Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wenhao ^1,2 ,  ZHU Zijiang ² , PANG Yao ² , ZHU Xiaolei ²

1. Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;
2. The Second Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;

Corresponding?author：

ZHU Zijiang, Email: zhuzijiang2005@sina.com

Keywords：

Controlled hypotension; video-assisted thoracoscopic surgery; subcarinal lymph node

DOI：

10.7507/1007-4848.201705023

Video：

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Objective To evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer.Methods We analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared.Results The operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05).Conclusion Controlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less drainage volume, which is safe and effective.

Citation： WANG Wenhao, ZHU Zijiang, PANG Yao, ZHU Xiaolei. Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(4): 299-302. doi: 10.7507/1007-4848.201705023 Copy

1.	丁寧寧, 毛友生. 早期非小細胞肺癌淋巴結轉移規律與清掃方式研究進展. 中國肺癌雜志, 2016, 19(6): 359-363.
2.	康曉征, 陳克能. 肺癌的縱隔淋巴結分期方法及意義. 中華胸心血管外科雜志, 2014, 30(3): 176-180.
3.	章智榮, 毛友生, 赫捷, 等. 臨床 Ⅰ 期非小細胞肺癌淋巴結轉移規律和清掃方式的探討. 中華腫瘤雜志, 2014, 36(7): 536-540.
4.	崔岳, 楊曉軍, 謝天鵬, 等. 非小細胞肺癌肺內淋巴結轉移規律的臨床研究. 中國胸心血管外科臨床雜志, 2016, 23(10): 982-987.
5.	Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
6.	Higuchi M, Yaginuma H, Yonechi A, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg, 2014, 9: 88.
7.	馬建強, 楊紹軍, 李旭, 等. 全胸腔鏡與傳統開胸肺癌根治術的比較. 中國微創外科雜志, 2016, 16(9): 802-806.
8.	Aokage K, Yoshida J, Ishii G, et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer, 2010, 70(2): 163-167.
9.	李躍, 孫冰生, 張真發, 等. 非小細胞肺癌淋巴結陽性率與預后的臨床分析. 中華醫學雜志, 2011, 91(24): 1682-1686.
10.	Okada M, Tsubota N, Yoshimura M, et al. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg, 1999, 118(2): 270-275.
11.	Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
12.	馬海波, 丁志丹, 曲戈, 等. 非小細胞肺癌隆突下淋巴結轉移與臨床病理特征的關系. 中國胸心血管外科臨床雜志, 2013, 20(1): 70-73.
13.	管仲, 翁文俊, 章斌, 等. 非小細胞肺癌手術中隆突下淋巴結的選擇性清掃. 江蘇醫藥, 2015, 41(9): 1033-1035.
14.	Verhagen AF, Schoenmakers MC, Barendregt W, et al. Completeness of lung cancer surgery: is mediastinal dissection common practice? Eur J Cardiothorac Surg, 2012, 41(4): 834-838.
15.	Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res, 2013, 3(4): 475-483.
16.	Erbesler ZA, Bakan N, Kara?ren GY, et al. A Comparison of the effects of esmolol and dexmedetomidine on the clinical course and cost for controlled hypotensive anaesthesia. Turk J Anaesthesiol Reanim, 2013, 41(5): 156-161.
17.	Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.

1. 丁寧寧, 毛友生. 早期非小細胞肺癌淋巴結轉移規律與清掃方式研究進展. 中國肺癌雜志, 2016, 19(6): 359-363.
2. 康曉征, 陳克能. 肺癌的縱隔淋巴結分期方法及意義. 中華胸心血管外科雜志, 2014, 30(3): 176-180.
3. 章智榮, 毛友生, 赫捷, 等. 臨床 Ⅰ 期非小細胞肺癌淋巴結轉移規律和清掃方式的探討. 中華腫瘤雜志, 2014, 36(7): 536-540.
4. 崔岳, 楊曉軍, 謝天鵬, 等. 非小細胞肺癌肺內淋巴結轉移規律的臨床研究. 中國胸心血管外科臨床雜志, 2016, 23(10): 982-987.
5. Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
6. Higuchi M, Yaginuma H, Yonechi A, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg, 2014, 9: 88.
7. 馬建強, 楊紹軍, 李旭, 等. 全胸腔鏡與傳統開胸肺癌根治術的比較. 中國微創外科雜志, 2016, 16(9): 802-806.
8. Aokage K, Yoshida J, Ishii G, et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer, 2010, 70(2): 163-167.
9. 李躍, 孫冰生, 張真發, 等. 非小細胞肺癌淋巴結陽性率與預后的臨床分析. 中華醫學雜志, 2011, 91(24): 1682-1686.
10. Okada M, Tsubota N, Yoshimura M, et al. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg, 1999, 118(2): 270-275.
11. Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
12. 馬海波, 丁志丹, 曲戈, 等. 非小細胞肺癌隆突下淋巴結轉移與臨床病理特征的關系. 中國胸心血管外科臨床雜志, 2013, 20(1): 70-73.
13. 管仲, 翁文俊, 章斌, 等. 非小細胞肺癌手術中隆突下淋巴結的選擇性清掃. 江蘇醫藥, 2015, 41(9): 1033-1035.
14. Verhagen AF, Schoenmakers MC, Barendregt W, et al. Completeness of lung cancer surgery: is mediastinal dissection common practice? Eur J Cardiothorac Surg, 2012, 41(4): 834-838.
15. Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res, 2013, 3(4): 475-483.
16. Erbesler ZA, Bakan N, Kara?ren GY, et al. A Comparison of the effects of esmolol and dexmedetomidine on the clinical course and cost for controlled hypotensive anaesthesia. Turk J Anaesthesiol Reanim, 2013, 41(5): 156-161.
17. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study

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