ObjectiveTo evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer.MethodsWe analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared.ResultsThe operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05).ConclusionControlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less drainage volume, which is safe and effective.
Objective To compare the safety of manual anastomosis and mechanical anastomosis after esophagectomy by meta-analysis. MethodsThe randomized controlled trials (RCTs) about manual anastomosis and mechanical anastomosis after esophagectomy were searched from PubMed, EMbase and The Cochrane Library from inception to January 2018 by computer, without language restrictions. Two authors according to the inclusion and exclusion criteria independently researched literature, extracted data, evaluated bias risk and used R software meta package for meta-analysis. Results Seventeen RCTs were enrolled, including 2 159 patients (1 230 by manual anastomosis and 1 289 by mechanical anastomosis). The results of meta-analysis showed that: (1) there was no significant difference in the incidence of anastomotic leakage between mechanical and manual anastomosis (RR=1.00, 95%CI 0.67–1.48, P=0.181); (2) no significant difference was found in the 30-day mortality (RR=0.95, 95%CI 0.61–1.49, P=0.631); (3) compared with manual anastomosis, the mechanical anastomosis group may increase the risk of anastomotic stenosis (RR=0.74, 95%CI 0.48-1.14, P<0.001). Conclusion Esophageal cancer surgery using a linear or circular stapler can increase the incidence of anastomotic stenosis after surgery. There is no significant difference in the anastomotic leakage and 30-day mortality between manual anastomosis, linear stapler and circular stapler.
Objective To compare the short-term effectiveness and the impact on cervical segmental range of motion using Prodisc-C Vivo artificial disc replacement and Zero-P fusion for the treatment of single-segment cervical spondylosis. MethodsThe clinical data of 56 patients with single-segment cervical spondylosis who met the selection criteria between January 2015 and December 2018 were retrospectively analyzed, and they were divided into study group (27 cases, using Prodisc-C Vivo artificial disc replacement) and control group (29 cases, using Zero-P fusion) according to different surgical methods. There was no significant difference between the two groups in terms of gender, age, type of cervical spondylosis, disease duration, involved segments and preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), surgical segments range of motion, upper and lower adjacent segments range of motion, overall cervical spine range of motion, and cervical curvature (P>0.05). The operation time, intraoperative blood loss, postoperative hospitalization stay, time of returning to work, clinical effectiveness indicators (VAS score, JOA score, NDI, and improvement rate of each score), and imaging indicators (surgical segments range of motion, upper and lower adjacent segments range of motion, overall cervical spine range of motion, and cervical curvature, prosthesis position, bone absorption, heterotopic ossification, etc.) were recorded and compared between the two groups. ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05); the postoperative hospitalization stay and time of returning to work in the study group were significantly shorter than those in the control group (P<0.05). Both groups were followed up 12-64 months, with an average of 26 months. There was no complication such as limb or organ damage, implant failure, and severe degeneration of adjacent segments requiring reoperation. The VAS score, JOA score, and NDI of the two groups at each time point after operation significantly improved when compared with those before operation (P<0.05); there was no significant difference in the above scores at each time point after operation between the two groups (P>0.05); there was no significant difference in the improvement rate of each score between the two groups at last follow-up (P>0.05). The surgical segments range of motion in the study group maintained to varying degrees after operation, while it in the control group basically disappeared after operation, showing significant differences between the two groups (P<0.05). At last follow-up, there was no significant difference in the upper and lower adjacent segments range of motion in the study group when compared with preoperative ones (P>0.05), while the upper adjacent segments range of motion in the control group increased significantly (P<0.05). The overall cervical spine range of motion and cervical curvature of the two groups decreased at 3 months after operation, and increased to varying degrees at last follow-up, but there was no significant difference between groups and within groups (P>0.05). At last follow-up, X-ray films and CT examinations showed that no prosthesis loosening, subsidence, or displacement was found in all patients; there were 2 cases (7.4%) of periprosthetic bone resorption and 3 cases (11.1%) of heterotopic ossification which did not affect the surgical segments range of motion. ConclusionBoth the Prodisc-C Vivo artificial disc replacement and Zero-P fusion have satisfactory short-term effectiveness in treatment of single-segment cervical spondylosis. Prodisc-C Vivo artificial disc replacement can also maintain the cervical spine range of motion to a certain extent, while reducing the occurrence of excessive motion of adjacent segments after fusion.
ObjectiveTo investigate the effect of perioperative allogeneic blood transfusion on the prognosis of patients with non-small cell lung cancer (NSCLC).MethodsThe databases including PubMed, The Cochrane Library, EMbase, CNKI, Wanfang Data, VIP and CBM were searched for literature about the effects of perioperative allogeneic blood transfusion on the prognosis of patients with NSCLC from the inception to May 2020. Two authors independently screened the literature, extracted and cross-checked data, and negotiated to resolve differences in opinions. Review Manager V5.3 (Cochrane Collaboration, Oxford, UK) software was used for data analysis.ResultsA total of 15 articles were included, including 5 897 patients. There were 1 649 patients in the trial group and 4 248 patients in the control group. The results of meta-analysis showed that the overall survival of the control group was significantly higher than that of the trial group (OR=0.58, 95%CI 0.47-0.70, P<0.000 01). The disease-free survival of the control group was significantly higher than that of the trial group (OR=0.43, 95%CI 0.36-0.52, P<0.000 01). The recurrence rate of the control group was significantly lower than that of the trial group (OR=1.85, 95%CI 1.34-2.55, P=0.000 2).ConclusionPerioperative allogeneic blood transfusion has adverse effects on the recurrence and survival of patients with NSCLC.
ObjectiveThe main objective of this study is to systematically evaluate the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction. MethodsThis study conducted a meta-analysis using Review Manager 5.4 software to compare the efficacy and safety of proximal gastrectomy and total gastrectomy in the treatment of Siewert Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CNKI, Wanfang Data, and VIP were searched for relevant literature published through March 2023. ResultsThis study included a total of 23 articles, among which 16 were retrospective studies, 5 were prospective studies, and 2 were RCT. In total, 2826 patients, 1389 patients underwent proximal gastrectomy and 1437 patients underwent total gastrectomy. Meta-analysis showed that proximal gastrectomy had less intraoperative bleeding than total gastrectomy [MD=-19.85, 95% CI (-37.20, -2.51), P=0.02] and shorter postoperative hospital stay. Total gastrectomy had a higher number of lymph node dissections than proximal gastrectomy [MD=-6.20, 95% CI (-7.68, -4.71), P<0.00001] and a lower incidence of reflux esophagitis [MD=3.02, 95% CI (1.24, 7.34), P=0.01]. In contrast, there was no statistically significant difference between the two procedures in terms of operative time, postoperative OS (1-year OS, 3-year OS, 5-year OS) and total postoperative complications (P>0.05). ConclusionProximal gastrectomy had an advantage in terms of intraoperative bleeding and postoperative length of stay, whereas total gastrectomy had an advantage in terms of number of lymph nodes cleared and incidence of reflux esophagitis, with no significant difference in long-term survival between the two procedures.