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.
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 evaluate the effectiveness and safety of chemotherapy regimens represented by pirarubicin (THP) vs. adriamycin hydrochloride (ADM) for non-Hodgkin lymphoma (NHL) in mainland China. Methods The randomized controlled trials (RCTs) about THP vs. ADM for treating NHL were collected in the databases such as CNKI, CBM, VIP and WanFang Data, and the references of the included studies were also retrieved manually, with the retrieval time from January 1989 to September 2012. According to the inclusion and exclusion criteria, two reviewers independently screened articles, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 15 RCTs involving 1 659 patients were included. The results of meta-analysis showed that: a) As for the total effective rate, the CTOP (C: cyclophosphamide, T: pirarubicin, O: vincristine, P: prednison) regimen was superior to the CHOP (C: cyclophosphamide H: adriamycin hydrochloride, O: vincristine, P: prednison) regimen with a significant difference (OR=1.07, 95%CI 1.02 to 1.12, P=0.006); and b) As for the safety, there were significant differences between the two groups in the incidence of cardiac toxicity (OR=0.42, 95%CI 0.30 to 0.57, Plt;0.000 01), gastrointestinal tract response (OR=0.69, 95%CI 0.56 to 0.85, P=0.000 5) and liver damage (OR=0.69, 95%CI 0.48 to 1.00, P=0.05). But no significant differences were found between the two groups in the incidence of mye1osuppression: the decreased hemoglobin (OR=0.83, 95%CI 0.61 to 1.14, P=0.25), leucopenia (OR=0.85, 95%CI 0.68 to 1.07, P=0.17), and thrombocytopenia (OR=0.99, 95%CI 0.70 to 1.39, P=0.95). Conclusion Based on the domestic evidences at current and compared with CHOP regimen represented by ADM, CTOP regimen represented by THP for treating NHL shows a higher total effective rate and less side effects. However, more high quality, large sample and double blind RCTs are required to prove this conclusion for the quality and quantity limitation of the included studies.
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.
Abstract: Objective To evaluate the feasibility and safety of combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis for the treatment of esophageal cancer. Methods We retrospectively analyzed clinical data of 40 patients with esophageal cancer who underwent esophagectomy in Beijing Chaoyang Hospital of Capital Medical University from March 2010 to March 2012. All the 40 patients were divided into 2 groups according to their different surgical approach， including 22 patients who underwent combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis （minimally invasive surgery group） and 18 patients who underwent Ivor Lewis esophagectomy （open surgery group）. Operation time， intra-operative blood loss， lymph node dissection， postoperative morbidity， hospital stay and cost were compared between the two groups. Results The hospitalcost of minimally invasive surgery group was significantly higher than that of open surgery group ［（78 181.5±8 958.8） yuan vs. （61 717.2±35 159.4） yuan， Z=4.078，P=0.000］ . There was no statistical difference in operation time ［（292.0±74.8） min vs. （256.1±41.0） min， t=1.838，P=0.074］， intra-operative blood loss ［（447.7±597.0） ml vs. （305.6±125.9） ml， Z=0.401，P=0.688］， total number of dissected lymph nodes （230 vs. 215， t=1.714，P=0.095）， postoperative morbidity ［22.7% （5/22） vs. 33.3% （6/18）， χ2=0.559，P=0.498］， time to resume oral intake ［（8.5±3.5） d vs. （11.1±9.6） d，t=1.202，P=0.237］， and postoperative hospital stay ［（11.6±5.7） d vs. （13.3±9.4） d， t=0.680， P=0.501）］ between the two groups. The minimally invasive surgery group was further divided into two subgroups according to operation date， including 10 patients in the early stage subgroup and 12 patients in the later stage subgroup. The operation time of the later stage subgroup was significantly shorter than that of the early stage subgroup ［（262.9±64.9） min vs. （327.5±73.0） min， t=2.197， P=0.040］， but not statistically different from that of the open surgery group ［（262.9±64.9） min vs. （256.1 ±41.0） min， t=0.353， P=0.727］. Intra-operative blood loss of the later stage subgroup was significantly reduced compared with those of the early stage subgroup ［（220.8±149.9） ml vs. （720.0±808.0） ml， Z=3.279， P=0.001)］ and the open surgery group ［（220.8±149.9）ml vs. （305.6±125.9） ml， Z=2.089， P=0.037）］. Conclusion Combined laparoscopic and thoracoscopic esophagectomy and intrathoracic esophagogastric anastomosis is a safe and effective surgical procedure for the treatment of esophageal cancer.
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.
目的 建立犬开放性气胸海水浸泡的实验模型 ,探讨实验动物早期死亡原因。 方法 2 0条健康成年杂种犬随机分为两组。对照组 :实验动物受伤后直接观察 ;实验组 :动物受伤后置入人工配制的海水中。监测血流动力学、呼吸、血液渗透压、血液电解质、动脉血气变化以及肺部病理改变。 结果 实验组死亡率明显高于对照组 ,平均生存时间为 45分钟。实验组经海水浸泡后有急性呼吸和循环功能衰竭、严重电解质平衡紊乱、高渗血症、重度肺损伤以及严重代谢性和呼吸性酸中毒。 结论 开放性气胸后海水浸泡可引起一系列严重的病理生理变化 ,其结果是导致实验动物早期死亡的重要原因。
Objective To explore the shortterm clinical effects of complex transplantation among the acellular dermal matrix(ADM) of heterogenic or heterocatal and autogenic split on the burnt wound as to find out a permanent substitution for the treatment on full skin thickness defect without scar. Methods Two kinds of ADM were used on the 18 patients with full thicknessburn wound through complex transplantation with autogenic splits. The patients with medialthickness autograft was used as control group. Survival rate was obtained 2 weeks after operation; contraction rate and the scores of Vancouver burn scale were obtained 8 weeks after operation. Results No significant difference was observed in survival rate among the three groups 2 weeks after operation(P＞0.05); no significant difference was observed in contraction rate of autografts and scores of Vancouver burn scale among the three groups 8 weeks after operation(P＞0.05). Conclusion ADM of heterogenic and ADM of heterocatal have similar effect on the reconstruction of skin, so the piglet ADM made in this way could be used as a substitution.
Objective To compare the combination of Xiao Chai Hu Tang and interferon versus the simple interferon for the management of chronic hepatitis B (CHB) in terms of clinical therapeutic effect and safety. Methods Such databases as PubMed, CBM disc, CNKI, VIP, Japana Centra Revuo Medicina were searched to include the randomized control trials (RCTs) of treating chronic hepatitis B by using Xiao Chai Hu Tang plus interferon as the treatment group and the interferon as the control group. The quality of the inclusive methodology was evaluated by two reviewers independently. RevMan5.0.24 software was employed for meta-analyses. Results Seven RCTs involving 668 patients were included and all of them were classified as Grade C methodologically. The results of meta-analyses demonstrated: compared with the simple interferon treatment, adding Xiao Chai Hu Tang to interferon was able to significantly increase the HBV-DNA negative conversion ratio (RR=1.44, 95%CI 1.18 to 1.76, P=0.000 4) and the HBeAg negative conversion ratio (RR=1.54, 95%CI 1.21 to 1.94, P=0.000 4); when the intervention duration was more than 12 weeks, the ALT normalization rate was improved significantly (24 weeks: RR=1.39, 95%CI 1.17 to 1.66, P=0.000 2; 12 weeks: RR=1.79, 95%CI 1.23 to 2.61, P=0.002) and the incidence of flu-like symptoms induced by interferon was significantly reduced (liver-protection treatment: RR=0.54, 95%CI 0.40 to 0.73, Plt;0.000 1; Non-liver-protection treatment: RR=0.75, 95%CI 0.59 to 0.95, P=0.02). The funnel plot was asymmetric, indicating publication bias. Conclusion Although Xiao Chai Hu Tang maybe has certain potential supplementary benefits to interferon for the management of CHB. The results of the above meta-analyses should be interpreted prudently because there exit disparities in domestic and international trails with the shortage of double blind or multi-centered clinical trials with high quality. The current evidence provides no way to compare the combination of Xiao Chai Hu Tang plus interferon with the simple interferon for the treatment of CHB and no accurate conclusion in terms of clinical therapeutic effects and safety.