ObjectiveTo summarize our experience of surgical resection of multiple ground-glass opacity (GGO) in recent years.MethodsClinical data of patients who underwent one-stage resections of multiple GGO from November 2015 to May 2019 in our hospital were collected, including 13 males and 52 females at an average age of 56.0±9.4 years. The clinical effects and pathological types of GGO were evaluated.ResultsTime interval from first discovery to surgery was 8-1 447 (236.5±362.4) days. There were 48 patients with unilateral surgery and 17 patients with bilateral surgery during the same period. Except for 2 patients who underwent open thoracotomy due to total thoracic adhesions, other patients underwent video-assisted thoracoscopic surgery (VATS). The mean postoperative hospital stay was 12.2±4.3 days. No severe perioperative complication or death occurred. A total of 156 GGO lesions were resected, 80 lesions were pure GGO, including 58 (72.5%) malignant lesions and 22 (27.5%) benign lesions, with an average diameter of 7.7±3.3 mm and 5.5±2.6 mm, respectively. Another 76 lesions were mixed GGO, including 69 (90.8%) malignant lesions and 7 (9.2%) benign lesions, with an average diameter of 13.6±6.6 mm and 7.7±3.5 mm, respectively.ConclusionPatients with multiple GGO should be treated with anti-inflammatory therapy firstly. When conservative treatment is ineffective and no benign outcomes are observed, surgical treatment should be considered. And when lung function is sufficient for patients to underwent surgeries, the simultaneous unilateral or bilateral thoracoscopic resection is suggested, and the sublobar resection or lobectomy methods can be adopted flexibly according to the clinical features of the lesion and the rapid pathological results, which will not increase the risk of postoperative complications. Otherwise, surgical resection should be given priority for pure GGO lesions with a diameter > 7.7 mm and mixed GGO lesions.
ObjectiveTo assess the efficacy of lymphadenectomy in different regions for esophageal squamous cell carcinomas located differently according to the lymph node grouping by Chinese expert consensus. MethodsThe medical records of 1 061 patients (886 males and 175 females with a median age of 60 (54, 65) years with esophageal cancer from March 2011 to December 2017 in our hospital were retrospectively analyzed. According to the pathological report, the lymph nodes were regrouped according to the Chinese lymph nodes grouping standard of esophageal cancer. The metastasis rate of each group of lymph nodes, the 5-year survival rate of metastatic patients and efficacy index (EI) were calculated. ResultsThe upper thoracic esophageal cancer mainly metastasized to the lymph nodes of C201-203 groups. The middle and lower thoracic tumors mainly metastasized to the lymph nodes of C205-207 groups. The lower thoracic tumor had a higher rate of metastasis to the abdominal lymph nodes. According to the metastasis rate, the mediastinal lymph nodes were divided into three regions: an upper mediastinum (C201-204), a middle mediastinum (C205-206), and a lower mediastinum (C207-209). The EIs of lymph nodes of C201-203 and C205-207 groups were higher. For patients with C201-207 groups metastasis, the 5-year survival rates ranged from 13.39% to 21.60%. For patients with positive lymph nodes in each region, tumors at different primary locations had no statistical difference in long-term survival (P>0.05). Patients with lymph nodes of C205 group in the upper thoracic tumors had lower EI and those in the middle and lower thoracic tumors had higher EIs. ConclusionThe effect of lymph node dissection in each area varies with the location of the tumor. No matter where the tumor is, it is necessary to dissect the upper mediastinal lymph nodes, especially the lymph nodes adjacent to the left and right recurrent laryngeal nerves. Group C205 should be classified into the lower mediastinal lymph nodes.
ObjectiveBy summarizing the clinical characteristics of perioperative patients with cross infection of novel coronavirus in thoracic surgery ward, to guide the prevention and treatment of nosocomial infection during the anti-epidemic period.MethodsThe clinical data of 451 patients with chest diseases in the Department of Thoracic Surgery of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 1st to 24th, 2020 were analyzed and followed up. There were 245 surgical patients and 206 non-surgical patients.ResultsIn the department, 7 patients (7/451, 1.55%) were infected with the novel coronavirus and all of them were surgical patients, whose preoperative imaging data did not reveal the imaging changes of novel coronavirus. There were 5 males and 2 females, aged 56 to 68 years. The patients with old age, smoking, surgery, coronary heart disease, chronic liver disease and tumor history were more susceptible to infection. From the spatial distribution of patient beds, it was found that the distance among infected patients was greater than 1 m, and no cross infection was found in the other patients of the same ward. During follow-up, two family members of noninfected patients were found to be infected one week after discharge. However, there was no overlap of spatiotemporal distribution between the family members and the infected patients during the hospitalization period.ConclusionThe novel coronavirus pneumonia rate in the department of thoracic surgery is low, which may be opportunistic infection. At the same time, a good control and prevention of epidemic disease can reduce the occurrence of cross infection in the department of thoracic surgery.
ObjectiveTo summarize the clinical experience in the prevention and treatment of novel coronavirus (2019-nCoV, SARS-CoV-2) disease (COVID-19) in the department of thoracic surgery of large grade A tertiary hospitals in Wuhan, and to provide feasible clinical practice strategies.MethodsThe clinical data of 41 COVID-19 patients in the department of thoracic surgery of 7 large grade A tertiary hospitals in Wuhan from December 15, 2019 to February 15, 2020 were analyzed retrospectively. There were 20 surgical patients (10 males and 10 females at an average age of 54.35±10.80 years) and 21 medical personnel (7 males and 14 females at an average age of 30.38±6.23 years).ResultsThe main clinical manifestations of COVID-19 patients were fever (70.73%) and cough (53.66%). Normal or reduced peripheral white blood cells and reduced lymphocyte counts were found in the COVID-19 patients, and some patients may have increased C-reactive protein. COVID-19 patients showed limited ground-glass opacities in early chest CT, which was evident in the edge band of lung. The disease could further develop into multiple pulmonary infiltrations, and pulmonary consolidation was found in severe cases. At the time of confirmed diagnosis, most of the medical personnel were ground-glass shadows and unilateral lesions, and even no obvious abnormalities were found in the lungs. The diagnosed COVID-19 patients were transferred to the isolation ward immediately and treated according to the "Diagnosis and Treatment Program of Novel Coronavirus Pneumonia", which was released by the National Health Commission of the People's Republic of China. At the end of follow-up on February 20, 2020, seven surgical patients (35.00%) were discharged and seven (35.00%) were dead, 13 (61.90%) medical personnel were discharged and no death was found.ConclusionsOf all COVID-19 patients in the department of thoracic surgery of hospitals in Wuhan, the proportion of severe degree and mortality in surgical patients are significantly higher than that of the general population, and medical personnel are prone to nosocomial infections. Early oxygen therapy and respiratory support may improve prognosis. During the epidemic period of COVID-19, elective or limited surgery is suggested to be postponed and the indications for emergency operation should be strictly controlled. Emergency operation is suggested to be treated in accordance with tertiary prevention. On the consideration of specialty in the department of thoracic surgery, all people of the ward should be carefully investigated for infection once one case is confirmed with COVID-19. Early detection, isolation, diagnosis, and treatment are the best preventive measures to improve the prognosis of COVID-19.