Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To analyze the nurses' current view and perceptions of enhanced recovery after surgery (ERAS) by a questionnaire and to promote the clinical application of ERAS. Methods We conducted a questionnaire study for nurses who attended the First West China Forum on Chest ERAS in Chengdu during September 26-27, 2016 and 259 questionnaires were collected for descriptive analysis. Results (1) The application status of ERAS: There were 13.5% responders whose hospital took a wait-an-see attitude, while the others' hospital took different actions for ERAS; 85.7% of nurses believed that ERAS in all surgeries should be used; 58.7% of nurses believed that the concept of ERAS was more in theory than in the practice; 40.2% of nurses thought that all patients were suitable for the application of ERAS; (2) 81.9% of nurses believed that the evaluation criteria of ERAS should be a combination of the average hospital stay, patients’ comprehensive feelings and social satisfaction; (3) 70.7% of nurses thought that the combination of subjects integration, surgery orientation and surgeon-nurse teamwork was the best model of ERAS; 44.8% of nurses thought the hospital administration was the best way to promote ERAS applications; (4) 69.1% of responders believed that immature plan, no consensus and norms and insecurity for doctors were the reasons for poor compliance of ERAS; 79.5% of nurses thought that the ERAS meeting should include the publicity of norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion ERAS concept has been recognized by most nurses. Multidisciplinary collaboration and hospital promotion is the best way to achieve clinical applications.
ObjectiveTo explore the relation of preoperative red blood cell distribution width (RDW) with prognosis in esophageal cancer.MethodsThe PubMed, EMbase, Web of Science, Cochrane Library, VIP, Wanfang, CNKI and SinoMed databases were searched to identify potential studies assessing the correlation between preoperative RDW and prognosis of esophageal cancer patients from establishment of databases to February 2019. The endpoint events included the overall survival (OS), cancer-specific survival (CSS) and disease-free survival (DFS). The Stata 12.0 software was applied for the meta-analysis and the hazard ratio (HR) and 95% confidence interval (CI) were calculated.ResultsA total of 10 retrospective studies involving 4 260 esophageal cancer patients from China or Japan were included. The score of Newcastle-Ottawa scale (NOS) of the included studies was more than 6 points. The results demonstrated that elevated preoperative RDW was significantly associated with poor CSS (HR=1.50, 95% CI 1.14 to 1.99, P=0.004) and DFS (HR=1.45, 95% CI 1.14 to 1.85, P=0.002), while no significant association between preoperative RDW and OS in esophageal cancer was observed (HR=1.17, 95% CI 0.95 to 1.45, P=0.143). Subgroup analysis based on the pathology revealed that preoperative RDW had high prognostic value in esophageal squamous carcinoma (ESCC) (HR=1.37, 95% CI 1.05 to 1.77, P=0.018).ConclusionPreoperative RDW may be an independent prognostic factor for Chinese and Japanese esophageal cancer patients, especially for ESCC patients. However, more prospective studies with bigger sample sizes from other countries are still needed to verify our findings.
Objective To clearly define and describe the difference of analgesic actions and side effects between dezocine and parecoxib sodium in video-assisted thoracic surgery (VATS) lobectomy. Methods Ninety patients underwent thoracotomy (lobectomy) and were hospitalized in the Department of Thoracic Surgery, West China Hospital, Sichuan University between August 2015 and January 2016. Patients were randomly divided into two groups including a parecoxib sodium group (a PG group, 43 patients) and a dezocine group (a DG group, 47 patients). We analyzed the occurrence of side effects in the two groups, as well as other outcomes including visual analogous scores and location of the pain et al. Results The occurrences of nausea, vomit and abdominal distention in the PG group (9.30%, 2.33%, 13.95%) were significantly lower than those of the DG group (25.53%, 17.02%, 40.43% , P=0.046, P=0.032, P=0.009) in the early period after operation. Pain scores at the postoperative 12 h, 24 h, 48 h and 72 h in the PG group (2.56±0.96, 2.47±0.96, 1.93±0.99, 0.98±1.24) were better than those of the DG group (4.00±1.60, 3.62±1.48, 3.36±1.55, 2.47±1.78,P=0.000, P=0.000, P=0.000, P=0.002). And the same results were found in the postoperative coughing VAS assessment. The mostly reported pain location was the chest drainage, incision site and chest wall in turn. Postoperative pain properties, in turn, were swelling, stabbing pain and numbness. Conclusion Postoperative pain after VATS lobectomy may be adequately controlled using parecoxib sodium. The low pain scores and decreased adverse effects are achieved.
Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. MethodsWe retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. ResultsThe rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). ConclusionThoracic surgery in the high-altitude medical center is safe and feasible.