ObjectiveTo explore the adjuvant treatment options for elderly patients or those with low cardiopulmonary function who cannot tolerate lobectomy for peripheral solid pathological stage ⅠA (pⅠA) non-small cell lung cancer (NSCLC). MethodsA retrospective analysis was conducted on the clinical data of patients with peripheral solid pⅠA stage NSCLC treated with lobectomy and compromised sublobar resection (CSR) in our center from 2018 to 2019. The incidence of postoperative complications and independent predictors of postoperative recurrence were analyzed. Patients in the CSR group were divided into a targeted therapy group, a chemotherapy group, and an observation group based on postoperative treatment measures. The 3-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of the three subgroups before and after propensity score matching (PSM) were compared. ResultsA total of 586 patients were included, including 288 males (49.15%) and 298 females (50.85%), with a median age of 64.00 years. There were 335 patients of lobectomy and 251 patients of compromised sublobar resection. There was no statistically significant difference in the incidence of postoperative complications between the lobectomy group and CSR group [RR=0.987, 95%CI (0.898, 1.085), P=0.789). Multivariate analysis showed that gender, tumor location, and size were independent risk factors for recurrence after CSR. After PSM, 17 patients were enrolled in each of the three subgroups of CSR. Kaplan-Meier survival curve analysis showed that there was no statistically significant difference in the 3-year RFS rate (P=0.115) and 5-year OS rate (P=0.101) between the targeted therapy group and the chemotherapy group after PSM, but both were significantly better than those in the observation group (P=0.041, P=0.009). Compared with lobectomy, there was no statistically significant difference in the 3-year RFS rate (P=0.069) and 5-year OS rate (P=0.540) in the targeted therapy group, while the chemotherapy group and observation group were significantly inferior to the lobectomy group (P<0.05). ConclusionCSR for treating elderly patients or those with low cardiopulmonary function with peripheral solid pⅠA stage NSCLC does not increase the incidence of postoperative complications. Gender, tumor location, and size are independent risk factors for postoperative recurrence. In terms of 3-year RFS rate and 5-year OS rate, adjuvant targeted therapy after CSR is not only superior to chemotherapy or observation but is also not inferior to lobectomy.
ObjectiveTo investigate the clinical effect of thoracoscopic lobectomy versus segmentectomy in the treatment of T1bN0M0 non-small cell lung cancer (NSCLC). MethodsClinical data of 181 patients with T1bN0M0 NSCLC admitted to our hospital from 2012 to 2015 were retrospectively analyzed. They were divided into a lobectomy group and a segmentectomy group according to surgical methods. There were 117 patients in the lobectomy group (46 males and 71 females aged 61.32±8.94 years) and 64 patients in the segmentectomy group (20 males and 44 females aged 58.55±12.57 years). Perioperative indicators and prognosis were compared between the two groups. ResultsThe segmentectomy group had longer operation time, less intraoperative blood loss, shorter postoperative hospital stay and more preservation of lung function compared with the lobectomy group (P<0.05). The lobectomy group had higher consolidation tumor ratio, bigger tumor diameter, and more lymph node sampling compared with the segmentectomy group (P<0.05). There was no statistical difference in 5-year overall survival or recurrence-free survival between the two groups (P<0.05). ConclusionFor patients with T1bN0M0 NSCLC, thoracoscopic segmentectomy and lobectomy have similar prognosis, but segmentectomy has advantages with less injury and faster recovery over lobectomy.
ObjectiveTo compare the differences in the learning curve and surgeon's perception for pulmonary lobectomy performed by a single surgeon using the da Vinci surgical robot versus a domestically-made robotic system. Methods A retrospective analysis was conducted on the clinical data of the first 70 consecutive patients who underwent lobectomy with the da Vinci robot and the first 70 with a domestic robot. All procedures were performed by a single thoracic surgeon at Gansu Provincial Hospital who initiated the use of both systems concurrently between 2021 and 2024. Data were analyzed using SPSS 26.0, and learning curves for both groups were plotted and analyzed using the cumulative sum (CUSUM) method. Results The da Vinci group included 41 males and 29 females with a mean age of (66.0±6.83) years and the domestic robot group included 42 males and 28 females;with a mean age of (65.09±6.14) years. For the da Vinci group, the mean operative time was (196.14±29.63) min. The CUSUM learning curve was best fitted by a cubic equation (R2=0.986; CUSUM=0.012X3−1.799X2+69.149X−59.239, where X was the surgical volume), which peaked at the 26th case, delineating the learning and mastery phases. Statistically significant differences were observed between these phases in operation time, setup time, console time, intraoperative blood loss, postoperative day 1 drainage, and number of lymph nodes dissected (all P<0.01). For the domestic robot group, the mean operative time was (187.57±24.62) min. Its CUSUM learning curve also followed a cubic fit (R2=0.910; CUSUM=0.008X3−1.152X2+40.465X+91.940), peaking at the 18th case. Significant improvements between the learning and mastery phases were also found for the same surgical metrics (all P<0.05). The surgeon's perception score was significantly higher for the da Vinci system compared to the domestic system (4.21±0.88 vs. 3.29±1.02, P<0.05). ConclusionCUSUM analysis effectively distinguishes the learning and mastery phases for both systems. The learning curve for da Vinci robotic lobectomy is overcome after 26 cases, whereas the domestic robot required 18 cases. In the mastery phase, operative time, setup time, intraoperative blood loss, and postoperative day 1 drainage are significantly lower, while the number of lymph nodes dissected is significantly higher compared to the learning phase for both systems. There are no significant differences in short-term efficacy or safety between the two groups. However, the da Vinci system provids a superior surgeon experience.
ObjectiveTo analyze the effect of 3D simulation technique in thoracoscopic lobectomy.MethodsFrom June 2015 to January 2018, 124 patients with left lower lobe resection underwent thoracoscopy with single-port thoracoscopic surgery, including 64 males and 60 females, aged 42–83 years. They were randomly divided into two groups including an experimental group (preoperatively given 3D simulation surgery in 59 patients) and a control group (preoperatively not given 3D simulation surgery in 65 patients). The clinical effect between the two groups was compared.ResultsAll patients recovered without any death during hospitalization. In the experimental group, the operation time, intraoperative blood loss and postoperative hospital stay were significantly less than those in the control group (P<0.05). There was no significant difference in postoperative drainage volume, and duration of drainage tube retention and analgesic drug usage between the two groups (P>0.05).Conclusion3D simulation technique for thoracoscopic lobectomy has advantage in short operation time, minor trauma and quick recovery. It has a guiding role in the preoperative planning of lung cancer surgery and is worthy of popularization and application.
Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.
ObjectiveTo investigate the perioperative efficacy and safety of all-port robotic lobectomy versus thoracoscopic lobectomy in stageⅠA non-small cell lung cancer. MethodsThe clinical data of patients with stageⅠA non-small cell lung cancer who underwent lobectomy with lymph node dissection performed by the same operator in our center from June 2019 to June 2022 were retrospectively analyzed. The patients were divided into a robotic group and a thoracoscopic group according to different procedures. We compared the relevant indexes such as operation time, intraoperative bleeding, number of lymph node dissection stations, number of lymph node dissection, postoperative tube time, postoperative hospitalization time, closed chest drainage volume, postoperative pain, postoperative complications and hospitalization cost between the two groups. ResultsThere were 83 patients in the robotic group, including 34 males and 49 females with a median age of 60.0 (53.0, 67.0) years, and 94 patients in the thoracoscopic group, including 36 males and 58 females with a median age of 60.5 (54.0, 65.3) years. There was no conversion to thoractomy or death in postoperative 90 days in both groups. No statistical difference was seen in the operation time, total postoperative drainage volume and postoperative complication rates between the two groups (P>0.05). Patients in the robotic group had less intraoperative bleeding (P<0.001), more lymph node dissection stations (P=0.002) and numbers (P=0.005), less postoperative pain (P=0.002), and shorter postoperative time with tubes (P=0.031) and hospital stay (P<0.001). However, the surgery was more expensive in the robotic group (P<0.001). ConclusionAll-port robotic surgery is safe and effective for patients with early-stage non-small cell lung cancer with less intraoperative bleeding, more lymph node dissection, less postoperative pain, and shorter hospital stay compared with the thoracoscopic surgery.
Proper management of chest drainage after pulmonary lobectomy is a topic that every thoracic surgeon must face up to. Reasonable chest drainage plays a critical role in postoperative normal physiological recovery. However， there are still controversies and discrepancies in many aspects of chest drainage management after pulmonary lobectomy. In this review，we focus on five aspects of chest drainage management after pulmonary lobectomy，including the choice of chest drainage system，single or double chest tubes，suction or not，treatment of persistent air leak，and removal of chest tube.
Abstract： Lung torsion is a very rare clinical event and characterized by rotation of entire lung or individual lobes around the proximal bronchus or blood vessel pedicle in a single direction. The outcomes of lung torsion vary according to different rotation degree. Mild lung rotation may cause hemodynamic changes of the rotated pulmonary tissue. Severe lung rotation may lead to pulmonary venous congestion， lung infarction， systemic intoxication symptoms， ischemia， hypoxia， respiratory failure， severe infection or even death. There are a number of causes of lung torsion， including thoracic surgery， blunt chest trauma， pneumonia， pneumothorax， pleural effusion and lung transplantation. The majority of lung torsion cases occur after thoracic surgeries especially lobectomy， with the right middle lobe being most easily endangered after right upper lobectomy. Lung torsion does not have typical clinical manifestations and thus is difficult to be differentiated from other diseases. Patients with lung torsion often cannot receive correct diagnosis， proper intervention and treatment in time， which may lead to a high mortality. This review focuses on the morbidity， pathogenesis， clinical manifestations， diagnosis， prevention and treatment of lung torsion.