Does a thoracoscopic approach provide better outcomes for pulmonary metastases?

Traditional open thoracotomy (OT) is the gold standard treatment for patients with pulmonary metastases. However, it remains controversial whether video-assisted thoracic surgery (VATS) can provide comparable outcomes to OT. We conducted this review to compare the outcomes of VATS with OT in pulmonary metastasectomy (PM). Relevant studies published up to November 2019 were identified from PubMed data base and screened. Studies were then selected by the researchers based on our selection criteria. Data including the type of study, patient groups, outcomes and key results were extracted from the included studies and summarized. Screening of 2,788 papers identified 9 that were relevant to our research question. The authors, dates of publication, journal details, type of study, patient groups, outcomes and key results from these papers were summarized. All 9 studies documented the survival rate (1-, 3- and 5-year survival). Metastases from colorectal cancer were investigated in three studies, and metastases from sarcoma were investigated in one study. The overall survival rate of VATS was not inferior to that of OT in patients with pulmonary metastases. VATS was also associated with better perioperative results compared with OT. In conclusion, VATS is suitable as an alternative surgical technique for PM.

Trans-sternotomy versus video-assisted thoracic surgery for early-stage thymoma patients: a meta-analysis.

BACKGROUND: Over the years, video-assisted thoracic surgery (VATS) thymectomy has progressively replaced trans-sternotomy (TS) in early-stage thymoma (Masaoka stage I and stage II). This meta-analysis aimed to confirm the differences in the efficacies of VATS and TS approaches in early-stage thymoma patients. METHODS: A thorough literature search of the following online databases was performed: PubMed, Cochrane Library, Web of Science, and EMBASE. Appropriate search terms, such as "thymoma or thymus neoplasms or Thymic Carcinoma" and "Video-Assisted Thoracic Surgeries or Video-Assisted Thoracoscopic", were used with MeSH search methods. Heterogeneity was assessed first with the Q-test and inconsistency index and sensitivity analysis and subgroup analysis were then used to find the source of heterogeneity. RESULTS: We retrieved 1,228 articles, 11 articles were selected as the subjects of our research, and 1,222 patients were included in the research (666 VATS cases versus 556 TS cases). VATS caused less blood loss (P=0.02), and required shorter hospital stay (P<0.001), shorter duration of chest tube drainage (P=0.03) than TS. No obvious difference was found in operative time (P=0.14), postoperative recurrence (OR =0.81, 95% CI: 0.35-1.85, P=0.613), postoperative complications (OR =0.60, 95% CI: 0.31-1.16, P=0.129) and R0 resection (OR =0.35, 95% CI: 0.12-1.04, P=0.06), but the trend showed that more patients in the TS group achieved R0 resection. CONCLUSIONS: For early-stage thymoma patients, VATS thymectomy seems to provide many advantages to be considered as a legitimate alternative to TS; however, when performing VATS, surgeons should pay special attention to ensure that R0 resection is achieved.

Effects of Intraoperative Fluid Management on Postoperative Outcomes After Lobectomy.

BACKGROUND: The amount and type of intraoperative fluid in patients with pulmonary resection currently are controversial. This study evaluated the dose-response relationship between intraoperative fluid administration and postoperative outcomes in minimally invasive lobectomy patients. METHODS: A retrospective analysis of adult patients undergoing minimally invasive lobectomy between May 2016 and April 2017 was performed. The primary exposure variables were intraoperative total fluid infusion rate and intraoperative colloid infusion rate. The observation outcomes were postoperative pulmonary complications (PPCs), acute kidney injury, in-hospital mortality, postoperative length of stay, and costs. Univariate analyses and multivariate analyses were performed. RESULTS: In 446 patients all resections were minimally invasive lobectomies. Two hundred one PPCs were observed in 172 patients. Binary logistics regression analysis demonstrated that compared with the moderate group of intraoperative total fluid infusion rate, the risk for PPCs was significantly increased at restrictive (odds ratio [OR], 2.202; 95% confidence interval [CI], 1.189-4.078; p = 0.012), moderately liberal (OR, 2.743; 95% CI, 1.451-5.184; p = 0.002), and liberal (OR, 2.609; 95% CI, 1.278-5.328; p = 0.008) groups. Compared with the moderate group of intraoperative colloid infusion rate, the risk for PPCs significantly increased at no colloid (OR, 2.095; 95% CI, 1.193-3.680; p = 0.010) and restrictive (OR, 2.911; 95% CI, 1.443-5.873; p = 0.003) groups. CONCLUSIONS: In patients undergoing minimally invasive lobectomy the infusion rates of intraoperative total fluid and intraoperative colloid were all significantly associated with PPCs. Both restrictive and liberal intraoperative fluid administration were related to adverse effects on postoperative outcomes.

Survival rates after lobectomy versus sublobar resection for early-stage right middle lobe non-small cell lung cancer.

BACKGROUND: Lung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early-stage non-small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early-stage right middle lobe NSCLC. METHODS: Patients who underwent lobectomy or sublobar resection for stage IA right middle lobe NSCLC tumors ≤ 2 cm between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results database of 18 registries. Cox regression model analysis was used to evaluate the prognostic factors. The lung cancer-specific survival (LCSS) and overall survival (OS) rates between the two groups were compared. RESULTS: A total of 861 patients met our criteria, including 662 (76.9%) patients who underwent lobectomy and 199 (23.1%) patients who underwent sublobar resection. No statistical differences in LCSS and OS rates were identified between the groups of patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1-2 cm, lobectomy was associated with more favorable LCSS and OS rates compared to sublobar resection. CONCLUSION: Lobectomy and sublobar resection deliver a comparable prognosis for patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1-2 cm, lobectomy showed better survival rates than sublobar resection.

Blocking transferrin receptor inhibits the growth of lung adenocarcinoma cells in vitro.

BACKGROUND: Transferrin receptor (TfR) is expressed in most lung cancers and is an indicator of poor prognosis in certain groups of patients. In this study, we blocked cell surface TfR to inhibit lung adenocarcinoma (LAC) cell growth in vitro and investigated the associated molecular mechanisms to determine a potential therapeutic target in human LAC. METHODS: RNA interference and antibody blocking techniques were used to block the function of TfR in LAC cells, and cell proliferation assays were used to detect the results. Affymetrix microarray analysis was conducted using H1299 cells in which TfR was blocked with an antibody to investigate the molecular mechanisms involved. RESULTS: The cell proliferation assay demonstrated that H1299 cell proliferation was significantly inhibited after small interfering RNA knockdown or blocking of TfR. Mechanistic studies found that 100 genes were altered more than two-fold after TfR was blocked and that blocking TfR was accompanied by decreased expression of the oncogene KRAS. CONCLUSION: Our data provide evidence that blocking TfR could significantly inhibit LAC proliferation by targeting the oncogene KRAS; therefore, TfR may be a therapeutic target for LAC. In addition, our results suggest a new method for blocking the signal from the oncogene KRAS by targeting TfR in LAC.

Is thymomectomy sufficient for non-myasthenic early stage thymoma patients? A retrospective, single center experience.

BACKGROUND: Thymic complete resection is considered the standard treatment for all thymic tumors; however, the ideal resection for non-myasthenic early stage thymic tumors has not yet been determined. We conducted a retrospective study to examine this unique scenario. METHODS: We retrospectively analyzed the data of 118 early stage thymoma patients who underwent thymectomy (TM) or thymomectomy (TMM) with curative intent between January 2003 and December 2013 at our institution. Patients with myasthenia, thymic carcinomas, tumors with undetermined histology, and more advanced stage thymoma patients were excluded. We compared overall survival (OS) and disease-free survival (DFS) according to the extent of thymic resection, tumor staging, and size. RESULTS: One hundred and eighteen patients were staged as early thymoma. TM was performed in 43 (35.6%) patients and TMM in 75 (64.4%). Forty-nine (65.3%) patients with a tumor ≤ 3 cm underwent TMM, and 9 (20.9%) TM. Twenty-six (34.7%) patients with a tumor > 3 cm underwent TMM, and 34 (79.1%) TM. Seventy-four patients were categorized as stage I: 57 (76%) underwent TMM and 17 (39.5%) TM. Forty-four patients were categorized as stage II: 18 (24%) underwent TMM and 26 (60.5%) TM. There was no statistically significant difference in recurrence between the groups (P = 0.250). CONCLUSION: No difference in the rate of recurrence was observed in early stage non-myasthenic patients following thymic resection and Masaoka-Koga staging. However, TM is considered a better option for early stage thymoma patients with tumors > 3 cm.

Down-Regulation of MiR-1294 is Related to Dismal Prognosis of Patients with Esophageal Squamous Cell Carcinoma through Elevating C-MYC Expression.

AIMS: Changes in the expression of microRNAs (miRNAs) have been found in many cancers. This study aimed to investigate the expression of miR-1294 in patients with esophageal squamous cell carcinoma (ESCC) and its effect on prognosis. The underlying mechanism was explored as well. METHODS: We examined the expression of miRNA in human ESCC cancer tissues and adjacent non-tumor controls using quantitative reverse transcription polymerase chain reaction (qRT-PCR). And the relationship between expressions of miR-1294 and ESCC prognosis was analyzed in this study. Over-expression and knock-down methods were used to investigate the biological functions of miRNA-1294. The effect of miRNA-1294 on cell proliferation was evaluated by MTT. Besides, the function of miR-1294 on cell migration and invasion were evaluated by transwell assays. RESULTS: MiR-1294 was significantly down-regulated in human ESCC tissues compared with the non-tumor controls tissues (P=0.014). And patients with low miR-1294 expression had a significantly poorer prognosis than those with a high miR-1294 expression (P=0.040). Negative association was defined between the expression of miR-1294 and the c-MYC expression in ESCC patients (Pearson correlation, r=-0.299, P=0.0079). Additionally, it was found that miR-1294 suppress esophageal cancer cells proliferation, migration and invasion capacity through targeting c-MYC in vitro. CONCLUSIONS: Down-regulation of miR-1294 correlates with poor prognosis of ESCC. It's partially due to the reduced function of c-MYC. This study may give insight into the understanding of pathogenesis of esophageal cancer and provide evidence for diagnosis and treatment of esophageal cancer.

Clinical analysis of acute lung injury after esophagectomy.

OBJECTIVE: Acute lung injury (ALI) is one of the most severe postoperative complications after esophagectomy for esophageal cancer patients. In order to clarify the mechanism of ALI, we, therefore, studied the operative course of a group of patients who underwent elective esophagectomy. MATERIALS AND METHODS: We retrospectively analyzed 75 patients underwent an esophagectomy and reconstruction for thoracic esophageal cancer. RESULTS: No statistically significant differences were observed between the two groups regarding their clinical backgrounds, such as their age, smoking index, preoperative pulmonary function, the location of the main tumor, and the tumor nodes metastasis stage. Operative time is thus considered to be a significant factor. The odds ratio (OR) of ALI in cases whose preoperative pulmonary function was 6.70 in comparison to the abnormal preoperative pulmonary functions. The OR for more intraoperative bleeding (>1000 g) was 0.83, compared with a lesser intraoperative bleeding although the difference was not statistically significant (P = 0.076). Anastomotic leakage occurred in four patients (44%) in Group I while it only occurred in two patient (6%) among the 33 Group II patients (P = 0.011). CONCLUSION: Greater surgical stress, such as a longer operative time, is thus considered to be associated with the first attack of ALI. The adverse events developing in the extrathoracic site, such as necrosis and local infection around anastomosis may, therefore, be the second attack. Furthermore, ALI may cause not only systemic inflammatory response syndrome but also other complications such as anastomotic leakage.

Are we really doing better with Hem-o-lok in VATS?

BACKGROUND: Due to advances in clip design, new types of surgical ligation clips are available that may reduce clip failure and improve function, but in the field of minimally invasive thoracic surgery, experience of using Hem-o-lok for pulmonary artery ligation is limited. METHODS: To assess risk factors and predictors of failure of the Hem-o-lok vascular clip, using vessels harvested from a porcine model. RESULTS: The Hem-o-lok clip had the worst holding strength compared to other clips. Its hemostatic ability for pulmonary vessels was far less stable compared with renal and hepatic vessels. The Hem-o-lok clip either leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the vessel sleeve was mobilized too "clean." CONCLUSION: Our experiment proved that the use of Hem-o-lok clips in video-assisted thoracoscopic surgery (VATS) has some potential risk. We recommend that all possible care be taken when it is applied to pulmonary vessels during VATS. Leaving some tissues around vessels may increase the thickness of the vessel, which, in turn, may increase the holding strength.

Expression of the recepteur d'originenantais receptor tyrosine kinase in non-small cell lung cancer and its clinical significance.

BACKGROUND: Recepteur d'originenantais (RON) is a receptor tyrosine kinase (RTK) that belongs to the MET proto-oncogene family. The aim of this study was to investigate the expression of RON receptor tyrosine kinase in human non-small cell lung cancer (NSCLC) and its relationship with clinical pathology of NSCLC and prognosis. METHODS: RON protein expression by immunohistochemistry (IHC) in 96 NSCLC specimens was evaluated and compared with the clinical pathology and prognosis, and 20 para-neoplastic tissues were included as controls. RON mRNA and protein expression in 25 fresh tissue samples of lung cancer and 10 normal lung tissues were also analyzed by reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting. RESULTS: The rate of positive RON expression differed significantly between NSCLC tissues (55.2%, 53/96) and para-neoplastic tissues (5%, 1/20) (P < 0.001). RON protein expression was not found to be associated with gender or age. However, RON expression positively correlated with clinical TNM stage (P = 0.004), histological types (P = 0.001), lymph node metastasis (P = 0.012) and differentiation (P = 0.035). RT-PCR and Western blotting analysis also confirmed that the expression of RON mRNA and protein was significantly increased in the NSCLC tissues versus normal tissues. In addition, RON expression was associated with a poor prognosis for patients with NSCLC (P = 0.045). CONCLUSIONS: The expression of RON protein and mRNA is significant in human NSCLC and low in para-neoplastic and normal tissues. Elevated RON expression may contribute to the occurrence, progression and metastasis of NSCLC, inferring that it could be useful as a new prognostic indicator for patients with NSCLC.

Chylous pleural effusion caused by mediastinal angiomyolipomas.

Classical angiomyolipomas are benign tumors composed of various tissues, including fat, abnormal blood vessels and smooth muscle cells. The present study reports a male patient affected by mediastinal angiomyolipomas with massive chylous pleural effusion. The tumors were characterized with histological and immunohistochemical methods.