Objective To assess the effects of physiotherapy on pulmonary function in COPD patients with lung cancer after lobectomy or pneumonectomy. Methods Fifty-five COPD patients with lung cancer undergoing lobectomy or pneumonectomy from January 2005 to May 2014 were recruited in the study. They were divided into group A received comprehensive physiotherapy before surgery and group B without comprehensive physiotherapy before surgery. The changes of lung function and tolerance were compared before physiotherapy (T1 time point) and after physiotherapy (T2 time point) in the group A, and between two groups before lung resection (T2 time point) and after lung resection (T3 time point). Results In group A, the forced expiratory volume in one second (FEV1), vital capacity (VC), peak expiratory flow at 50% of vital capacity (FEF50) and FEF25 increased significantly respectively by 16.96%, 14.75%, 20.69% and 13.79% compared with those before physiotherapy. Meanwhile, six-minutes walking distance (6MWD) achieved a significant improvement. After resection of lung, FEV1 and VC appeared to reduce, and pulmonary small airway function, tolerance, and clinical features deteriorated significantly. The differences between T2 and T1 in FEV1, FEF50 and FEF25 in the patients with FEV1%pred ≥80% and 50%-80% were similar with those in the patients with FEV1%pred<50%. The differences between T2 and T3 in FEF50 and FEF25 in the patients with FEV1%pred≥80% and 50%-80% were higher than those with FEV1%pred<50%. For the patients with lobectomy, FEV1 and VC in the group B were lower than those in the group A (FEV1: 10.24% vs. 22.44%; VC: 10.13% vs. 20.87%). For the patients with pulmonary resection, FEV1 and VC had little differences (FEV1: 36.33% vs. 36.78%; VC: 37.23% vs. 38.98%). Conclusion Physiotherapy is very important for the preoperative treatment and postoperative nursing of COPD patients with primary lung cancer.
ObjectiveTo evaluate clinical outcomes of single utility port video-assisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage peripheral non-small cell lung cancer. MethodsWe retrospectively analyzed the clinical data of 46 consecutive patients with early-stage peripheral non-small cell lung cancer who underwent single utility port complete VATS lobectomy in the First Affiliated Hospital of Hebei north University from December 2012 through November 2014. There were 39 male patients and 7 female patients with their age of 42-76 (60.26±4.38) years (VATS group). There were 58 patients with early-stage peripheral non-small cell lung cancer who underwent lobectomy via traditional thoracotomy including 47 male and 11 female patients with their age of 44-73 (61.42±3.67) years for the same period (conventional thoracotomy group). Clinical outcomes were compared between the two groups. ResultsAll the operations were successful. There was no conversions during single utility port VATS lobectomy, and no periopera-tive death in both groups. The VATS group had significantly less blood loss (126.10±48.56 ml vs. 260.84±69.70 ml), and amount of thoracic drainage (230.52±50.22 ml vs. 380.16±96.24 ml, P<0.05). Hospital stay was significantly shorter in the VATS group than the conventional thoracotomy group (6.42±1.40 days vs. 9.64±2.08 days, P<0.05). However, there was no significant difference between the VATS group and the conventional thoracotomy group with regard to the opera-ting time (146.25±19.68 minutes vs. 139.26±25.39 minutes), number of lymph nodes procured (13.56±2.31 vs. 14.12±3.06), and postoperative complications (13.0% vs. 19.0%, P>0.05). ConclusionSingle utility port VATS lobectomy for patients with early-stage peripheral non-small cell lung cancer is technically feasible, with less blood loss and shorter hospital stays for achieving acceptable standards of lymph node dissection. It is a promising surgical procedures for patients with early-stage peripheral non-small cell lung cancer.
ObjectiveTo investigate the feasibility,safety and short-term clinical outcomes of complete videoassisted thoracoscopic surgery (VATS) lobectomy for patients with early-stage lung cancer (LC). MethodsClinical data of 138 consecutive patients with early-stage LC who underwent lobectomy in the First People's Hospital of Jining from January 2012 to May 2013 were retrospectively analyzed. There were 71 patients undergoing complete VATS lobectomy including 39 male and 32 female patients with their age of 57.9±10.6 years (VATS group) and 67 patients undergoing lobectomy via traditional thoracotomy including 36 male and 31 female patients with their age of 60.3±8.2 years (thoracotomy group). Operation time,intraoperative blood loss, groups and number of lymph node dissection,thoracic drainage duration, postoperative hospital stay,vision analogue scores (VAS) on the 1st,3rd and 30th postoperative day, and postoperative morbidity were compared between the 2 groups. ResultsAll the patients in both groups success fully received their operation. Intraoperative blood loss (147±113 ml vs. 146±91 ml) number of lymph node dissection (9.9±3.6 vs. 10.0±3.6) group of lymph node dissection (3.1±1.3 vs. 3.4±1.3) and VAS on the 1st and 3rd postoperative day of VATS group were not statistically different from those of the thoracotomy group (P>0.05). Operation time (119±27 minutes vs. 135±29 minutes) thoracic drainage duration (3.0±0.9 days vs. 3.8±1.2 days) postoperative hospital stay (8.0±2.1 days vs. 10.2±5.4 days) VAS on the 30th postoperative day (2.6±0.7 vs. 3.2±1.1) and postoperative morbidity (8.5% vs. 19.4%) of VATS group were significantly shorter or lower than those of the thoracotomy group (P<0.05). Fifty-nine patients in VATS group and 58 patients in the thoracotomy group were followed up for 2-18 months after disc harge. During follow-up,there was no death in either group. There was 1 patient with brain metastasis,1 patient with liver metastasis,and 2 patients with bone metastasis. ConclusionComplete VATS lobectomy is safe and feasible for the treatment of early LC with the advantages of minimal invasiveness,less morbidity,better postoperative recovery and less chronic incision pain. Complete VATS lobectomy can also achieve similar standardization of lymph node dissection as routine thoracotomy.
Abstract： Air leak is still a common postoperative complication after selective lobectomy. The majority of patients undergoing lobectomy have some risk factors of postoperative air leak or persistent air leak. Nowadays，preventive measures of postoperative air leak mainly include preoperative, intraoperative （surgical technique，reinforcement material，pleural cavity reduction），and postoperative （pleurodesis，chest drainage management） strategies. Many of these new measures have been applied in clinical practice with satisfactory outcomes.
Objective To investigate clinical outcomes of complete video-assisted thoracoscopic lobectomy and summarize our preliminary experience. Methods Clinical data of 60 consecutive patients who underwent complete video-assisted thoracoscopic lobectomy in General Hospital of Chengdu Military Command from March 2010 to August 2011 were retrospectively reviewed. There were 37 male patients and 23 female patients with their median age of 52.1 （17-77） years. There were 7 patients undergoing left upper lobectomy， 19 patients undergoing left lower lobectomy， 12 patients undergoing right upper lobectomy， 3 patients undergoing right middle lobectomy， 17 patients undergoing right lower lobectomy， and 2 patients undergoing combined right middle and lower lobectomy. Results The average operation time was 161 （50-270） minutes， average intra-operative blood loss was 310 （50-800） ml， average number of lymph node dissection was 13.4 （6-29）， average postoperative thoracic drainage was 950 （250-2 800） ml， average duration of thoracic drainage was 4.6 （3-11） days， average intensive care unit stay was 1.2 （1-3） days， and average postoperative hospital stay was 7.7（4-14） days. None of the patients had any severe postoperative complication. Fifty-two patients were followed up for 7 to 24 months， and 8 patients were lost during follow-up. During follow-up， 5 patients had lung cancer metastases， including 2 patients with mediastinal lymph node metastases and 3 patients with distant metastases. After chemoradiotherapy，3 patients lived well but 2 patients died. None of the other patients had any severe complication during follow-up. Conclusion Complete video-assisted thoracoscopic lobectomy is a safe and effective surgical strategy for patients with benign or malignantpulmonary disease.
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.
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.
Abstract: Objective To investigate the feasibility of videoassisted thoracoscopic surgery (VATS) ronchial sleeve lobectomy for lung cancer, and to describe this treatment method. Methods Between December 2010 and April 2011, three patients in our hospital underwent VATS bronchial sleeve lobectomy as treatment for right upper lobe nonsmall cell lung cancer. The patients were one female and two males, aged 61, 65, and 62 years. Surgical incisions were the same as for singledirection VATS right upper lobectomy. The right superior pulmonary vein was firstly transected, followed by the first branch of the pulmonary artery. Then, the lung fissure was transected and the mediastinal lymph nodes, including the subcarinal nodes, were also dissected to achieve sufficient exposure of the right main bronchus. The bronchus was transected via the utility incision, and the anastomosis was accomplished by continuous suture with 30 Prolene stitches. Another 0.5 cm port in the 7th intercostal space at the posterior axillary line was added in the third operation for handling of a pair of forceps to help hold the needle during anastomosis. A sealing test was performed to confirm that there was no leakage after completion of the anastomosis, and the stoma was covered with biological material. Bronchoscopy was performed to clear airway secretions and to confirm that there was no stenosis on postoperative day (POD) 1. Results The lobectomy and lymph node dissection was finished in 5158 minutes (averaging 54.7), and the time needed foranastomosis was 4055 minutes (averaging 45.7). Total blood loss was 55230 ml (averaging 155.0 ml). Number of dissected lymph nodes was 1821 (averaging 19.3). One patient was diagnosed with adenocarcinoma of the right upper lobe with metastatic hilar lymph node invasive to the right upper lobar bronchus. The other two patients were both diagnosed with centrally located squamous cell carcinoma of the right upper lobe, and all the patients achieved microscopically negative margins. There was no stenosis of the anastomosis stoma, and the postoperative course was uneventful. These patients were discharged on POD 810 (averaging 8.7 days), and they recovered well during the followup period, which lasted 2 to 6 months. [WTHZ]Conclusion [WTBZ]For experienced skillful thoracoscopic surgeons, VATS bronchial sleeve lobectomy is safe and feasible. Making the incisions of a singledirection VATS lobectomy with an additional miniport may be an ideal approach for this procedure.
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.
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.