ObjectiveTo review the clinical experience and evaluate the results in patients who underwent caudate lobectomy for malignant tumor at caudate lobe of liver.
MethodsClinicopathological characteristics of 51 patients who underwent caudate lobectomy because of malignant tumors at caudate lobe of liver in our hospital from May 2007 to December 2013 were reviewed retrospectively, and operative detail, complication rate, and survival rate were described.
ResultsThe cancer were resected successfully in 51 patients with malignant tumors at caudate lobe of liver. Thirty patients were performed isolated caudate lobectomy and 21 patients performed combined lobectomy. Of the 51 patients, 9 patients were treated with retrograde caudate lobectomy. The operation time was 180.0-360.0 min, with the average value of 244.0 min. The bleeding volume was 400.0-1 000.0 mL, with the average value of 630.0 mL. In all patients, there was no perioperative death and no postoperative bleeding happened, and 17 patients who suffered from interrelated complications were cured or got better by conservative treatments. Fifty-one patients were followed up for 6-60 months, and the median survival time was 38.0 months. During the follow-up period, 29 patients dead, 21 patients suffered from recurrence, and 12 patients suffered from metastasis. The cumulative survival rates of 1-, 3-, and 5-year were 76.1%, 54.7%, and 31.8% respectively after caudate lobectomy.
ConclusionThe caudate lobectomy in treatment of malignant tumor at caudate lobe of liver is effective and feasible.
ObjectiveTo investigate the effect of multi-sided foramen ultrafine drainage tube with metal support on the formation of thoracic residual cavity after uniportal video-assisted thoracoscopic (VATS) upper lobectomy. MethodsThe clinical data of the patients who underwent uniportal VATS upper lobectomy for lung cancer in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from January 2021 to April 2022 were retrospectively analyzed. According to the type of ultrafine drainage tube used in the surgery, the patients were divided into a test group (using metal-supported multi-sided foramen ultrafine drainage tube) and a control group (using ordinary 12F ultrafine drainage tube). The incidence of postoperative thoracic residual cavity and operation-related data were compared between the two groups. ResultsA total of 200 patients were enrolled, including 126 males and 74 females, with a mean age of 57.52 years. There were 90 patients in the test group, and 110 patients in the control group. The incidence of postoperative thoracic residual cavity in the test group was lower than that in the control group (P=0.045). The differences in the postoperative bedtime, postoperative visual analogue scale, postoperative analgesic pump using time, postoperative hospitalization time, times of postoperative thoracentration and drainage, postoperative drainage time and hospitalization cost between the two groups were statistically significant (P<0.05). The incidences of postoperative lung infection, pleural effusion and atelectasis complications were lower in the test group than those in the control group (P<0.05). The differences in the preoperative anesthesia time, operation time, intraoperative bleeding and postoperative lung leakage were not statistically significant (P>0.05). ConclusionThe use of multi-sided foramen ultrafine drainage tube with metal support can reduce the incidence of thoracic residual cavity after uniportal VATS upper lobectomy, and can reduce pain and economical burdens and the incidence of operation-related complications, accelerating the recovery of patients after surgery. The application of multi-sided foramen ultrafine drainage tube with metal support in uniportal VATS upper lobectomy can be widely used in the clinic.
ObjectiveTo compare the postoperative enhanced recovery outcomes of lobectomy performed under non-intubated video-assisted thoracic surgery (NIVATS) versus intubated video-assisted thoracic surgery (IVATS). Methods Computerized searches were performed in the following databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Information, China Biomedical Literature Database (CBMdisc), Web of Science, Clinicaltrials.gov, The Cochrane Library, EMbase, and PubMed. We collected randomized controlled trials (RCTs) and observational studies comparing NIVATS and IVATS. The search period extended from the inception of each database to April 1, 2023. Two independent researchers screened the literature and assessed study quality. ResultsA total of 14 studies were included, comprising 4 RCTs, 7 retrospective cohort studies, and 3 propensity score matching studies, involving 1 840 patients. Meta-analysis results indicated that, compared to IVATS, NIVATS was associated with significantly shorter operative time [MD=–13.39, 95%CI (–20.16, –6.62), P<0.001], shorter length of hospital stay [MD=–0.81, 95%CI (–1.39, –0.22), P=0.005], shorter chest tube duration [MD=–0.73, 95%CI (–1.36, –0.10), P=0.02], shorter postoperative anesthesia recovery time [MD=–20.34, 95%CI (–26.83, –13.84), P<0.001], and shorter time to oral intake after surgery [MD=–5.68, 95%CI (–7.63, –3.73), P<0.001]. Furthermore, NIVATS showed a lower incidence of postoperative airway complications [OR=0.49, 95%CI (0.34, 0.71), P<0.001] and less total chest tube drainage volume [MD=–251.11, 95%CI (–398.25, –103.98), P<0.001], all contributing to significantly accelerated postoperative enhanced recovery for patients. Conclusion NIVATS is a safe and technically feasible anesthesia method in thoracoscopic lobectomy, which can to some extent replace IVATS.
ObjectiveTo explore the effects of rehabilitation therapy on postoperative pulmonary function and exercise capacity of patients with lung cancer during the hospitalization in the setting of enhanced recovery after surgery (ERAS) protocols.MethodsA total of 110 lung cancer patients undergoing thoracoscopic lobectomy in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from September 2017 to December 2018 were randomly divided into the rehabilitation treatment group (the trial group, n=54) and the non-rehabilitation treatment group (the control group, n=56). The trial group got out of bed within 24 hours after surgery and performed respiratory rehabilitation training. The control group did not receive rehabilitation after surgery. Pulmonary function and 6-minute walking distance (6MWD) were evaluated preoperatively and prior to discharge in both groups to compare the differences in pulmonary function and exercise capacity between the two groups.ResultsThe preoperative forced vital capacity (FVC) in the trial group and the control group were (2.45±0.57) and (2.47±0.61) L, respectively; the forced expiratory volume in the first second (FEV1) were (2.29±0.55) and (2.22±0.55) L, respectively; 6MWD were (592±51) and (576±57) m, respectively; the differences between the two groups were not statistically significant (P>0.05). Prior to discharge, the FVC in the trial group and the control group were (1.43±0.36) and (1.19±0.33) L, respectively; FEV1 were (1.28±0.32) and (1.06±0.61) L, respectively; 6MWD were (264±43) and (218±37) m, respectively. The results of pre-discharge evaluation were significantly lower than those of preoperative evaluation (P<0.01). The pre-discharge FVC, FEV1, and 6MWD in the trial group were significantly superior to those in the control group (P<0.01).ConclusionIn the setting of ERAS protocols, postoperative rehabilitation therapy during hospitalizations can improve pulmonary function and promote the recovery of exercise capacity in lung cancer patients more effectively.
Surgery has remained the cornerstone of lung cancer therapy. Sleeve lobectomy, which is featured by not only the maximal resection of tumors but also the maximal preservation of functional lung parenchyma, has been proved to be a valid therapeutic option for the treatment of some centrally located lung cancer . Evidence points toward equivalent oncologic outcomes with improved survival and quality of life after sleeve resections compared with pneumonectomy. However, the postoperative morbidities and the long-term results after sleeve lobectomy remain controversial, especially in relation to nodal involvement and after induction therapy. With the development of technology, minimally invasive procedures have been performed more and more widely.
Objective
To evaluate the clinical effects of harmonic scalpel application in thoracoscopic surgery for lung cancer, which may guide its reasonable application.
Methods
We retrospectively analyzed the clinical data of 145 lung cancer patients receiving thoracoscopic surgery from January to March 2017 in our hospital. There were 57 patients with thoracoscopic pulmonary wedge resection, and harmonic scalpel was used in 34 patients (8 males, 26 females at age of 59.68±10.91 years), and was not used in 23 patients (13 males and 10 females at age of 59.13±11.21 years). There were 88 patients receiving thoracoscopic pulmonary lobectomy, among whom harmonic scalpel was used in 80 patients (36 males and 44 females at age of 59.68±10.91 years), and was not used in 8 patients (5 males, 3 females at age of 61.63±5.60 years). We recorded the perioperative outcomes of all patients.
Results
In the 34 patients undergoing thoracoscopic pulmonary wedge resection by harmonic scalpe, the operation time was 90.09±43.52 min, the blood loss was 21.32±12.75 ml, the number of lymph nodes resected was 5.12±4.26, duration of drainage was 3.15±1.16 d, volume of drainage was 535.00±291.69 ml, the length of postoperative hospital stay was 4.56±1.40 d, and no postoperative complication was observed. In the 80 patients receiving thoracoscopic pulmonary lobectomy by harmonic scalpel, operation time was 131.88±41.82 min, blood loss was 42.79±31.62 ml, the number of lymph nodes resected was 13.54±8.75, duration of thoracic drainage was 4.47±2.30 d, drainage volume was 872.09±585.24 ml, the length of postoperative hospital stay was 5.81±2.26 d, and 20 patients had postoperative complications. No complication occurred in the 8 patients without harmonic scalpel.
Conclusion
Harmonic scalpel showed satisfactory effectiveness and safety in lung cancer thoracoscopic surgery.
ObjectiveTo compare clinical results between single and double chest tube applications after lung cancer resection, and explore the role of single chest tube in postoperative fast track recovery.
MethodNinety-three patients with lung cancer who underwent lobectomy between March and December of 2009 in West China Hospital of Sichuan University were included in this study. All the patients were divided into a single-tube group including 46 patients (39 males and 7 females) with their age of 58.4±9.5 years, and a double-tube group including 47 patients (32 males and 15 females) with their age of 58.2±9.0 years. Drainage amount, duration, postoperative hospital stay, and incidences of pneumothorax and pleural effusion after removal of chest tubes were compared between the 2 groups.
ResultsThe percentage of patients undergoing complete video-assisted thoracic surgery (VATS) of the double-tube group was significantly higher than that of the single-tube group, and the percentage of patients undergoing thoracotomy of the double-tube group was significantly lower than that of the single-tube group (P < 0.05). Drainage amount of the double-tube group was significantly larger than that of the single-tube group (824.4±612.5 ml vs. 510.7±406.7 ml, P < 0.05). There was no statistical difference in drainage duration, postoperative hospital stay, the incidences of subcutaneous emphysema, pneumothorax, pleural effusion or re-insertion of chest drain between the 2 groups (P > 0.05).
ConclusionClinical results of single chest tube is better than or equivalent to those of double chest tubes after lung cancer resection, and drainage duration of single chest tube application might be shorter.
Objective To investigate the risk factors of postoperative urinary retention of non-small cell lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy without indwelling urinary catheterization.
Methods In this prospective trial, we recruited 148 patients who were scheduled for lung cancer lobectomy under general anesthesia by VATS in Department of Thoracic Surgery in West China Hospital from July through December 2015. These patients were divided into two groups including a trial group and a control group. There was no indwelled urethral catheter in the trial group. And the patients in the control group were indwelled urethral catheter routinely. Postoperative urinary retention, urinary tract infection, the postoperative hospitalization duration and the clinical data were recorded.
Results There was no significant difference between the trial group and the control group in postoperative urinary retention (9.46% vs. 6.76%, P=0.087). However, the ratios of the male patients and the patients with history of abdomen operation, and international prostate symptom score (IPSS) of the urinary retention patients (83.33%, 33.33%, 26.55±7.00) were statistically higher than those of the patients without urinary retention (56.62%, 0.00%, 15.31±8.31, P=0.017, P=0.000, P=0.031). Postoperative urinary tract infection rates in the trial group and the patients with urinary retention (4.05%，25%) were statistically higher than those in the control group and the patients without urinary retention (1.35%, 0.74%, P=0.049, P=0.048).
Conclusion The risk factors of postoperative urinary retention patients with non-small cell lung cancer undergoing VATS lobectomy are male patients, history of abdomen operation, and moderate to severe hyperplasia of prostate.
ObjectiveTo investigate the impact of chronic obstructive pulmonary disease (COPD) and surgical approach on postoperative fast track recovery and hospitalization cost of patients undergoing lung cancer resection, and explore clinical pathways and clinical value of fast track recovery.
MethodClinical data of 129 consecutive patients undergoing lung cancer resection by one surgical group in West China Hospital from January 2010 to March 2011 were retrospectively analyzed. According to whether the patients had concomitant COPD, all the patients were divided into COPD group including 53 patients (39 males and 14 females) with their average age of 56.31±10.51 years, and non-COPD group including 76 patients (37 males and 39 females) with their average age of 65.92±7.85 years. According to different surgical approaches, all the patients were divided into complete video-assisted thoracoscopic surgery (VATS) group including 83 patients (44 males and 39 females) with their average age of 61.62±10.80 years, and routine thoracotomy group including 46 patients (32 males and 14 females) with their average age of 62.95±9.97 years. Postoperative morbidity, average hospital stay and hospitalization cost were compared between respective groups.
ResultsThere was no statistical difference in postoperative morbidity (53% vs. 40%, P=0.134)or average hospital stay[(7.66±2.95) days vs. (7.36±2.74)days, P=0.539] between COPD group and non-COPD group. Postoperative morbidity (34% vs. 65%, P < 0.001)and average hospital stay[(6.67±2.52)days vs. (8.61±3.01) days, P < 0.001] of VATS group were significantly lower or shorter than those of routine thoracotomy group. Total hospitalization cost (￥44 542.26±11 447.50 yuan vs. ￥23 634.13±6 014.35 yuan, P < 0.001) and material cost (￥37 352.53±11 807.81 yuan vs. ￥12 763.08±7 124.76 yuan, P < 0.001) of VATS group were significantly higher than those of routine thoracotomy group. Average medication cost of VATS group was significantly lower than that of routine thoracotomy group (￥7 473.54±4 523.70 vs. ￥10 176.71±6 371.12, P < 0.001). There was no statistical difference in other cost between VATS group and routine thoracotomy group.
ConclusionVATS lobectomy can promote postoperative fast track recovery of lung cancer patients, but also increase material cost of the surgery. COPD history does not influence postoperative fast track recovery or hospitalization cost.
Objective To explore the effect of early short-term use of low-dose steroids on early acute lung injury (EALI) after video-assisted thoracoscopic lobectomy. Methods Patients who underwent video-assisted thoracoscopic lobectomy in our department from January 2019 to January 2022 were selected for this retrospective cohort study. They were divided into an early steroid treatment group and a control group based on whether steroids were used in the early postoperative period. In the early steroid treatment group, in addition to routine postoperative treatment, low-dose methylprednisolone was administered intravenously, at 80-120 mg/d for 3 consecutive days. In the control group, routine postoperative treatment was given, but no steroids were used in the first 3 days. A chest computed tomography (CT) scan was performed on postoperative day (POD) 1, and POD3 or POD4 to assess lung injury. Chest CT scores, the EALI incidence, the length of hospital stay, and the incidence of poor incision healing were recorded. ResultsA total of 521 patients were included, consisting of 255 males and 266 females, aged 11-80 years. There were 203 patients in the early steroid treatment group and 318 patients in the control group. On POD1, the incidence of EALI was 16.0% in the control group and 13.8% in the steroid group, with no significant difference between the two groups (P>0.05). There was also no significant difference in the CT scores of patients with EALI in the two groups (P>0.05). On POD3/4, the incidence of EALI was 33.6% in the control group and 22.7% in the steroid group, showing a significant difference (P=0.007). When comparing the CT scores of patients with EALI in both groups, the scores were lower in the steroid group, but the difference was not significant (P>0.05). The overall incidence of EALI on POD1-4 was 37.4% in the control group and 26.1% in the steroid group, showing a significant difference (P=0.007). Of these, 28.9% of patients in the control group showed radiological progression, which means new EALI occurred or existing EALI progressed, while the progression rate was 14.8% in the steroid group (P<0.001). The length of hospital stay was significantly shorter in the steroid group compared to the control group (P<0.001), but the incidence of poor incision healing was not (P>0.05). Conclusion Early use of corticosteroids cannot reduce the incidence and severity of EALI on POD1, but it can reduce the incidence of EALI on POD3/4 and decrease the risk of radiological progression, and also lower the overall risk of EALI after surgery, without extended postoperative hospital stays or increased incidence of poor incision healing. Therefore, early postoperative use of low-dose corticosteroids can help to inhibit the occurrence and progression of EALI. It is suggested to use as early as possible especially in patients with high risks of postoperative EALI.
