Abstract：?Objective?To evaluate clinical outcomes of single utility port complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage lung cancer.?Methods?We retrospectively analyzed the clinical data of 162 consecutive patients with early-stage lung cancer who underwent single utility port complete VATS lobectomy from September 2009 to October 2011 in Chinese PLA General Hospital （single utility port group），and compared them with 221 patients with early-stage lung cancer who underwent video-assisted mini-thoracotomy （VAMT） lobectomy in the same period （VAMT group）. The clinical outcomes including operation time, intraoperative blood loss, lymph node dissection number, time to first activity out of bed, chest drainage duration and postoperative complications, were compared between the two groups.?Results?No perioperative death was observed in both groups. There were statistical differences in the intraoperative blood loss （162.8±75.6 ml vs. 231.4±62.8 ml）, time to first activity out of bed （2.2±0.3 d vs. 3.7±0.5 d） , and chest drainage duration （3.5±0.2 d vs. 4.6±0.4 d） between the two groups （P＜0.05）. There was no statistical difference in operation time （133.7±22.0 min vs. 124.9±25.7 min） , lymph node dissection number （11.7±1.9 vs. 12.5±2.7）， and incidence of serious postoperative complications （7.4% vs. 8.1%）between the two groups.?Conclusion?Single utility port complete VATS lobectomy and lymph node dissection are safe and reliable for patients with early-stage lung cancer with less injury and better postoperative recovery compared with VAMT.
Treatment of Non-small Cell Lung Cancer by Single-direction Four-hole Complete Video-assisted Thoracoscopic Lobectomy HUANG Jia, ZHAO Xiao-jing, LIN Hao, TAN Qiang, DING Zheng-ping, LUO Qing-quan. (Shanghai Lung Tumor Clinical Medical Center, Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai 200030, P. R. China) Corresponding author：LUO Qing-quan, Email：luoqingquan@hotmail. com Abstract： Objective To explore the feasibility and safety of single-direction four-hole video-assisted thoracoscopic lobectomy in the treatment of non-small cell lung cancer (NSCLC). Methods Between January 2007 and December 2010, 428 patients with NSCLC were surgically treated by single-direction complete video-assisted thoracoscopic lobectomy in Shanghai Chest Hospital. There were 186 males and 242 females; aged 33 to 78 years. All the patients were diagnosed as primary NSCLC at early clinical stage. Among the 428 patients, 134 patients underwent right upper lobectomy, 48 patients underwent right middle lobectomy, 98 patients underwent right lower lobectomy, 4 patients underwent right middle and lower lobectomy, 72 patients underwent left upper lobectomy, and 72 patients underwent left lower lobectomy. All the 428 patients were divided into two groups according to their surgical approach：a three-hole group (300 patients) and a four-hole group (128 patients).The clinical results of the two groups were analyzed. Results A total of 412 patients underwent complete video-assisted thoracoscopic lobectomy, and 16 patients (3.7%) underwent conversion to open surgery. The average operation time was 132.1 (120-180) min, average length of incision was 3.7 (3-5) cm, and average blood loss was 150.0 (50-800) ml. There was no statistical difference in extubation time, intraoperative blood loss, and postoperative hospital stay between the two groups. But the operation time of the four-hole group is significantly shorter than that of the three-hole group （P＜0.05）. The 16 patients who underwent conversion to open surgery received intraoperative blood transfusion. Five patients died of severe pulmonary infection, pulmonary embolism, and acute cerebral infarction. Fifty two patients had squamous cancer, 340 patients had adenocarcinoma, 20 patients had adenosquamous carcinoma, 8 patients had poorly differentiated carcinoma, 6 patients had big cell lung cancer, and 2 patients had carcinoid. Postoperative persistent lung air leak occurred in 4 patients, thoracic empyema in 2 patients, pulmonary infection in 4 patients, arrhythmia in 26 patients, pulmonary embolism in 2 patients, chylothorax in 2 patients, and acute cerebral infarction in 2 patients. The overall 3-year survival rate was 83.6%（358/428）. Conclusion Single-direction four-hole complete video-assisted thoracoscopic lobectomy is feasible, safe and consistent with the operation standard in the surgical treatment for NSCLC patient. It is also helpful to reduce the operation time and facilitate lymph node dissection. Key words： Video-assisted thoracoscopic surgery； Lobectomy； Single-direction； Four-hole； Non-small cell lung cancer
Objective To investigate the clinical value of using videoassisted thoracoscopic lobectomy（VATS lobectomy） to treat primary nonsmall cell lung cancer(NSCLC) so that the videoassisted thoracoscopic surgery(VATS) can be better used in clinic. Methods From September 2007 to December 2008, seventysix NSCLC patients were collected. Thirtyseven patients underwent VATS lobectomy(VATS group), 21 male and 16 female with an average age of 60.4 years. Among them 20 underwent videoassisted minithoracotomy lobectomy, and 17 underwent total thoracoscopic lobectomy. Thirtynine patients underwent conventional thoractomy(conventional thoracotomy group), 32 male and 7 female with an average age of 58.7 years. Perioperative clinical and laboratory parameters of the two groups were compared. Results There was no severe complication and perioperative mortality in both groups. There were statistical significances between VATS group and conventional thoracotomy group in incision length (7.6±1.9 cm vs. 28.5±3.6 cm, t=-31.390,P=0.000), postoperative dosage of dolantin(160±125 mg vs.232±101 mg，t=-2.789,P=0.007), postoperative chest tube time(chest tube output＞100ml,4.8±2.5 d vs. 8.1±3.2 d，t=-4.944,P=0.000） and postoperative hospitalization time(12.1±3.0 d vs. 15.7±4.7 d，t=-3.945,P=0.000). There was no statistical significance between two groups in operation time（t=1.732，P=0.087）, intraoperative blood loss（t=-1.645，P=0.105） and the number of lymph node dissection（t=-0.088，P=0.930）. The total hospitalization expenses in VATS group were higher than that in conventional thoracotomy group, but there was no statistical significance（t=1.303，P=0.197）. The serum levels of glucose at 1st day after operation（7.2±1.2 mmol/L vs. 8.4±2.2 mmol/L, t=5.603,P=0.000）and the total count of white blood cell (12.7±3.8×10.9/L vs. 15.1±5.9×10.9/L,t=5.082,P=0.004) in VATS group were significantly lower than that in conventional thoracotomy group. The prealbumin(PA) level in VATS group was significantly higher than that in conventional thoracotomy group（215.0±45.5 mg/L vs.147.3+50.8 mg/L,t=-7.931,P=0.000). Conclusion VATS lobectomy could clean lymph node completely. Its advantages include less postoperative trauma, lower acute phase response, mild pain, rapid recovery, shorter hospitalization time and less economic burden. It could be an operation approach for early NSCLC patients who have been strictly selected.
Abstract: Objective To summarize the clinical experiences and surgical treatment of pulmonary sequestration (PS) in order to improve the diagnosis and treatment of PS. Methods Between August 1993 and February 2007, our department enrolled 21 PS patients, 8 male patients and 13 female patients, with the age ranging from 13 to 70 years old. The patients were examined by chest radiography, computerized tomography (CT), computerized tomography angiography (CTA), magnetic resonance imaging (MRI), position emission tomographyCT(PET-CT) before the surgery. Sequestrectomy was performed on patients with extralobar sequestration (ELS) and lobectomy was performed on patients with intralobar sequestration (ILS). There were 10 cases of left lower lobectomy, 3 cases of right lower lobectomy, 4 cases of left sequestrectomy, 3 cases of right sequestrectomy and 1 case of total pneumonectomy. Results Postoperative pathology confirmed all cases of PS, including 7 cases of ELS and 14 cases of ILS. Seven patients were diagnosed to have PS by preoperative diagnostic procedures. During the surgery, we found aberrant supporting arteries from the general circulation in 18 cases among which 11 were supported by the thoracic aorta, 6 by the abdominal aorta and 1 by both the thoracic and abdominal aorta. The diameter of the aberrant artery was between 0.2 cm and 1.1 cm (mean 0.7 cm). Double ligation and transfixion were performed during the operation. In addition, we found venous drainage through the inferior pulmonary vein in 3 patients and double ligation was performed. No perioperative death or complications occurred. Followup was done till January 2009 on all the patients but one with a followup rate of 95.2% (20/21). The followup time ranged from 12 to 67 months. All patients survived well except that 1 died from liver metastasis 2 years after the operation because of lung cancer. Conclusion PS is rare and its symptoms are nonspecific, which can cause misdiagnosis and missed diagnosis. The diagnosis of PS mainly depends on CT, CTA, MRI and selected arteriography. Once diagnosed, PS should be removed by surgery. During the surgery, aberrant vessels should be separated and treated with double ligation and transfixion. As for those big aberrant vessels, transfixion can be performed after vascular decompression.
ObjectiveTo investigate the efficacy of total thoracoscopy (VATS) lobectomy and the thoracotomy for the treatment of benign lung disease. MethodsWe retrospectively analyzed the clinical data of 70 patients with benign lung diseases in the First People's Hospital of Qujing between January 2012 and September 2013. According to the surgical way, the patients were divided into two groups including a total VATS group involved in 35 patients with 25 males and 10 females, aged 18 to 71 years, mean age of 41.3±6.4 years and a thoracotomy group involved in 35 patients with 26 males and 9 females, aged 19 to 72 years, mean age of 42.4±5.6 years. Then we compared the efficacy of the two groups. ResultsThere was no statistical difference (P > 0.05) in operative time and postoperative survival rate comparison. While in the total VATS group, the total thoracoscopic incision length, bleeding volume or pain time, postoperative day time of analgesia, thoracic drainage volume, postoperative drainage tube pulling time and hospitalization time were all lower than those in the thoracotomy group with statistical differeces (P < 0.05). ConclusionThe thoracoscopic lobectomy for treatment of benign pulmonary lesions is superior to the conventional thoracotomy with much less bleeding and pain, more faster postoperative recovery and less impact on the patient's body. It's suitable for clinical application in normal hospital.
Four hundred and eighty two paients suffering from intrahepatic bile duct stone undergoing lobectomy and segmental resection (from 1975 to 1994,9) has reported. 63% of the patient in this group underwent 1-5 operations, including different types of biliary-intestinal anastomosis (21.6%). 482 cases underwent different types of hepatectomy, including left lateral-lobetomy 321 cases (66.6%),left hemihepatectomy 80 cases(16.6%), right hemihepatectomy 19 cases (3.9%), and multiple segmental resections 39 cases (8.1%, including Ⅴ+Ⅷ 11 cases, Ⅵ+Ⅶ 28 cases). Other type hepatectomy combined with guadrate lobectomy 20 cases (4.1%). Postoperative complication rate was 10.2%, including diliary fistula. hemobilia and subdiaphragmatic and resectional surface infectioin, 85% of the patients were followed up with an excellent result of 88%. The authors emphsize that hepatic lobectomy nad segmental resection is the core of treatment and selection of operative methods depends on clinical-patholigic types of the disease.
Objective To evaluate the survival outcomes of segmentectomy versus lobectomy for T1c non-small cell lung cancer (NSCLC). Methods We searched PubMed, EMbase, Cochrane Central Register of Controlled Trials (CENTRAL), CNKI (China National Knowledge Infrastructure), and Wanfang Data, with the search time limit set from the inception of the databases to February 2024. Three researchers independently screened the literature, extracted relevant information, and evaluated the risk of bias of the included literature according to the Newcastle-Ottawa Scale (NOS). Meta-analysis was conducted using STATA 15.1. Results A total of 8 retrospective cohort studies were included, involving 7 433 patients. The NOS scores of the included studies were all ≥7 points. Patients who underwent lobectomy had significantly higher five-year overall survival (OS) rates compared to those who underwent segmentectomy (adjusted HR=1.11, 95%CI 0.99-1.24, P=0.042). Compared with lobectomy, segmentectomy showed no significant difference in adjusted three-year OS rate (adjusted HR=0.88, 95%CI 0.62-1.24) and adjusted five-year lung cancer-specific survival (adjusted HR=1.10, 95%CI 0.80-1.51, P=0.556) of patients with T1c NSCLC. Moreover, there were no differences in the five-year adjusted relapse-free survival (adjusted HR=1.23, 95%CI 0.82-1.85, P=0.319), and adverse events (OR=0.57, 95%CI 0.37-0.90, P=0.015) in the segmentectomy group were significantly less than those in the lobectomy group. Subgroup analysis based on whether patients received neoadjuvant therapy showed that among studies that excluded patients who received neoadjuvant therapy, no significant difference in 5-year adjusted OS rate was observed between the segmentectomy group and lobectomy group (adjusted HR=1.02, 95%CI 0.81-1.28, P=0.870). Conclusion Segmentectomy and lobectomy show no significant difference in long-term survival in stage T1c NSCLC patients, with segmentectomy associated with fewer postoperative complications. Further high-quality research is needed to con?rm the comparative ef?cacy and safety of lobectomy and segmentectomy for T1c NSCLC patients.
ObjectiveTo evaluate the safety and efficacy of segmentectomy for early stage non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 88 patients with pulmonary malignant or benign lung tumor who underwent segmentectomy in our hospital between January 2007 and December 2012. There were 45 male and 43 female patients. There were 29 patients in the segmentectomy group and 59 patients in the lobectomy group. Nonsmall cell lung cancer patients underwent segmentectomy were matched with non-small cell lung cancer patients who underwent lobectomy. Perioperative factors and tumor relative prognosis were analyzed. ResultsSegmentectomy were performed in 29 patients in our institution. Average operation time was 210 minutes. Intraoperative blood loss was 166 ml. Postoperative drainage was 2 147 ml. The average extubation duration was 6 days. No significant difference was found in operation time (P>0.999), intraoperative blood loss (P=0.207), postoperative drainage (P=0.946), extubation duration (P=0.804), and postoperative complication (P>0.999) between segmentectomy pulmonary benign disease and segmentectomy lung cancer groups. Compared with lobectomy, segmentectomy showed similar operation time (P=0.462), intraoperative blood loss (P=0.783), extubation duration (P=0.072), complication ratio (P>0.999), and postoperative recurrence/metastasis ratio (P=0.417). While the number of N1 lymph nodes (P=0.033) and N1 station (P=0.024) were fewer in the segmentectomy group than those in the lobectomy group. The overall survival rate (P=0.340) and disease free survival rate (P=0.373) were both comparable between the segmentectomy and the lobectomy group. ConclusionSegmentectomy could be an alternate of lobectomy for patients with selective pulmonary benign disease, and for some early stage non-small cell lung cancer patients with restricted pulmonary function.
ObjectiveTo evaluate the safety and efficacy of single utility port video-assisted thoracoscopic lobec-tomy in the treatment of benign pulmonary diseases. MethodsFrom January 2011 to April 2014, 48 patients with benign pulmonary diseases underwent single utility port video-assisted thoracoscopic lobectomy in the First Affiliated Hospital of Soochow University. The patients included 21 males and 27 females, with their mean age of 47.4 years. There were 5 patients received right upper lobectomy, right middle lobectomy in 5 patients, right lower lobectomy in 5 patients, left upper lobectomy in 8 patients, and left lower lobectomy in 20 patients. the clinical outcomes included operation time, intraoperative blood loss, chest drainage duration, postoperative hospital stay and postoperative complications. ResultsThere were 2 patients conversion to open surgery. The average operation time was 147.2±50.4 min, intraopera-tive blood loss was 160.2±25.3 ml, postoperative chest drainage duration was 4.8±2.8 d, postoperative hospital stay was 7.4±1.9 d. There was no hospital death or serious postoperative complications. Postoperative pathological diagnosis showed bronchiectasis in 17 patients, inflammatory pseudotumor in 11 patients, tuberculosis in 9 patients, aspergillosis in 4 patients, pulmonary sequestration in 3 patients, bronchogenic cyst in 2 patients, pulmonary abscess in 1 patient, and hamartoma in 1 patient. No long-term complications were noticed in 48 patients during a mean follow-up of 6 months. ConclusionSingle utility port video-assisted thoracoscopic lobectomy is safe and feasible in the treatment of benign pulmonary diseases.
ObjectiveTo evaluate effect and safety of a novel conservative therapy for post-lobectomy bronchopleural fistula. MethodsWe retrospectively analyzed the clinical data of 20 patients with post-lobectomy bronchopleural fistula in our hospital between 2000 and 2013 year. There were 12 males and 8 females at average age of 67.7±8.7 years. Endobronchial naso-bronchial lavage (ENBL) was used for 10 patients (an ENBL group). Traditional method-thoracostomy drainage tube (TDT) was used for the other 10 patients (a TDT group). ResultsCompared with the TDT group, shorter hospital day was found in the ENBL group (49.7±9.6 d versus 68.3±9.8 d, P < 0.001). Fistula healing time was also shorter in the ENBL group than that in the TDT group (43.7±9.7 d versus 62.6±8.8 d, P < 0.001). There were lower complication rate, less inflammatory reaction, and better recovery in the ENBL group than those in the TDT group. ConclusionENBL may be a promising procedure for post-lobectomy bronchopleural fistula.