Objective To make a survival analysis for the stage ⅠA non-small cell lung cancer patients who underwent lobectomy, segmentectomy or wedge resection and to discuss whether the segmentectomy and wedge resection can be used as a conventional operation. Methods The clinical data of 474 patients diagnosed with ⅠA non-small cell lung cancer from January 2012 to June 2015 in the First Affiliated Hospital of China Medical University were retrospectively anlyzed. There were 192 males and 282 females with a mean age of 60 years. Their sex, age, histological type, tumor size, surgical pattern, smoking, drinking, survival rate, disease-free survival rate, recurrence rate were compared. Results Disease-free survival rate of patients with wedge resection was significantly lower than that of the patients undergoing lobectomy and segmentectomy (P<0.05). When tumor diameter≤19 mm, the disease-free survival rate of patients with wedge resection was lower than that of patients with lobectomy (P=0.006) and segmentectomy (P=0.065). Disease-free survival rate of patients with tumor diameter of 20-<30 mm was significantly lower than that of patients with tumor diameter≤19 mm (P=0.026). Excluding patients with wedge resection, disease-free survival of the patients with lobectomy and segmentectomy and tumor diameter of 20-<30 mm was significantly lower than that of patients with tumor diameter≤19 mm (P=0.036). Patients with wedge resection had significant higher risk of local recurrence than that of patients undergoing lobectomy (P<0.001) and segmentectomy (P=0.002). Conclusion StageⅠA non-small cell lung cancer patients undergoing segmentectomy can obtain approximate survival and disease-free survival rate compared with those with lobectomy, especially in patients with tumor diameter≤19 mm. Pulmonary wedge resection as surgical treatment of lung cancer patients must be selected carefully according to the actual situation and surgical purposes.
Objective To evaluate the clinical effects of harmonic scalpel application in thoracoscopic surgery for lung cancer, which may guide its reasonable application. Methods We retrospectively analyzed the clinical data of 145 lung cancer patients receiving thoracoscopic surgery from January to March 2017 in our hospital. There were 57 patients with thoracoscopic pulmonary wedge resection, and harmonic scalpel was used in 34 patients (8 males, 26 females at age of 59.68±10.91 years), and was not used in 23 patients (13 males and 10 females at age of 59.13±11.21 years). There were 88 patients receiving thoracoscopic pulmonary lobectomy, among whom harmonic scalpel was used in 80 patients (36 males and 44 females at age of 59.68±10.91 years), and was not used in 8 patients (5 males, 3 females at age of 61.63±5.60 years). We recorded the perioperative outcomes of all patients. Results In the 34 patients undergoing thoracoscopic pulmonary wedge resection by harmonic scalpe, the operation time was 90.09±43.52 min, the blood loss was 21.32±12.75 ml, the number of lymph nodes resected was 5.12±4.26, duration of drainage was 3.15±1.16 d, volume of drainage was 535.00±291.69 ml, the length of postoperative hospital stay was 4.56±1.40 d, and no postoperative complication was observed. In the 80 patients receiving thoracoscopic pulmonary lobectomy by harmonic scalpel, operation time was 131.88±41.82 min, blood loss was 42.79±31.62 ml, the number of lymph nodes resected was 13.54±8.75, duration of thoracic drainage was 4.47±2.30 d, drainage volume was 872.09±585.24 ml, the length of postoperative hospital stay was 5.81±2.26 d, and 20 patients had postoperative complications. No complication occurred in the 8 patients without harmonic scalpel. Conclusion Harmonic scalpel showed satisfactory effectiveness and safety in lung cancer thoracoscopic surgery.
Objective To explore the feasibility and safety of 2 μm thulium laser in thoracoscopic wedge resection. Methods The clinical data of 137 patients who underwent thoracoscopic wedge resection with thulium laser (as a thulium laser group, 64 patients, including 22 males, 42 females, average age of 58.39±10.40 years) and staplers (as a stapler group, 73 patients, including 33 males, 40 females, average age of 60.79±10.96 years) in thoracic Department of Xuanwu Hospital between April 2016 and August 2018 were retrospectively analyzed. In the study, the intraoperative blood loss, the operative time, chest tube duration, daily amount of fluid leak, hospital stay and hospitalization costs were compared between two groups. Results The intraoperative blood loss of the thulium laser group (16.05±23.67 mL) was significantly shorter or lower than that of the stapler group (28.56±32.09 mL) (P=0.011). Besides, the post operation hospital stay and hospitalization costs of the thulium laser group (4.72±2.49 d, 37 127.33±9 302.14 yuan) were also significantly shorter or lower than those of the stapler group (5.67±2.02 d, 49 545.76±13 831.93 yuan) (P=0.015, P=0.000). Furthermore, no statistical difference was found between the thulium laser group and the stapler group in the operative time (116.38±41.91 min vs. 108.36±47.25 min), total hospital stay (10.13±2.98 d vs. 11.05±3.26 d), daily amount of fluid leak (138.38±72.23 mL vs. 152.7±77.54 mL), chest tube duration (2.89±2.34 d vs. 3.52±1.48 d) and the frequency of postoperative fever (0.89±1.55 times vs. 1.23±1.70 times). Conclusion Applying 2 μm thulium laser to thorascopic wedge resection is safe and feasible. Besides, 2 μm thulium laser can achieve a similar result to that of the standard technique by using staplers.
ObjectiveTo analyze the operation outcomes and learning curve of uniportal video-assisted thoracoscopic surgery (VATS).MethodsAll consecutive patients who underwent uniportal VATS between November 2018 and December 2020 in Shangjin Branch of West China Hospital of Sichuan University were retrospectively enrolled, including 62 males and 86 females with a mean age of 50.1±13.4 years. Operations included lobectomy, segmentectomy, wedge resection, mediastinal mass resection and hemopneumothorax. Accordingly, patients' clinical features in different phases were collected and compared to determine the outcome difference and learning curve for uniportal VATS.ResultsMedian postoperative hospital stay was 5 days, and the overall complication rate was 8.1% (12/148). There was no 30-day death after surgery or readmissions. Median postoperative pain score was 3. Over time, the operation time, incision length and blood loss were optimized in the uniportal VATS lobectomy, the incision length and blood loss increased in the uniportal VATS segmentectomy, and the postoperative hospital stay decreased in the uniportal VATS wedge resection.ConclusionUniportal VATS is safe and feasible for both standard and complex pulmonary resections. While, no remarkable learning curve for uniportal VATS lobectomy is observed for experienced surgeon.
ObjectiveTo evaluate the safety and application value of three-dimensional reconstruction for localization of pulmonary nodules in thoracoscopic lung wedge resection.MethodsThe clinical data of 96 patients undergoing thoracoscopic lung wedge resection in our hospital from January 2019 to August 2020 were retrospectively reviewed and analyzed, including 30 males and 66 females with an average age of 57.62±12.13 years. The patients were divided into two groups, including a three-dimensional reconstruction guided group (n=45) and a CT guided Hook-wire group (n=51). The perioperative data of the two groups were compared.ResultsAll operations were performed successfully. There was no statistically significant difference between the two groups in the failure rate of localization (4.44% vs. 5.88%, P=0.633), operation time [15 (12, 19) min vs. 15 (13, 17) min, P=0.956], blood loss [16 (10, 20) mL vs. 15 (10, 19) mL, P=0.348], chest tube placement time [2 (2, 2) d vs. 2 (2, 2) d, P=0.841], resection margin width [2 (2, 2) cm vs. 2 (2, 2) cm, P=0.272] or TNM stage (P=0.158). The complications of CT guided Hook-wire group included pneumothorax in 2 patients, hemothorax in 2 patients and dislodgement in 4 patients. There was no complication related to puncture localization in the three-dimensional reconstruction guided group.ConclusionBased on three-dimensional reconstruction, the pulmonary nodule is accurately located. The complication rate is low, and it has good clinical application value.
Objective To investigate the surgical procedure selection, operation technique and safety of anatomic sublobar resection for pulmonary nodules. Methods The clinical data of 242 patients with clinical stage ⅠA lung cancer who underwent anatomic sublobar resection in our hospital between 2017 and 2020 were retrospectively analyzed. There were 81 males and 161 females with a median age of 57.0 (50.0, 65.0) years. They were divided into 4 groups according to the surgical methods, including a segmentectomy group (n=148), a combined segmentectomy group (n=31), an enlarged segmentectomy group (n=43) and an anatomic wedge resection group (n=20). The preoperative CT data, operation related indexes and early postoperative outcomes of each group were summarized. Results The median medical history of the patients was 4.0 months. The median maximum diameter of nodule on CT image was 1.1 cm, and the consolidation/tumor ratio (CTR) was ≤0.25 in 81.0% of the patients. A total of 240 patients were primary lung adenocarcinoma. The median operation time was 130.0 min, the median blood loss was 50.0 mL, the median chest drainage time was 3.0 d, and the hospitalization cost was (53.0±12.0) thousand yuan. The operation time of combined segmentectomy was longer than that of the segmentectomy group (P=0.001). The operation time (P=0.000), intraoperative blood loss (P=0.000), lymph nodes dissected (P=0.007) and cost of hospitalization (P=0.000) in the anatomic wedge resection group were shorter or less than those in the other three groups. There was no significant difference in the drainage time, total drainage volume, air leakage or postoperative hospital stay among the four groups (P>0.05). Conclusion The combined application of segmentectomy and wedge resection technique provides a more flexible surgical option for the surgical treatment of early lung cancer with ground glass opacity as the main component.
Lobectomy and systematic nodules resection has been the standard surgical procedure for non-small cell lung cancer (NSCLC). However, increased small-size lung cancer has been identified with the widespread implementation of low-dose computed tomography (LDCT) screening, and it is controversial whether it is proper to choose lobar resection for the pulmonary nodules. Numerous retrospective researches and randomized clinical trials, such as JCOG0201, JCOG0804/WJOG4507L, JCOG0802 and CALGB/Alliance 140503, revealed that the sublobar resection was safe and effective for NSCLC with maximum tumor diameter≤2 cm and with consolidation tumor ratio (CTR)≤0.25, and that segmentectomy was superior to lobectomy with significant differences in 5-year overall survival rate and respiratory function for patients with small-size (≤2 cm, CTR>0.5) NSCLC and should be the standard surgical procedure. It is the principle for multiple primary lung cancer that priority should be given to primary lesions with secondary lesions considered, and it is feasible to handle the multiple lung nodules based on the patients' individual characteristics.
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 assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR).MethodsWe retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively.ResultsThere was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. ConclusionMid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.
Pulmonary endometriosis (PEM) is a rare disease, which is diagnosed according to typical clinical manifestations, imaging characteristics and histopathological characteristics. This paper reports the clinical data, pathological characteristics, treatment and follow-up of 3 patients with PEM admitted to the Affiliated Hospital of Zunyi Medical University. Combined with the related literature of PEM, the clinicopathological analysis, differential diagnosis and treatment methods are discussed. To improve clinical and pathological doctors' understanding of pulmonary Endometriosis.