In recent years, with the improvement of CT resolution, the reduction of radiation dose, the popularization of lung cancer screening and the enhancement of people's health awareness, the detection rate of lung nodules is higher and higher. Due to the close relationship between lung nodules and lung cancer, more and more attention has been paid to them. Although patients with early and middle stage lung cancer receive complete resection, all postoperative patients are at risk of recurrence and metastasis. Adjuvant or neoadjuvant therapy can improve the survival and reduce the recurrence and metastasis. Therefore, the multidisciplinary team, as the best model, provides a standardized and individualized plan for the diagnosis and treatment of lung nodules and lung cancer patients. However, in the clinical practice, the work efficiency of the multidisciplinary team is not high, and the participation rate of patients is low; therefore the multidisciplinary doctor model with thoracic surgeons as the mainstay is a reasonable alternative.
Objective To study the distribution and drugresistance of pathogens isolated from patients who suffered from lower respiratory infections after thoracotomy and provide basis for rational use of antibiotics in clinical practice. Methods A total of 118 patients suffered from lower respiratory infections after thoracotomy in Beijing Lung Cancer Center and the Thoracic Surgery Department of Xuanwu Hospital between January 1,2006 and December 31, 2009. We performed a retrospective study on pathogens from their lower respiratory tract. Of these patients, 89 are male and 29 are female with a mean age of 64.6 years. Sputum specimens were obtained by sterile sputum collectors or bronchofibroscopes, and then were sent to microorganism laboratory immediately. Cytological screening was carried out before specimen inoculation. Bacterial culture, identification and drug sensitivity test were performed with routine methods. Results A total of 201 strains of pathogens from the lower respiratory tract were identified. There were 126(62.7%) strains of gramnegative bacilli, 66(32.8%) strains of grampositive cocci, and 9(4.5%) strains fungi. The four prevalent gramnegative bacilli strains with the highest isolating rate between 2006 and 2009 included 34(27.0%) strains of acinetobacters, 28(22.2%) strains of verdigris Pseudomonas, 19(15.1%) strains of Klebsiellas and 19(15.1%) strains of Escherichia coli. Verdigris Pseudomonas ranked first in isolating rate among prevalent gramnegative bacilli strains from 2006 to 2008, but it was replaced by cinetobacters (9 strains, 40.9%) in 2009. The most prevalent strains of grampositive cocci were staphylococcus aureus (35 strains, 53%) from 2006 to 2009. Gramnegative bacilli were most sensitive to imipenem and no grampositive cocci were resistant to vancomycin. Conclusion Gramnegative bacilli are the most common pathogens in lower respiratory infections after thoracotomy and show extremely high drugresistance rate. Drugresistance monitoring of pathogens should be promoted. It may contribute to rational antimicrobial therapy and effective control of infections.
Recently, World Health Organization/International Agency for Research on Cancer (WHO/IARC) published the World Cancer Report 2020. This report described the cancer burden of the world, the risk factors of cancer, biological process in cancer development and the prevention strategies of cancer. Based on current status of China’s cancer burden and prevention strategies, this paper briefly interpreted the key points of cancer prevention and control in the report.
ObjectiveThe clinical trial evidence and expert consensus in the airway management were systematically summarized in this guideline to provide clinical guidance for healthcare professionals.MethodsA total of 40 clinical questions were proposed by 32 experts, and 12 clinical questions were finally identified through the Delphi method and the PICO (patient, intervention, control, outcome) principle from 2019 to 2020. PubMed, Web of Science, Wanfang database and CNKI were searched from establishment of each database up to November, 2020. The evidence of 160 articles was graded according to GRADE method, including 18 in class A, 36 in class B, 69 in class C, and 37 in class D. Four symposiums were organized for discussion of the recommendations. Finally, 23 recommendations were made for these 12 clinical questions, among which 10 were strongly recommended and 13 were weakly recommended.ResultsSmoking cessation for at least 4 weeks, pulmonary function assessment and pulmonary rehabilitation exercise were recommended in the perioperative period, especially at least 1 week of pulmonary rehabilitation exercise for the patients with high risk factors. Anesthesia was maintained by inhalation or intravenous anesthesia. It was recommended to choose short acting drugs, monitor the depth of anesthesia and muscle relaxation during operation, and use protective ventilation strategy. Postoperative use of drugs and mechanical measures to prevent venous thromboembolism, the appropriate application of drainage tube, preemptive analgesia and multimodal analgesia for pain management were recommended. Inhaled corticosteroids with bronchodilators could be used in perioperative period to reduce airway hyperresponsiveness and postoperative cough.ConclusionFor perioperative airway management, smoking cessation, pulmonary function assessment and pulmonary rehabilitation exercise are recommended in the perioperative period. The rational use of anesthetic drugs and protective ventilation strategy are emphasized during the operations. Postoperative pain management and cough treatment should be strengthened, and drainage tube should be used properly.
Objective To compare the safety and efficacy of thulium laser wedge resection of the lung under uniportal thoracoscopy with the other two traditional surgical methods (mechanical cutting stapler wedge resection and segmentectomy) in the treatment of small pulmonary nodules.MethodsClinical data of 125 patients with small pulmonary nodules receiving uniportal video-assisted thoracoscopic surgery from December 2017 to December 2018 in our hospital were retrospectively analyzed. Among them, 33 patients had thulium laser wedge resection (a thulium laser group), including 10 males and 23 females, with an average age of 59.21±11.31 years; 48 patients had mechanical stapling pulmonary wedge resection (a mechanical stapling pulmonary wedge resection group), including 17 males and 31 females, with an average age of 57.27±11.30 years; and 44 patients had pulmonary segmentectomy (a pulmonary segmentectomy group), including 21 males and 23 females, with an average age of 63.00±9.68 years. The surgical margin air leakage, operation time, intraoperative blood loss, postoperative hospital stay, drainage days, average daily drainage volume, fever, pain and hospitalization expenses were compared among the three groups. ResultsThe body mass index, gender, smoking history, benign and malignant pathological results, average maximum diameter of lesions and lesion location distribution were not statistically different among the three groups (P>0.05). The average age and the proportion of pleural adhesions in the thulium laser group were not statistically different from those of the other two groups (P>0.05). In the distribution of the number of lesions, the proportion of multiple lesions in the mechanical stapling pulmonary wedge resection group was higher than that of the other two groups, and there was no statistical difference between the other two groups. The intraoperative blood loss in the thulium laser group was less than that of the other two groups (P≤0.05). There was no statistical difference in the classification of surgical margin air leakage or the operation time among the three groups (P>0.05). The proportion of postoperative fever and hospitalization expenses in the thulium laser group were lower or less than those of the other two groups (P<0.05). The length of hospitalization stay and postoperative chest tube placement in the thulium laser group was significantly shorter than that of the pulmonary segmentectomy group (P<0.05), which was not statistically different from the mechanical stapling pulmonary wedge resection group (P>0.05). There was no statistical difference in the average daily drainage volume or the proportion of pain among the three groups (P>0.05). Conclusion The thulium laser wedge resection under uniportal thoracoscopy is a safe, effective and economical method for the treatment of small pulmonary nodules.
ObjectiveTo explore and analyze the related influencing factors for common intraoperative complications during CT-guided percutaneous radiofrequency ablation of pulmonary tumor. MethodsWe retrospectively analyzed the clinical data of the patients who underwent CT-guided percutaneous radiofrequency ablation of pulmonary tumor in our hospital from December 2018 to December 2019, and analyzed the influencing factors for complications. ResultsA total of 106 patients were enrolled. There were 58 (54.7%) males and 48 (45.3%) females aged 46-81 (68.05±8.05) years. All patients successfully completed the operation. The operation time was 47.67±16.47 min, and the hospital stay time was 2.45±1.35 d. The main intraoperative complications were pneumothorax (16.0%, 17/106) and intrapulmonary hemorrhage (22.6%, 24/106). Univariate analysis showed that the number of pleural punctures had an impact on the occurrence of pneumothorax (P=0.00). The length of the puncture path (P=0.00), ablation range (P=0.03) and ablation time (P=0.00) had an impact on the occurrence of intrapulmonary hemorrhage. Multivariate logistic regression analysis showed that the size of the lesion (OR=17.85, 95%CI 3.41-93.28, P=0.00) and the number of pleural punctures (OR=0.02, 95%CI 0.00-0.11, P=0.00) were independent influencing factors for the occurrence of pneumothorax. The length of the puncture path (OR=15.76, 95%CI 5.34-46.57, P=0.00) was the independent influencing factor for the occurrence of intrapulmonary hemorrhage. ConclusionPercutaneous radiofrequency ablation of pulmonary tumor is safe and with a high success rate, but intraoperative complications are affected by many factors, so the surgeons should be proficient in operating skills to avoid complications.
Pulmonary adenocarcinoma in situ is reclassified as precursor glandular lesions in the fifth edition of WHO classification of thoracic tumours, causing widespread attention and heated debate among domestic thoracic oncologists, radiologists, pathologists and surgeons. We would like to comment on the topic and make a few suggestions on the management of pulmonary nodule during lung cancer screening. We are open to all suggestion and welcome debates.
Recently, sponsored by the Science Popularization Department of the China Anti Cancer Association, jointly organized by the Rehabilitation Branch of the China Anti Cancer Association and the Mijian Digital Cancer Patient Course Management Platform, and co-organized by the Science Popularization Special Committee of the China Anti Cancer Association, The "2022 White Paper on the Quality of Life of Chinese Lung Cancer Patients" has been officially released (herein after referred to as the "White Paper"), which mainly elaborates on the basic situation of Chinese lung cancer patients and the medical, social, and economic impacts caused by the disease. This article interprets the White Paper in order to help the public understand the real situation of lung cancer patients and provide important empirical evidence and valuable insights for the diagnosis, treatment, and rehabilitation of lung cancer in China.
With the widespread application of high-resolution and low-dose computed tomography (CT), especially the increasing number of people participating in lung cancer screening projects or health examinations, the detection of pulmonary nodules is increasing. At present, the relevant guidelines for pulmonary nodules focus on how to follow up and diagnose, but the treatment is vague. And the guidelines of European and American countries are not suitable for East Asia. In order to standardize the diagnosis and treatment of pulmonary nodules and address the issue of disconnection between existing guidelines and clinical practice, the Lung Cancer Medical Education Committee of the Chinese Medicine Education Association has organized domestic multidisciplinary experts, based on literature published by experts from East Asia, and referring to international guidelines or consensus, the "Chinese expert consensus on multidisciplinary minimally invasive diagnosis and treatment of pulmonary nodules" has been formed through repeated consultations and thorough discussions. The main content includes epidemiology, natural course, malignancy probability, follow-up strategies, imaging diagnosis, pathological biopsy, surgical resection, thermal ablation, and postoperative management of pulmonary nodules.
Lung cancer is the highest morbidity of malignant tumor in China, and bone metastasis is one of the common sites. With the development of imaging and nuclear medicine technology, the level of early diagnosis of bone metastasis has been improved. There are also many evidence-based evidences and advances in systemic therapy (chemotherapy, targeted therapy, immunotherapy) and bone modification drugs for treatment of bone metastases from lung cancer. The comprehensive treatment model under the guidance of multiple disciplines (including medical oncology, surgery, radiotherapy, interventional medicine, nuclear medicine, psychological rehabilitation, etc.) has been widely implemented in clinical practice. Therefore, Lung Cancer Medical Education Committee of China Medicine Education Association, Youth Specialists Committee of Lung Cancer, Beijing Medical Award Foundation and Lung Cancer Specialty Committee of Chinese Elderly Health Care Association have written the "Chinese Clinical Guidelines on Diagnosis and Treatment of Lung Cancer Bone Metastasis (Version 2024)", based on the "Expert Consensus on Diagnosis and Treatment of Lung Cancer Bone Metastasis (Version 2019)". The aim is to enhance the comprehensive treatment level of lung cancer bone metastasis in China.