A prospective comparative study examing the impact of uniportal and three portal video-assisted thoracic surgery on short-term quality of life in lung cancer / 中华外科杂志

Objective@#To evaluate the effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection.@*Methods@#The perioperative data and short-term quality of life of 120 patients received uniportal and three portal video-assisted thoracic surgery for radical lung cancer resection were analyzed from September to November 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of University of Science and Technology of China. There were 64 male and 56 female patients aging of (62±10) years (ranging from 28 to 82 years). There were 60 cases received uniportal (uniportal group) and 60 cases received three portal video-assisted thoracic surgery (three-portal group). Quality of life by measurement of functional and symptom scales was assessed before surgery at baseline, and 1, 2, 4, and 8 weeks after the operation. The t test, χ2 test, Fisher exact test and Wilcoxon rank-sum test were used to compare the date between the 2 groups. Repeated measurement variance was used for comparison of the quality of life at different time points.@*Results@#There were no statistically significant differences in the clinicopathological features of the two groups (P>0.05). Intraoperative bleeding volume ((92±85) ml vs. (131±91) ml, t=2.387, P=0.019), postoperative catheter time ((4.4±3.1) days vs. (6.0±3.9) days, t=2.401, P=0.018), and postoperative hospitalization time ((6.2±4.0) days vs. (8.3±4.6) days, t=2.626, P=0.010) in the patients with uniportal group were less than that in three-portal group. Preoperative functional areas, symptom areas and overall health scores were similar in the two group. The functional areas such as physical function, role function, emotional function and social function and overall health status of uniportal group were significantly higher than those of three-portal group in postoperative time, while the fatigue and pain of uniportal group were significantly lower than that of three-portal group.@*Conclusions@#Uniportal video-assisted thoracic surgery can achieve the same safety and radical of three-portal video-assisted thoracic surgery. It has advantages in intraoperative bleeding volume, postoperative time after operation, hospitalization time and postoperative life quality.

Learning curve of uniportal video-assisted thoracoscopic surgery lobectomy for the treatment of resectable lung cancer / 中华外科杂志

Objective@#To analyze the learning curve of uniportal video-assisted thoracoscopic surgery (VATS) lobectomy for the treatment of resectable lung cancer.@*Methods@#The clinical data of 160 patients with resectable lung cancer who underwent uniportal VATS lobectomy by a single surgical team between May 2016 and April 2017 at Department of Thoracic Surgery, the First Affiliated Hospital of the University of Science and Technology of China were analyzed retrospectively. The study group consisted of 90 male and 70 female patients with age of 28 to 84 years (median: 62 years). The patients were divided into four groups from group A to D according to chronological order. The operation time, incision length, intraoperative blood loss, number of dissected lymph nodes and nodal stations, the proportion of changes in operation mode, postoperative complications, chest drainage duration and hospitalization time were individually compared among the four groups by variance analysis and χ2 test.@*Results@#The 4 groups were similar in terms of incision length, chest drainage duration, number of dissected lymph nodes and nodal stations and postoperative hospitalization time (P>0.05). The difference of the operation time ((185.9±17.9) minutes vs. (139.9±10.7) minutes vs.(128.7±7.8) minutes vs.(124.0±9.3) minutes, F=219.605, P=0.000), intraoperative blood loss ((233.9±135.8) ml vs. (126.8±18.1) ml vs. (116.4±22.6) ml vs.(112.8±25.3) ml, F=26.942, P=0.000), the proportion of changes in operation mode (17.5% vs.7.5% vs. 5.0% vs. 5.0%, χ2=8.300, P=0.040), and the incidence of postoperative complications (27.5% vs. 10.0% vs. 10.0% vs. 7.5%, χ2=8.643, P=0.034) among the 4 groups was statistically significant.@*Conclusions@#Uniportal VATS lobectomy can be safely and feasibly performed for resectable lung cancer, learning curve for uniportal VATS lobectomy is approximately 40 cases. Operation time, intraoperative blood loss, postoperative complications and the proportion of changes in operation mode can be used as the main measures during surgery.

Prognostic Value of Neutrophil-to-lymphocyte Ratio in Patients with Lung Adenocarcinoma Treated with Radical Dissection / 中国肺癌杂志

BACKGROUND@#Previous studies have shown that the neutrophil-to-lymphocyte ratio (NLR) has a significant impact on the prognosis of many malignant tumors such as gastric cancer, colorectal cancer and pancreatic cancer, but the study on the prognosis of patients with resectable lung adenocarcinoma is less. The aim of this study is to investigate the correlation between the NLR and the clinicopathologic features of adenocarcinoma of lung patients who underwent radical pneumonectomy. Furthermore, this study aimed to clarify the predictive and prognostic significance of NLR in patients who underwent pneumonectomy for lung adenocarcinoma.@*METHODS@#This study reviewed the medical records of 163 patients with lung adenocarcinoma who underwent pneumonectomy. The receiver operating characteristic (ROC) curve and Youden index were used to determine the cut-off value of the NLR. Survival curves were described by Kaplan-Meier method and compared by Log-rank test. The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.@*RESULTS@#When the NLR value was 2.96, the Youden index was maximal, with a sensitivity of 77.5% and a specificity of 75.9%. The 5-year survival rate in the low NLR group was higher than that in the high NLR group (P<0.05). The univariate and multivariate analyses showed that TNM staging and NLR were independent factors in predicting survival rate.@*CONCLUSIONS@#The NLR value was a simple and useful tool to predict the prognosis of lung adenocarcinoma after radical pneumonectomy.

Short-term Outcome of Uniportal and Three Portal Video-assisted Thoracic Surgery for Patients with Non-small Cell Lung Cancer / 中国肺癌杂志

BACKGROUND@#Currently, there are many reports on the advantages of three portal video-assisted thoracic surgery (VATS) in the treatment of lung cancer, but there are few reports on the comparison between uniportal and three portal video-assisted thoracic surgery. In this study, we aimed to evaluate the recent curative effect of the postoperative short-term quality of life between uniportal and three portal video-assisted thoracic surgery for non-small cell lung cancer.@*METHODS@#We retrospectively evaluated 266 patients with NSCLC who underwent intended VATS lobectomy by a single surgical team in our ward between January 2016 and August 2017. The general clinical date, perioperative data and short-term life quality were individually compared and analyzed between the two groups.@*RESULTS@#The two groups were similar in terms of clinicopathological features, total number of dissected lymph nodes and nodal stations, postoperative complications and pulmonary complications (P>0.05). Compared with three portal VATS, the intraoperative blood loss, chest tube duration, postoperative thoracic drainage, length of stay and NRS score were significantly decreased in uniportal VATS, with significant differences (P<0.05).@*CONCLUSIONS@#As a more minimally invasive surgery, uniportal VATS can be safely and effectively performed for resectable lung cancer, which would achieve even better operation curative effect than three portal VATS.

A retrospective study of lymphadenectomy and conversive rate in uniportal video-assisted thoracoscopic pneumonectomy / 中华胸心血管外科杂志

Objective To discribe the technique for uniportal video-assisted thoracoscopic pneumonectomy and lymphadenectomy,and to evaluate the feasibility,safety and the short-term clinical outcomes of this approach.Methods The clinical data of 283 patients with resectable non-small cell lung cancer who received uniportal or three-port video-assisted thoracoscopic pneumonectomy between January 2015 and December 2016 was analyzed retrospectively.Of those 283 patients,151 underwent uniportal video-assisted thoracoscopic pneumonectomy and 132 underwent three-port video-assisted thoracoscopic pneumonectomy.The clinicopathologic factors,operatinal factors,postoperative complications,the number of total lymph nodes dissected or the stations of the total lymph nodes dissected,and conversive rate of the two groups were compared by t test and x2 test.Results The two groups were similar in terms of clinicopathologic data,postoperative complications,length of opertion and conversive rate(P ＞ 0.05).The approach of uniportal video-assisted thoracoscopic pneumonectomy was associated with a significant decrease in surgical blood loss [(126.12 ± 212.13) ml vs.(178.61 ± 173.17) ml,P =0.02],volume of 3 days of post operative chest drainage [(505.25 ± 109.60) ml vs.(566.67 ± 233.35) ml,P =0.004],chest tube duration [(4.31 ±3.12)dvs.(6.93 ±3.10)d,P＜0.001] and postoperative stay [(5.49 ± 4.77) d vs.(7.23±4.24)d,P=0.001].There was no significant difference between the two groups in the number of total lymph nodes dissected or the stations of the total lymph nodes dissected (P ＞ 0.05).The stations of 4L and 5-13 in left lymphadenectomy and the stations of 2 R,3,4R and 7-13 in the right lymphadenectomy did not differ between the two groups(P ＞ 0.05).Conclusion Our uniportal video-assisted thoracoscopic pneumonectomy can be safety and effectively performed for resectabte non-small cell lung cance with favorable early outcomes.

Analysis of short-and long-term outcomes after esophagectomy in elderly cancer pa-tients / 中国肿瘤临床

Objective:To analyze the short-and long-term outcomes of elderly patients after esophagectomy by comparing preopera-tive comorbidities, postoperative complications, and survival rates among different age groups. Methods:We retrospectively reviewed the data of 253 patients who underwent esophagectomy from January to December 2010 in The First Affiliated Hospital of University of Science and Technology of China. Eighty-eight (34.8％) patients were aged<60 years (group A), 145 (57.3％) were aged 60-75 years (group B), and 20 (7.9％) were aged≥75 years (group C). The short-and long-term outcomes of the patients were analyzed. Results:There were significant differences in three group of patients with hypertension before operation (P<0.05). There were statistically sig-nificant differences among all complications, major complications, pulmonary infection, arrhythmia, and respiratory insufficiency (P<0.05), except for anastomotic leakage and other complications (P>0.05). The mean follow-up was 50.7 months. The median overall sur-vival and 1-, 3-, and 5-year overall survival rates were 68 months and 98.9％, 86.8％, and 69％, respectively, for group A;61 months and 93.1％, 76.1％, and 51％, respectively, for group B;and 32 months and 63.3％, 46％, and 28.8％, respectively, for group C (P<0.001). The median progression-free survival (PFS) and 1-, 3-, and 5-year PFS rates were 60 months and 98.86％, 85.2％, and 45.5％, respectively, for group A;43 months and 87.6％, 53.1％, and 26.9％, respectively, for group B;and 11 months and 30％, 20％, and 10％, respectively, for group C (P<0.001). The differences in survival rates between groups A and B, A and C, and B and C were statistically significant (P<0.001). The multivariate analysis showed that age and TNM stage IV were independent risk factors for overall survival and PFS (P<0.05). Conclusions:The long-term survival rate decreases significantly in elderly patients with esophageal cancer. In addition, age and advanced pathological stage of tumor are independent risk factors for long-term outcomes.

A Comparative Study of Acute and Chronic Pain between Single Port and Triple Port Video-assisted Thoracic Surgery for Lung Cancer / 中国肺癌杂志

BACKGROUND@#Through the comparative analysis of the acute and chronic pain postoperative between the single port and triple port video-assisted thoracic surgery to seek the better method which can reduce the incidence of acute and chronic pain in patients with lung cancer.@*METHODS@#Data of 232 patients who underwent single port -VATS (n=131) or triple port VATS (n=101) for non-small cell lung cancer (NSCLC) on January 1, 2016 to June 30, 2017 in our hospital were analyzed. The clinical and operative data were assessed, numeric rating scale (NRS) was used to evaluate the mean pain score on the 1th, 2th, 3th, 7th, 14th days, 3th months and 6th months postoperative.@*RESULTS@#Both groups were similar in clinical characteristics, there were no perioperative death in two groups. In the 1th, 2th, 7th, 14th days and 3th, 6th months postoperative, the NRS score of the single port group was superior, and the difference was significant compared with the triple port (P0.05). Univariate and multivariate analysis of the occurrence on the chronic pain showed that the operation time, surgical procedure and the 14th NRS score were risk factors for chronic pain (P<0.05).@*CONCLUSIONS@#The single port thoracoscopic surgery has an advantage in the incidence of acute and chronic pain in patients with non-small cell lung cancer. Shorter operative time can reduce the occurrence of chronic pain. The 14th day NRS score is a risk factor for chronic pain postoperative.

A Retrospective Study of Mean Computed Tomography Value to Predict the Tumor Invasiveness in AAH and Clinical Stage Ia Lung Cancer / 中国肺癌杂志

BACKGROUND@#Recently, the detectable rate of ground-glass opacity (GGO ) was significantly increased, a appropriate diagnosis before clinic treatment tends to be important for patients with GGO lesions. The aim of this study is to validate the ability of the mean computed tomography (m-CT) value to predict tumor invasiveness, and compared with other measurements such as Max CT value, GGO size, solid size of GGO and C/T ratio (consolid/tumor ratio, C/T) to find out the best measurement to predict tumor invasiveness.@*METHODS@#A retrospective study was conducted of 129 patients who recieved lobectomy and were pathological confirmed as atypical adenomatous pyperplasia (AAH) or clinical stage Ia lung cance in our center between January 2012 and December 2013. Of those 129 patients, the number of patients of AAH, AIS, AIS and invasive adenocarcinoma were 43, 26, 17 and 43, respectively. We defined AAH and AIS as noninvasive cancer (NC), MIA and invasive adenocarcinoma were categorized as invasive cancer(IC). We used receiver operating characteristic (ROC) curve analysis to compare the ability to predict tumor invasiveness between m-CT value, consolidation/tumor ratio, tumor size and solid size of tumor. Multiple logistic regression analyses were performed to determine the independent variables for prediction of pathologic more invasive lung cancer.@*RESULTS@#129 patients were enrolled in our study (59 male and 70 female), the patients were a median age of (62.0±8.6) years (range, 44 to 82 years). The two groups were similar in terms of age, sex, differentiation (P>0.05). ROC curve analysis was performed to determine the appropriate cutoff value and area under the cure (AUC). The cutoff value of solid tumor size, tumor size, C/T ratio, m-CT value and Max CT value were 9.4 mm, 15.3 mm, 47.5%, -469.0 HU and -35.0 HU, respectively. The AUC of those variate were 0.89, 0.79, 0.82, 0.90, 0.85, respectively. When compared the clinical and radiologic data between two groups, we found the IC group was strongly associated with a high m-CT value, high Max CT value, high C/T ratio and large tumor size. Gender, solid tumor size, tumor size, C/T ratio, m-CT value and MaxCT value were selected factor for multivariate analysis, when using the preoperatively determined variables to predict the tumor invasiveness, revealed that tumor size, C/T ratio, m-CT value and Max CT value were independent predictive factors of IC.@*CONCLUSIONS@#The musurements of Max CT value, GGO size, solid size of GGO and C/T ratio were significantly correlated with tumor invasiveness, and the evaluation of m-CT value is most useful musurement in predicting more invasive lung cancer.

A preliminary observe of the different age children with unilateral hearing loss / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the effect on children with unilateral hearing loss (UHL).@*METHOD@#One hundred and one children with unilateral hearing loss were included in this study from October 2008 to December 2009 in Shenzhen Children's Hospital, 95 of them were investigated on speech recognition abilities, learning abilities et al by telephone interviews.@*RESULT@#The intelligence quotient (IQ) including full-scale intelligence quotient, verbal intelligence quotient and performance intelligence quotient were significantly lower in the severe and profound unilateral hearing loss group when compared with school children with bilateral normal hearing (P 0.05).@*CONCLUSION@#IQ, speech recognition abilities and learning abilities were affected during unilateral hearing loss children, but proper, early intervention can compensate the deleterious effects of UHL.