Great progress has been made in immunotherapy for esophageal squamous cell carcinoma in recent years. However, for thoracic surgeons, immunotherapy is still a new thing and they lack enough experience. Therefore, this paper attempts to discuss some hot issues of immunotherapy, including the indications, side effects, clinical efficacy and evaluation of efficacy. The author hopes that this article will help and attract the attention of thoracic surgeons.
Patients with thoracic malignancy have a high incidence of perioperative venous thromboembolism (VTE), but its onset is insidious, often asymptomatic or atypical, and is easily overlooked. Early identification and standardized prevention of VTE can effectively reduce the risk of VTE. "Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)" has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future VTE prevention in thoracic surgery. It is hoped that through our joint efforts, we can reduce the incidence of perioperative VTE and mortality of thoracic surgery, and strive to improve the long-term survival of patients with lung cancer and esophageal cancer.
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+EUS+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve ctDNA and radiomics for risk stratification to advance precision organ-preserving strategies.
Objective To study the role of ultracision harmonic scalpel and skin flap in axillary fossa external fixation in operation of breast cancer. Methods One hundred and sixty-six patients with breast cancer were included in this study between May 2009 and November 2009. Combined group (n=51) applied ultracision harmonic scalpel combined with skin flap external fixation. External fixation group （n=52） used the skill of skin flap external fixation. Routine group included 63 patients. Operative time, accidental injury during operation， volume of bleed and drainage, time of drainage, detection amount of lymph node, and complications such like subcutaneous fluidity were observed and recorded. Results The operative time and detection amount of lymph node were not different among three groups （Pgt;0.05）. The volume of bleed in combined group was less than that in other groups （Plt;0.05）. The volume of drainage and the time of drainage were decreased or shorten by turns from routine group, external fixation group to combined group （Plt;0.05）. The incidence rate of subcutaneous fluidity in combined group was lower than that in routine group （Plt;0.05）. Conclusions Using ultracision harmonic scalpel in operation of breast cancer can remarkably reduce the volume of bleed and drain postoperatively. Ultracision harmonic scalpel combined with skin flap external fixation is safety and can reduce the incidence rate of subcutaneous fluidity, thus can be applied widely in breast cancer operation.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
Objective To investigate the changes in osteoprotegerin (OPG) / receptor activator of nuclear factor-κB ligand (RANKL) ratio in sepsis-associated acute lung injury (SA-ALI) and the role of regulation of this ratio on the inflammatory response in SA-ALI. Methods Eighteen C57BL/6 male mice were randomly divided into sham operation group, cecal ligation and perforation (CLP) group and RANKL group, with 6 mice in each group. Before the experiment, the RANKL group was intraperitoneally injected with 5 μg (0.2 mL) of recombinant RANKL antibody, whereas both the sham operation group and the CLP group were intraperitoneally injected with a volume-matched normal saline. One hour later, the sham operation group underwent only abdominal exploration and repositioning, while the other groups underwent the CLP surgery to induce the SA-ALI model. After 24 h of modelling, all mice were sacrificed and samples were collected. Pathological evaluation of lung tissues was performed by haematoxylin-eosin staining; enzyme-linked immunosorbent assay was used to detect serum concentrations of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-1β; while the mRNA and protein expression of OPG and RANKL, along with their ratio values, were detected by real-time polymerase chain reaction for quantitative analysis and protein immunoblotting. Results The SA-ALI mouse model was successfully established. Compared with the sham operation group, mice in the CLP group showed disturbed alveolar structure, obvious alveolar and interstitial haemorrhage and inflammatory cell infiltration, elevated serum levels of IL-6, TNF-α and IL-1β (P<0.05), significantly increased mRNA and protein expression of OPG and elevated OPG/RANKL ratio in lung tissue (P<0.05), whereas RANKL mRNA and protein expression was significantly decreased (P<0.05). Compared with the CLP group, the pathological damage of lung tissue in the RANKL group was reduced, the infiltration of alveolar and interstitial inflammatory cells was significantly improved, and the alveolar structure and morphology were more regular, with lower serum levels of IL-6, TNF-α and IL-1β (P<0.05), significantly lower mRNA and protein expression of OPG and OPG/RANKL ratio in lung tissue (P<0.05), and significantly higher mRNA and protein expression of RANKL in lung tissue (P<0.05). Conclusion The alteration of OPG/RANKL ratio may be related to the pathophysiological process of SA-ALI, and the decrease in its level may reflect the attenuation of the inflammatory response in SA-ALI.
Abstract: Objective To explore the significance of peripheral serum hepatocyte growth factor (HGF) and transforming growth factor-β (TGF-β) in preoperative staging of patients with nonsmall cell lung cancer. Methods Fifty patients, including 30 males and 20 females, with complete clinical data and final pathological diagnosis of nonsmall cell lung cancer were treated in Beijing Chaoyang Hospital from September 2006 to November 2007. Their age ranged from 36 to 76 years old (62.4±10.0 years old). Among the patients, there were 26 patients of adenocarcinoma, 23 patients of squamous cell carcinoma and one patient of large cell carcinoma. Twenty other normal subjects were chosen to form normal control, including 11 males and 9 females, aged from 18 to 67 years old (43.8±14.2 years old). Peripheral serum HGF and TGF-β were measured with enzymelinked immunosorbent assay (ELISA), and the relationship between the level of HGF, TGF-β and preoperative staging was analyzed. Results The peripheral serum HGF and TGF-β level has no relation with patient’s age, sex, smoking history or histology type. The level of HGF in the T2 and T3 patients was significantly higher than that of normal control (373.90±234.00 pg/ml vs. 211.30±154.60 pg/ml, t=2.759, P=0008; 563.80±316.10 pg/ml vs. 211.30±154.60 pg/ml, t=4076, P=0.000). The level of TGF-β in the T-3 patients was significantly higher than that of normal control (3.34±2.80 ng/ml vs. 1.82±0.90 ng/ml, t=2.190, P=0.037). The level of TGF-β in the N1-2 patients was significantly higher than that of the N0 patients (2.60±2.00 ng/ml vs. 1.53±0.74 ng/ml, t=-2.387, P=0.021). TGF-β level (5.97±2.65 ng/ml) in patients with distant metastasis (stage Ⅳ) was significantly higher than that of patients in other stages. Conclusion The HGF and TGF-β level is related to the staging of lung cancer. Such examinations combined before operation may present a reference value for preoperative staging and providing the best treatment plan for the patients.
It has been absent from an accepted criteria for normalization and quality control of the thoracic surgery until now. The ideal assessing instrument which will be used to evaluate the technical skills and surgical procedures should present a few vital characterizations below: objectivity, speciality in the content, detailed structure, and quantifiability. Objective structured assessment of technical skills (OSATS) has developed as a reliable method of surgical skills measurement. This article focuses on the history of OSATS and its prospect in the thoracic surgery area by reviewing relevant literatures.
Objective To observe the mRNA and protein expression of wingless-type MMTV integration site family member 5a (Wnt5a), glycogen synthase kinase 3 (GSK3), and β-catenin, as well as the muscle fibers and adipose tissue presented in pathological staining in the gastrocnemius muscle of white rabbits with blunt gastrocnemius contusion injuries, and provide a basis for revealing the repair mechanism of the pressing and kneading method in treating skeletal muscle injury. Methods Forty-two healthy male and female New Zealand white rabbits were selected. They were randomly divided into blank group, model 3-day group, model 7-day group, model 14-day group, press-and-knead 3-day group, press-and-knead 7-day group, and press-and-knead 14-day group, by using a random number table method, with 6 rabbits in each group. Samples of the model groups and the press-and-knead groups were taken on the 4th, 8th and 15th days after operation. The mRNA and protein expression of Wnt5a, GSK3, and β-catenin were detected by quantitative polymerase chain reaction and Western blot; the muscle tissue myofibers and adipose tissue were observed by hematoxylin and eosin (HE) staining and oil red O staining. Results The HE staining results showed that significant fibrous tissue proliferation and inflammatory cell infiltration occurred in the model 7-day group; in the model 14-day group, some muscle fibers were degenerated, necrotic, and regenerated, accompanied by fibrous tissue proliferation, slight inflammatory cell infiltration, and slight calcification; in the press-and-knead groups, obvious muscle fiber degeneration, necrosis, and regeneration, and inflammatory cell infiltration were observed, accompanied by significant fibrous tissue proliferation. The oil red O staining results showed that adipocyte deposition was visible in the model groups, which was the heaviest in the model 7-day group; in the press-and-knead groups, muscle fibers and sequences were not significantly damaged, and a small amount of adipocyte infiltration was visible in the interstitial space. There were statistically significant differences in the mRNA expression and protein expression of Wnt5a, GSK3, and β-catenin in the gastrocnemius among groups (P<0.001). Conclusions The histopathological changes of gastrocnemius muscle injury recover gradually over time, and the pressing and kneading method stimulates the mRNA expression activities of Wnt5a, GSK3, and β-catenin, which may slow down the degradation of β-catenin protein by the scaffolding protein complex (of which GSK3 is an important component), so that the protein level of β-catenin is maintained in the stable range at all times. This leads to a reduction of fatty degeneration in the gastrocnemius muscle after the intervention of pressing and kneading method, and promotes the functional repair of the injured skeletal muscle.
