Objective To evaluate the efficacy and safety of perioperative comprehensive management in non- small cell lung cancer (NSCLC) with chronic obstructive pulmonary disease (COPD). Methods Clinical studies about effect of different perioperative comprehensive management on patients with early NSCLC combined with COPD were searched from PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang databases from inception to November 1st, 2017. Two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, and then meta-analysis was conducted by RevMan 5.3 and Stata 14.0 softwares. Results A total of 20 articles were identified including 1 079 patients. The results of meta-analysis showed that perioperative comprehensive management improved the forced vital capacity (FVC), maximum minute ventilation (MVV), predictive value of postoperative one-second rate (ppoFEV1%), carbon monoxide diffusing capacity (DLCO) and percent forced expiratory volume in one second (FEV1%) (MD=–0.47, 95%CI –0.62 to –0.32, P<0.000 01; MD=–0.17, 95%CI –0.22 to –0.11, P<0.000 01; MD=–4.24, 95%CI –5.37 to –3.11, P<0.000 01; MD=–7.54, 95%CI –8.33 to –6.76, P<0.000 01; MD=–1.33, 95%CI –2.16 to –0.50, P=0.002; MD=–6.93, 95%CI –9.45 to –4.41, P<0.000 1, respectively). However, there was no significant difference in the rate of DLCO (DLCO%) and ventilation at maximal workload (VEmax) between pre- and post-management (MD=–2.91, 95%CI –11.31 to 5.50, P=0.5; MD= 0.18, 95%CI –2.23 to 2.58, P=0.89, respectively). With regard to cardiac function, perioperative comprehensive management improved the maximal oxygen consumption (VO2max), 6-minute walk distance (6MWD) and anaerobic threshold (AT) (MD=–2.28, 95%CI –3.41 to –1.15, P<0.000 1; MD=–57.77, 95%CI –77.90 to –37.64, P<0.000 1; MD=–2.71, 95%CI –3.30 to –2.12, P<0.000 1, respectively). As to complications, compared with conventional treatment group, perioperative comprehensive management group had fewer postoperative short-term complications (OR=0.39, 95%CI 0.26 to 0.58, P<0.000 01). Besides, perioperative comprehensive management also shortened hospital stay (MD=–2.38, 95%CI –3.86 to –0.89, P=0.002). Conclusion Perioperative comprehensive management can significantly improve lung function in patients with NSCLC combined with COPD, reduce short-term postoperative pulmonary complications and shorten the hospital stay with good efficacy and safety.
ObjectiveTo investigate the clinical effect and prognosis of laparoscopic complete mesocolic resection (CME) in the treatment of elderly patients with stage Ⅲ right colon cancer.MethodsClinical data of 280 elderly patients (aged 60 years or older) who underwent stage Ⅲ right hemicolectomy in the First Hospital of Lanzhou University from 2010 to 2015 were collected. Among them, 160 patients underwent laparoscopic CME treatment were set as the observation group, and 120 patients underwent conventional laparotomy were set as the control group. The mean operative time, intraoperative blood loss, postoperative first anal exhaust time, number of lymph nodes dissection, number of positive lymph nodes, length of hospital stay and postoperative complications were compared between the two groups. The postoperative local recurrence rate, distant metastasis rate, 3-year cumulative survival rate and postoperative recurrence risk factors were analyzed.ResultsThere were no statistically significant differences between the observation group and the control group in operative time, number of lymph node dissection, number of positive lymph nodes and postoperative distant metastasis rate (P>0.05). The amount of intraoperative blood loss, postoperative anal first exhaust time, days of hospitalization, and postoperative recurrence rate in the observation group were less or shorter or lower than those in the control group, with statistically significant differences (P<0.05). The 3-year survival rate in the observation group was higher than that in the control group (log-rank χ2 =11.865, P=0.001), and the disease free survival in the observation group was also higher than that in the control group (log-rank χ2=7.567, P=0.006). Logistic regression was used to analyze the cases of postoperative recurrence in the two groups, and it was found that the degree of tumor differentiation, vascular invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence.ConclusionLaparoscopic CME in the treatment of elderly patients with stage Ⅲ right colon cancer is effective, it is safe and feasible, which can effectively prolong the survival time of patients.