Effect of da Vinci robot-assisted versus traditional thoracoscopic bronchial sleeve lobectomy.

OBJECTIVE: To analyze the short-term effect of Da Vinci robot-assisted thoracoscopic (RATS) bronchial sleeve lobectomy, so as to summarize its safety and effectiveness. METHODS: It was a retrospective single-center study with the inclusion of 22 cases receiving RATS lobectomy and 49 cases of traditional thoracoscopic surgery. Further comparison was performed focusing on the baseline characteristics and perioperative performance of the two groups. RESULTS: Compared with the traditional thoracoscopic surgery group, RATS group had more advantages in the number of lymph nodes dissected (P = 0.003), shorter postoperative length of stay in the hospital (P = 0.040), shorter drainage time (P = 0.022), reduced drainage volume (P = 0.001). Moreover, this study found for the first time that there was a shortening in the operation of sleeve lobectomy by using Da Vinci robot-assisted surgical system (P = 0.001). The operation cost of RATS group is more expensive (96000 ± 9100.782 vs 63000 ± 5102.563 yuan; P＜0.001). CONCLUSION: Compared with the traditional thoracoscopic bronchial sleeve lobectomy, RATS lobectomy shows advantages of higher operating sensitivity, shorter operation time, faster postoperative recovery, and more lymph nodes dissected. Collectively, RATS bronchial sleeve lobectomy is safe and effective in operation.

Analysis of the short-term outcomes of biportal robot-assisted lobectomy.

BACKGROUND: The present study aimed to assess the short-term consequences of biportal robot-assisted lobectomy, validating its safety and effectiveness. METHODS: A retrospective analysis evaluated the clinical data and short-term results of 18 patients in the single medical group of the centre who underwent biportal robot-assisted lobectomy plus lymph node dissection from November 2020 to March 2021. RESULTS: Lobectomy and lymph node dissection could be successfully accomplished in all 18 patients with the assistance of a biportal robot; there was no conversion to thoracotomy during the operation. There were 10 males and 8 females with their ages ranging from 37 to 73 (58.83 ± 9.07) years. The total operation time was 74-146 (105.06 ± 18.22) min. Punching time was 2-9 (5.11 ± 1.74) min. Docking time was 8-16 (11.94 ± 2.41) min. Console time was 50-104 (78.06 ± 17.40) min. Chest closing time was 8-17 (10.28 ± 2.74) min. Blood loss was 60-132 (94.11 ± 41.41) ml. The number of lymph nodes dissected was 16-30 (21.78 ± 4.13). Chest tube duration was 2-10 (4.06 ± 1.98) days. Drainage on the first day following surgery was 100-500 (337.22 ± 117.01) ml. Total drainage was 370-1100 (692.78 ± 161.01) ml. Duration of hospital stay was 4-12 (5.89 ± 1.94) days. The median 24 and 72 h visual analogue score scores were 4 (3-7) and 3 (2-5). Total cost (¥) was 51 000-85 000 (68 000 ± 10 000), respectively. There was one case of atrial fibrillation and one case of pulmonary infection. The complication rate was 11.11%. No serious complications were recorded after surgery, and no deaths occurred within 30 days post-surgery. The final pathological diagnosis revealed 10 cases of squamous cell carcinoma, 7 cases of adenocarcinoma and 1 case of benign disease. CONCLUSION: The biportal robot-assisted lobectomy was found to be safe and effective in the treatment of lung cancer.

RNF168 is highly expressed in esophageal squamous cell carcinoma and contributes to the malignant behaviors in association with the Wnt/ß-catenin signaling pathway.

E3 ubiquitin ligase RING finger protein 168 (RNF168) is one of the key proteins in DNA damage repair. Abnormal expression of RNF168 has recently been found in some tumors. However, the role of RNF168 in the development of esophageal squamous cell carcinoma (ESCC) has not been fully elucidated. Here we report that expression of RNF168 in esophageal squamous cell carcinoma is increased with respect to normal esophageal epithelial tissue. Notably, in ESCC patients, increased RNF168 expression was associated with tumor stage and depth of invasion. Knockdown of the RNF168 gene inhibited proliferation of esophageal cancer cells, promoted cell apoptosis, and interfered with cell movement, ultimately inhibiting tumor xenograft growth. Mechanistic studies showed that RNF168 influenced the malignant behavior of esophageal cancer cells by regulating the Wnt/ ß-catenin signaling pathway. In addition, RNF168 expression was positively correlated with wingless-type MMTV integration site family member 3A (WNT3A) expression, and high expression of RNF168 and WNT3A predicted a low survival rate. In conclusion, our findings highlight the important role of RNF168 in ESCC tumorigenesis and provide new biomarkers and therapeutic targets for the treatment of ESCC.

Ribophorin II promotes cell proliferation, migration, and invasion in esophageal cancer cells in vitro and in vivo.

Esophageal cancer is a common digestive tract cancer, which is a serious threat to human health. Ribophorin II (RPN2) is a part of an N-oligosaccharyltransferase complex, which is excessively expressed in many kinds of cancers. In the present study, we explore the biological role of RNP2 in esophageal cancer. First, we found that the expression of RPN2 was higher in esophageal cancer tissues than in adjacent non-tumor tissues, and negatively correlated with E-cadherin expression. RPN2 expression levels in esophageal cancer tissues were positively associated with differentiation and tumor node metastasis (TNM) stage. Furthermore, the expression of RPN2 was increased significantly in esophageal cancer cell lines compared with normal cells. The effect of RPN2 down-regulation on cell proliferation, cell migration, and cell invasion was examined by cell counting kit-8 (CCK8), wound healing assay, and Transwell assay, respectively. Silencing RPN2 effectively inhibited cell proliferation of esophageal cancer cells in vitro and in vivo Cell migration and invasion were also weakened dramatically by siRPN2 treatment of esophageal cancer cells. In addition, protein expression of proliferating cell nuclear antigen (PCNA), matrix metalloproteinase (MMP-2), and E-cadherin in esophageal cancer cells was determined by Western blot analysis. PCNA, MMP-2, E-cadherin, Snail and phosphorylation-Smad2/3 expression was also regulated notably by siRPN2 treatment. These findings indicate that RPN2 exhibits oncogenetic capabilities in esophageal cancer, which could provide novel insights into esophageal cancer prevention and treatment.

A comparison of clinical effects of removing foreign bodies from esophagus by rigid esophagoscope and flexible esophagoscope / 中国胸心血管外科临床杂志

@#Objective    To collect the data of esophageal foreign body patients, and to evaluate the clinical effects of two different surgical methods in our hospital. Methods    The clinical data of 294 patients who were treated in Gansu Provincal Hospital from January 2012 to June 2018 were analyzed retrospectively. The clinical data were collected and analyzed by SPSS 22.0. In order to to evaluate the efficacy of flexible esophagoscope (FE) and rigid esophagoscope (RE) in the treatment of esophageal foreign bodies.The patients were divided into two groups: a RE group including 118 patients with 62 males and 56 females at age of  6 (3-37) years and a FE group including 176 patients with 84 males and 92 females at age of 6 (3-59) years. Results    There was no significant difference in age, age stratification, gender and foreign body type between the two groups. There was a statistical difference in the initial clinical symptoms (P=0.041) or in esophageal foreign bodies position (P=0.037) between the two groups. The success rate of foreign body removal was similar between the two groups (P=0.632). The success rate was 88.9% (105/118) in the RE group, 87.5% (154/176) in the FE group. The operation time was significantly longer in the RE group than that in the FE group (10.8 ±17.4 min vs. 17.5±21.6 min, P<0.001). The postoperative hospitalization time in the RE groups was longer than that in the FE group (21.5 ±24.2 hours vs. 12.5 ±21.3 hours, P<0.05). There was a statistical difference in the incidence of postoperative complications between the two groups (P=0.034). In the RE group, the main complication was mucosal edema (15.3%). And the rate of bleeding was higher (15.9%) in the FE group. There were 30 patients (25.5%) in the RE group with minor postoperative complications versus the FE group with 40 patients (22.7%); and 1 patient (0.8%) in the RE group with severe complications versus the FE group with 5 paients (2.8%). Conclusion    Based on the analysis of this study, it is found that RE has higher safety. But the indications are strict, the professional requirements of the operator and the selection of patients are stronger. The FE is convenient to use, the operation crowd is wide, and the suitable crowd is wide. Therefore, for specific patients, after improving the relevant examination and preoperative evaluation of patients, clinicians need to choose appropriate surgical methods to ensure the success of the operation, and reduce the postoperative complications as far as possible.

Advances and prospects in the application of robotic surgery system in the treatment of esophageal cancer / 中国胸心血管外科临床杂志

@#At present, the application of the robot assisted surgery system in the surgical treatment of esophageal cancer is gradually emerging, and it is more and more widely used and recognized in the field of surgery. According to the domestic and foreign literatures, the robot has many advantages, and robotic assisted esophageal cancer surgery has been proved to be safe and effective, and its short-term efficacy is significantly better than thoracotomy. Other studies have shown that in long-term follow-up, the effect is comparable to video-assisted thoracoscopic surgery. In this paper, the author are systematically reviewed the development history of the robot assisted surgery system, the effect of robotic assisted esophagectomy on safety, surgical method, short-term efficacy and long-term prognosis. The traditional open surgery and thoracoscopic laparoscopic esophagectomy has been carried on the detailed comparison to provide some advice and theoretical basis for esophageal cancer surgery robot system.

MicroRNA-182 promoted esophageal squamous cell carcinoma cell growth and metastasis via targeting YWHAG.

PURPOSE: To study the functioning mode of miR-182 on esophageal squamous cell carcinoma (ESCC) cell growth and metastasis and provide therapeutic targets for ESCC. METHODS: miR-182 expression level in ESCC cell lines was examined by quantitative real-time polymerase chain reaction (qRT-PCR). Using miR-182 inhibitor, we analyzed the effects of miR-182 down-expression on cell proliferation, invasion, cell apoptosis and cell cycle. Dual-luciferase activity assay was used to examine the potential target gene YWHAG which was predicted by several databases. Protein level was studied using western blotting. RESULTS: Decreased expression of miR-182 in ESCC cells was accompanied by decreased cell invasion and proliferation, promotion of cell apoptosis and cell cycle arrest at G0/G1 phase. Dual-luciferase and western blot confirmed YWHAG as a target gene of miR-182. Furthermore, silence of YWHAG counteracted the suppressive effect of miR-182 down-expression on cell growth and metastasis. CONCLUSIONS: miR-182 could suppress ESCC cell proliferation and metastasis via regulating YWHAG, which might provide a new target for ESCC diagnosis and therapy.

[Application of VSD in 6 Cases of Postoperative Infection
-A Clinical Experience Sharing].

BACKGROUND: Surgical site infection is one of the common postoperative complications of thoracic surgery, and its harm is related to infection degree and location. Light causes local pain, prolonged hospitalization and increased cost. Severe infection can lead to severe infection, even septic shock and life-threatening. Therefore, proper treatment of incision infection can help to promote recovery, reduce the burden of disease and lay a good foundation for further treatment. The traditional surgical treatment of wound infection includes thorough drainage, intensive dressing change and antibiotic use. There are many shortcomings such as long treatment process, ineffective treatment effect and so on. The experience of using vacuum sealing drainage (VSD) in 6 cases of postoperative infection patients in our department is summarized in order to improve the traditional treatment of postoperative infection in patients after thoracic surgery. METHODS: The clinical data of patients with postoperative incision infection or fistula after thoracic surgery in our department were reviewed and summarized. 6 patients treated with VSD material for postoperative infection. The process and final clinical results of them were summarized and discussed. RESULTS: In this study, fever and wound exudation disappeared within 6 h-10 h after VSD use, 5 cases of wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well at the cutting edge of the operation, the second stage operation was performed to close the chest and skin. One patient was seriously infected, and the secretion was still more after VSD removal, reposition VSD device next time, the VSD device was removed 7 d later. The wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well, close the chest and skin second stage. In all 6 patients, the symptoms were relieved, the symptoms improved and the surgical incision healed well. In 2 patients with esophageal cancer, the average operation time was 427.5 min, the average hospitalization time was 40 d, the average number of times of dressing change was 8.5, the average total cost during hospitalization was 111,893.47 yuan patients with chronic empyema, the average operation time was 192.5 min. The average hospital stay was 27.75 days, the average number of times of dressing change was 5.5, and the average total expenditure during hospitalization was 48,237.71 yuan. CONCLUSIONS: VSD has a good effect on the treatment of postoperative incision infection patients in thoracic surgery. It can reduce the pain and burden of patients and ensure the quality of life of postoperative infected patients.

Da Vinci robot system in the surgical treatment of mediastinal lesions: A case control study / 中国胸心血管外科临床杂志

@#Objective     To summarize the clinical data about mediastinal lesions, then to analyze the treatment effect of da Vinci robot system in the surgical treatment of mediastinal lesions. Methods     We retrospectively analyzed the clinical data of 49 patients with mediastinal lesions in our hospital between January 2016 and October 2017. These patients were divided into two groups including a da Vinci robot group and a video-assisted thoracoscopic surgery (VATS) group according to the selection of the treatments. There were 25 patients with 14 males and 11 females at age of 56.5±17.9 years in the da Vinci group and 24 patient with 15 males and 11 females at age of 53.0±17.8 years in the VATS group. Results     There was no statistical difference in surgery time between the two groups (t=–0.365, P=0.681). Less intraoperative blood loss ( t=–2.569, P<0.001), less postoperative drainage amount within three days after surgery ( t= – 6.325, P=0.045), shorter period of bearing drainage tubes after surgery ( t=–1.687, P=0.024), shorter hospital stays ( t= – 3.689, P=0.021), lower visual analogue scale (VAS) scores of postoperative 48 hours (t=–7.214, P=0.014) with a statistical difference in the da Vinci robot group compared with the VATS group. Conclusion     The da Vinci robot system is safe and efficient in the treatment of mediastinal lesions compared with video-assisted thoracoscopic approach.