ObjectiveTo discuss the safety and feasibility of no chest tube (NCT) after thoracoscopic pneumonectomy.MethodsThe online databases including PubMed, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to October 2020 to collect the research on NCT after thoracoscopic pneumonectomy. Two reviewers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The RevMan 5.3 software was used for meta-analysis.ResultsA total of 17 studies were included. There were 12 cohort studies and 5 randomized controlled trials including 1 572 patients with 779 patients in the NCT group and 793 patients in the chest tube placement (CTP) group. Meta–analysis results showed that the length of postoperative hospital stay in the NCT group was shorter than that in the CTP group (SMD=–1.23, 95%CI –1.59 to –0.87, P<0.000 01). Patients in the NCT group experienced slighter pain than those in the CTP group at postoperative day (POD)1 (SMD=–0.97, 95%CI –1.42 to –0.53, P<0.000 1), and POD2 (SMD=–1.10, 95%CI –2.00 to –0.20, P=0.02), while no statistical difference was found between the two groups in the visual analogue scale of POD3 (SMD=–0.92, 95%CI –1.91 to 0.07, P=0.07). There was no statistical difference in the 30-day complication rate (RR=0.93, 95%CI 0.61 to 1.44, P=0.76), the rate of postoperative chest drainage (RR=1.51, 95%CI 0.68 to 3.37, P=0.31) or the rate of thoracocentesis (RR=2.81, 95%CI 0.91 to 8.64, P=0.07) between the two groups. No death occurred in the perioperative period in both groups.ConclusionIt is feasible and safe to omit the chest tube after thoracoscopic pneumonectomy for patients who meet the criteria.
ObjectiveTo explore the best neoadjuvant treatment strategy for esophageal cancer and provide a theoretical basis for clinical formulation of neoadjuvant treatment plan. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched from inception to May 2022. Two researchers independently performed literature screening and data extraction. The quality of the studies was evaluated by the Cochrane risk of bias tool, and data analysis was performed in RStudio environment using R3.6.3 software. ResultsA total of 24 studies were included, covering 5 286 patients treated with surgery alone, neoadjuvant chemotherapy (NCT), neoadjuvant radiotherapy (NRT), or neoadjuvant chemoradiotherapy (NCRT) followed by combined surgical treatment. The risk of bias of the studies was low. The results of the network meta-analysis showed that combined surgical treatments after NCRT [HR=0.77, 95%CI (0.70, 0.85)] and NCT [HR=0.89, 95%CI (0.81, 0.98)] were effective methods to improve patients' overall survival (OS) compared with surgery alone. In addition, NCRT could significantly reduce the incidence of local recurrence [OR=0.43, 95%CI (0.30, 0.58)] and distant metastasis [OR=0.71, 95%CI (0.52, 0.93)] in patients with esophageal cancer. However, NCRT [RR=1.30, 95%CI (0.77, 2.20)] increased the mortality rate of patients at 30 d after surgery. ConclusionThe available evidence suggests that NCRT combined with surgery is the best option for treating patients with resectable esophageal cancer, but this treatment carries the risk of increased 30 d postoperative mortality. Future studies should focus on optimizing the NCRT regimen with the aim of improving patients’ OS while effectively reducing postoperative mortality. In addition, more high-quality randomized controlled trials are needed to support the results of the study.
Objective To integrate and analyse the burden of disease of oesophageal cancer due to alcohol consumption and the differences between males and females in China from 1990 to 2019, and to predict the trend of change in the burden of disease from 1990 to 2019, in order to improve its prevention and treatment strategies. Methods Data on the burden of disease of oesophageal cancer due to alcohol consumption in China from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) 2019 database and integrated and analysed, and the corresponding trends were analysed by the Joinpoint regression model using Joinpoint 4.9.1.0 software. The grey prediction model [GM (1, 1)] was used to predict the disease burden status of oesophageal cancer attributable to alcohol consumption in China from 2020 to 2029. Results Oesophageal cancer attributable to tobacco, alcohol consumption, high BMI, and insufficient fruit and vegetable intake accounted for the first, second, third, fourth, and fifth largest number of oesophageal cancer deaths in 2019 in China, respectively. In terms of gender, the number of deaths and the standardised mortality rate of males in 2019 were 18.97 and 20.00 times higher than those of females, respectively; the number of DALYs and the standardised DALYs rate of females in 2019 were 33.08 and 24.78 times higher than those of females, suggesting that the disease burden of oesophageal cancer due to alcohol consumption is higher among females in China. From 1990 to 2019 Chinese oesophageal cancer due to alcohol consumption, the AAPC values for the number of deaths and the number of DALYs were 2.08% and 1.63%, respectively, which showed an increasing trend, and the change trend was statistically significant (P<0.05); the AAPC values for the standardised death rate and the rate of standardised DALYs were -0.92% and -1.23%, respectively, which showed a decreasing trend, and the change trend was statistically significant (P<0.05). The overall burden of disease for all age groups from 1990 to 2019 showed an increasing trend, with both their mortality and DALYs rates increasing with age, and the elderly population aged 55 years or older was the main group of the burden of disease. The grey prediction model showed that the overall standardised mortality rate and standardised DALYs rate declined to 2.94/100 000 and 67.94/100 000, respectively, by 2029, with a greater decline in females than in females. Conclusion Although the burden of disease for alcohol-induced oesophageal cancer in China has decreased over the past 30 years, it is still low compared with the overall burden of disease for oesophageal cancer, and the burden of disease for females is much higher than that for females. Focusing on prevention and treatment for males and the elderly remains a major problem for drinking-induced oesophageal cancer in China.