The 30 patients in the calcified lymph node group included 17 patients with one calcified lymph node and 13 patients with two or more calcified lymph nodes,and a total of 65 calcified lymph nodes were recorded.The calcified lymph nodes with the size ≤5 mm were the most common (53.8%),and complete calcification was the most common form (55.4%) in lymph node calcification.The mean operation duration had no significant difference between the calcified lymph node group and the control group (t=-1.357,P=0.180).The intraoperative blood loss (t=-2.646,P=0.010),chest tube retention time (t=-2.302,P=0.025),and hospitalization days (t=-2.274,P=0.027) in the calcified lymph node group were higher than those in the control group. Conclusion Calcified lymph nodes increase the difficulty and risk of VATS lobectomy in the COPD patients with lung cancer.The findings of this study are conducive to predicting the perioperative process of VATS lobectomy.

Minimally invasive esophagectomy for esophageal carcinoma: clinical analysis of 160 cases / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility, safety and clinical application value of minimally invasive esophagectomy (MIE).</p><p><b>METHODS</b>Clinical data of 160 patients undergoing minimally invasive approach in the West China Hospital of Sichuan University between February 2008 and December 2011 were analyzed retrospectively.</p><p><b>RESULTS</b>There were 140 males and 20 females with a mean age of 59.6 years. Approaches to esophagectomy were thoracoscopic and laparoscopic esophagectomy (n=139), thoracoscopic and mediastinoscopic esophagectomy (n=3), laparoscopic-assisted Ivor Lewis resection (n=15), thoraco-laparoscopic Ivor Lewis resection (n=3). The mean operative time was 364 (range 230-780) min and the mean blood loss was 286.2 (range 20 to 4000) ml. The tumor free resection margins (R0) were completely in 152 cases (95.0%). The mean lymph node harvested was 19.4 (range 6-39). There were 11 (6.9%) cases converted to open operation including 9 thoracotomy and 2 laparotomy. The intraoperative complication rate was 11.3% (18/160). The average length of intensive care unit (ICU) stay was 22.1(range 0 to 430) h and the average length of postoperative hospital stay was 13.1 (range 7-93 d). Postoperative complication occurred in 34.4% of patients. The 30-day mortality was 1.2% (2/160) and the overall mortality was 2.5% (4/160).</p><p><b>CONCLUSION</b>MIE is technically feasible and safe for the treatment of esophageal carcinoma, which provides good or even better outcomes than open approach.</p>