To compare the perioperative safety and short-term efficacy between robot- and video-assisted thoracoscopic lung cancer surgery based on propensity scores matching.

The clinical data were from 286 patients with primary lung cancer undergoing lobectomy or sublobectomy and lymph node dissection or sampling in the Department of Thoracic Surgery, Qilu Hospital of Shandong University from August 2020 to October 2020. Among them, 130 cases underwent Da Vinci robot-assisted thoracic surgery (RATS) , while 156 cases underwent video-assisted thoracic surgery (VATS) . The perioperative data were compared after controlling confounding factors by propensity score matching.

Eighty-eight cases in each group were successfully matched by propensity score matching analysis. The operational time of the RATS group was slightly longer than that of the VATS group , the difference was not statistically significant (P=0.625) . The intraoperative blood loss in the RATS group was less than that in the VATS group (P<0.001) . The number of lymph node dissection stations (P<0.001) and the number of lymph node dissections (P=0.031) in the RATS group were higher. In terms of hospitalization expenses, the RATS group was higher than that compared with the VATS group (P<0.001) . There was a statistically significant difference in the results of the NRS score after operation (P<0.001) , and the NRS score was higher. There were no statistically significant differences in lymph node ascending rate, time of drainage, drainage, hospital stay after operation, and postoperative complications (P>0.05) .

RATS has similar perioperative safety and short-term efficacy to VATS in resectable lung cancer. RATS has advantages in intraoperative blood loss and lymph node dissection. The disadvantage is the increased hospitalization cost and postoperative pain.

To study whether there is any difference in postoperative quality of life between breast cancer patients undergoing immediate breast reconstruction and breast mastectomy without breast reconstruction.

From November 2017 to November 2019, 150 breast cancer patients underwent modified radical mastectomy in the Department of Breast Cancer Surgery, the First Affiliated Hospital of Hainan Medical University. According to different operation method, the patients were divided into the immediate reconstruction group (radical + reconstruction group, n=25) and the mastectomy without immediate breast reconstruction group (total mastectomy group, n=125). According to the EORTC QLQ-BC45 (Quality of life questionnaire for assessing quality of life in breast cancer patient), the quality of life in two groups of patients was assessed 6 months after their surgeries. Another self-made breast cancer questionnaire was made to compare the life satisfaction of their spouses.

After the bias was eliminated by the propensity score, there were no significant differences in intraoperative blood loss, length of hospital stay, flap necrosis, drainage tube placement time, and infection. Immediate reconstruction group patients scored better in body image, sexual enjoyment, future expectations (P<0.05). The results of the self-made questionnaire analysis showed that the spouses of the immediate reconstruction group scored better than the spouses of the mastectomy without immediate breast reconstruction group in terms of the body image, self-function, and emotional family (P <0.05). Logistics regression analysis suggested that age and economic level were related to the quality of life of the two groups after surgery (P<0.05).

The quality of life of patients undergoing immediate breast reconstruction is better than those undergoing breast ablation. Satisfaction with family well-being is better than that of patients with mastectomy. Age, financial level and education level may influence the choice of breast cancer patients.

To evaluate the effect of operative treatment of non-flail chest rib fractures.

A retrospective analysis of 109 patients who underwent non-flail chest rib fractures between May 2015 and June 2016 was conducted. We compared patients’ pain index and pulmonary function parameters (vital capacity, VC; forced vital capacity in the first second, FEV₁; peak expiratory flow, PEF) at different stages: at hospital admission (IN), on the day before surgery (PRE), and on postoperative days one (D1), two (D2), and seven (D7).

The 109 patients included 85 men (78.0%) and 24 women (22.0%) between the age of 23 and 74 ( with a mean of 52). 75 had multiple injuries (68.8%), 34 had chest trauma solely (31.2%), the average injury severity score (ISS) was 18.2.The average number of fractured ribs was 5.8 ( ranging from 3-16). The average length of time from admission to operative intervention was 4.4 days (ranging from 1-16). The fractures healed in all patients, while superficial wound infections occurred in two cases (1.8%), skin numbness around the incision occurred in 5 cases (4.6%). Pain and pulmonary function parameters (VC, FEV₁, PEF) had improved significantly by postoperative day seven (P<0.05).

In patients with three or more non-flail chest rib fractures , early surgical treatment is safe, and can effectively relieve pain , leading to rapid recovery of lung function.

The purpose of this study is to evaluate the impact and prognostic impact of the findings on thin-section computed tomography in distinguishing multiple lung cancers from pulmonary ground glass opacity.

We reviewed the clinical data of 3254 surgically resected c-stage I lung cancer patients, 312 (9.6%)with multiple lung tumors. All patients were classified into 3 groups based on the extent of ground glass opacity (GGO) and consolidation tumor ratio (CTR), including GGO-dominant (GD)(0 ≤CTR < 0.5), solid-dominant (SD) (0.5 ≤CTR < 1.0) , and pure-solid (PS) (CTR =1.0). Patients with multiple lung tumors were divided into 6 groups based on imaging findings, including GD+ GD group, GD+ SD group, GD+ PS group, SD+ SD group, SD+ PS group and PS+ PS group , and their prognoses were compared with that of c-stage I lung cancer using Cox’s proportional hazard model.

Among all, 251(80.4%) have surgically resected more than two tumors and pathologically determined as multiple lung cancers patients . Among 312 patients , 90 in GD+ GD group (28.8%), 70 in GD + SD group(22.4%), 66 in GD+ PS group(21.2%), 16 in SD + SD group(5.1%), 27 in SD+ PS group(8.7%), and 43 in PS + PS group(13.8%). Based on the results of multivariate analyses, PS+ PS revealed the independent risk factors for prognosis impact(P<0.001). The overall survival rate (OS) was 96.7% in group GD+ GD, 98.6% in group GD + SD, 84.8% in group GD+ PS , 93.8% in group SD+ SD , 77.8% in group SD+ PS , 41.9% in group PS + PS , which showing a significant difference between PS+ PS group and the other groups (P<0.05).

Among all patients with multiple lung cancers, patients in PS+ PS group have lower survival rate, which would contribute to the upstaging of T descriptors. The imaging findings of GGO and its classifications are extremely important to prognosis evaluation.

To evaluate the clinical effects of a new method for the placement of feeding tubes in the treatment of esophageal cancer with Ivor-Lewis surgery.

A total of 117 cases with esophageal cancer in the same surgery group from January 2013 to December 2016 were collected from Department of Thoracic Surgery, Affiliated Hospital of Inner Mongolia Medical University. Before March 2015, 49 cases of enteral nutrition were treated with jejunostomy. After that date, 68 cases were treated with the new method of Nose-Duodenal feeding tube placement. Tube-placement time, tube-carrying comfort, the incidence of anastomotic leakage, pulmonary infection, and complications related to the nutrition tube were compared.

Nutrition tube were successfully placed for 117 cases. One case with nose-duodenal feeding tube placement failed. There were no hospital deaths in the two groups. The duration of operation was significantly shorter in the nose-duodenal tube group than in the jejunostomy group [(6.2±1.8) min vs (18.2±8.2) min, P<0.05]. The incidence of throat discomfort in patients with nose-duodenal tube was significantly higher than that in the jejunostomy group (36.8% vs 16.3%, P<0.05). There was no significant difference in the incidence of pulmonary infection, nausea and vomiting, and anastomotic leakage between the two groups (P>0.05). No postoperative gastric emptying and acute gastric dilatation occurred. Two patients in the jejunostomy group had abdominal wall fistula leakage (1 case was eventually extirpated due to multiple exudates), and 2 patients had incomplete intestinal obstruction; One patient in the nose-duodenal tube group had irritability after surgery. One patient pulled out the stomach tube and duodenal nutrition tube due to anxiety.

In the treatment of esophageal cancer, the use of nose-duodenal nutrition tube placement method is simple, less traumatic, shorter, with fewer complications and good clinical results.

To verify the efficacy of Caprini and Rogers risk assessment models of screening for venous thromboembolism (VTE) in patients undergoing thoracic surgery.

A single center retrospective study was performed in the department of thoracic surgery in Beijing Chao-Yang Hospital affiliated to Capital Medical University from July to December in 2016. The Caprini and Rogers risk score were recorded retrospectively for each patient. Meanwhile, by using of logistic bivariate regression analysis, we have obtained the predicted probability of Caprini and Rogers in combination diagnosis. We have drawn receiver operating characteristic curves (ROC) respectively, and calculated the area under the curve (AUC), then we have done pairwise comparison severally. The Youden index was taken as the cutoff point.

The total incidence of VTE after thoracic surgery was 13.4%. The AUC for the the Caprini model, the Rogers model and the predictive probability model were 0.713±0.043 (P<0.001), 0.577±0.062 (P=0.207) and 0.730±0.041 (P<0.001) respectively. There was no significant difference in AUC between Caprini model and the other two models (P>0.05); while the AUC of the predictive probability model was significantly higher than that of the Rogers model (P=0.015). Caprini model had a sensitivity of 0.923 and a specificity of 0.47 when the Youden index was 0.393. The Rogers model had a sensitivity of 0.385 and a specificity of 0.75 when the Youden index was 0.135. The predictive probability model had a sensitivity of 0.962 and a specificity of 0.48 when the Youden index was 0.444.

The combined use of Caprini and Rogers risk assessment model can improve the accuracy of screening for venous thromboembolism in patients undergoing thoracic surgery.

To describe the technique and outcomes for an initial series of 200 cases of lobectomy and segmentectomy using single-intercostal two-port video-assisted thoracoscopic surgery(VATS), and investigate the effect of this technique on postoperative chronic pain.

Between June 2014 and August 2015, 217 consecutive patients attempted lobectomy and segmentectomy using single-intercostal two-port VATS. Between January 2014 and June 2014, the same surgeon continuously completed 80 cases of lobectomy and segmentectomy using three-port approach. The clinical data of all these patients were retrospectively analyzed, including the data on chronic pain at the follow-up 6 months after operation.

Among the 217 patients attempting lobectomy and segmentectomy using single-intercostal two-port VATS, 200 patients(173 cases of primary lung cancer and 27 cases of benign diseases) successfully completed the operation(141 cases of lobectomy and 59 cases of segmentectomy), and the other 17 patients transferred to three-port approach or open surgery due to various reasons. Of these 200 patients, the mean duration of surgery was (160.1 ± 56.1) min, the mean number of lymph node dissection was 10.5 ± 5.3, the mean duration of hospitalization after operation was (6.4 ± 2.9)d, complications occurred in 46 patients, and 1 patient died within 30 d after surgery. A total of 92 patients undergoing single-intercostal two-port VATS and 71 patients with three-port approach were successfully followed up 6 months after surgery, the prevalence of chronic pain and the mean chronic pain score of the former were significantly lower than that of the latter[25.0% vs 43.7%, χ²=6.300, P=0.012; (2.3±0.8) vs (3.6±1.6), t=3.912, P<0.001].

Lobectomy and segmentectomy using single-intercostal two-port VATS is safe and feasible for most patients. Compared with three-port approach, this technique significantly reduces the prevalence and score of chronic pain.

To develop an aggregate score system to stratify the risk of anastomotic leakage after esophageal carcinoma surgery so as toscreen the patients with high risk for post-operative anastomotic leak.

The clinical data of patients undergoing esophageal carcinoma surgery in Department of Thoracic Surgery, Beijing Chaoyang Hospital between January 2010 and January 2015 were retrospectively collected, and a total of 285 patients were included for analysis. The independent risk factors for anastomotic leak after surgery were determined by univariate analysis and multivariate Logistic regression analysis. The scoring system was developed by proportional weighing of the independent risk factors, and patients were grouped into different classes according to their total score.

The incidence of anastomotic leak after operation was 9.5%(27/285), and the in-hospital mortality was 2.8%(8/285). Multivariate Logistic regression analysis revealed that the site of anastomosis(neck), age (>69 years) and hypoalbuminemia (<25 g/L) were independently correlated with anastomotic leak after esophageal carcinoma surgery. With each risk factor receiving weighted score of 1, the patients were divided into 4 groups with an increased incidence of anastomotic leak: score 0 group, 2.2%; score 1 group, 7.4%; score 2 group, 21.0%; and score 3 group, 37.5%.

The aggregate score system is a reliable and practical tool for identifying patients with high risk of developing anastomotic leak after esophageal carcinoma surgery.

To investigate the outcomes of fast track video-assisted thoracoscopic surgery for non-smallcell lung cancer, and summarize the treatment experience.

The clinical data of 240 patients with non-smallcell lung cancer treated in the Affiliated Hospital of Hainan Medical College between October 2011and October 2013 were retrospectively analyzed. Among these 240 patients, 170 were treated by video-assisted thoracoscopic surgery (thoracoscopic surgery group), and the other 70 were managed with conventional thoracotomy(conventional thoracotomy group). The operation time, volume of blood loss during operation, volume of postoperative chest drainage, chest tube intubation time, postoperative hospital stay and incidence of complications were compared between two groups, and the related indicators of immune stress before anesthesia(T0), 1h after skin incision(T1), at the end of operation(T2), 24 h after operation(T3) and 48 h after operation(T4) were observed.

There was no case ofperioperative death in two groups. The operation time, volume of blood loss during operation, volume of postoperative chest drainage, chest tube intubation time and postoperative hospital stay in thoracoscopic surgery group were significantly better than those in conventional thoracotomy group(t=-11.0, P=0.00; t=-3.2, P=0.00; t=-12.7, P=0.00; t=-9.4, P=0.00; t=-6.0, P=0.00). However, there was no significant difference in the incidence of postoperative complications between two groups (χ²=1.48, P=0.22). The related indicators of immune stress 24 h after operation (T3) and 48 h after operation (T4) in thoracoscopic surgery group were significantly higher than those in conventional thoracotomy group (P<0.01). The concentration of norepinephrine (NE) in the peripheral blood 24 h after operation (T3) and 48 h after operation (T4) in thoracoscopic surgery group was lower than that in conventional thoracotomy group (t=-11.81, P=0.00; t=-20.06, P=0.00).

Thoracoscopic surgery has the advantages of shorter operation time and hospitalization time, smaller volumes of blood loss during operation and postoperative drainage, less postoperative stress and immune response, and is worthy of application.

Patients with cardiovascular diseases are at high risk for thoracic surgery, and the preoperative risk evaluation and management is usually difficult. In 2014, the authority organization American Heart Association(AHA)/American College of Cardiology(ACC) and European Society of Cardiology(ESC)/European Society of Anaesthesiology(ESA) published new guidelines respectively on cardiovascular assessment and management for non-cardiac surgery and introduced a number of recommendations in the field. The article aims to comment on the two guidelines based on the clinical practice experience in Shanghai Chest Hospital in order to give some recommendations on preoperative evaluation at two aspects. First, it is aimed to identify patients for whom the perioperative period may constitute an increased risk of morbidity and mortality, aside from the risks associated with the underlying disease. Second, it may help to design perioperative strategies to reduce additional perioperative risks.

To evaluate the correlation between preoperative coagulation assays’ levels and overall survival (OS) in patients with non-small cell lung cancer (NSCLC) after complete resection.

A retrospective study of 754 patients with NSCLC undergoing complete resection was conducted at the Tianjin Medical University Cancer Institute and Hospital from January 2004 to December 2008. The correlation of preoperative coagulation assays’ levels with other variables was evaluated by Kruskall-Wallis and Mann-Whitney U test. Univariate and multivariate analysis was employed to determine the association between the preoperative level of coagulation factors and OS.

All preoperative coagulation tests’ levels prothrombin time (PT); international normalized ratio (INR); activated partial thromboplastin time (APTT); thrombin time (TT); fibrinogen (Fbg); D-dimer)were associated with T stage and clinical stage. Univariate analysis of survival showed that preoperative prolonged prothrombin time (PT) (χ²=8.254, P=0.004) and International Normalized Ratio (INR) (χ²=5.404, P=0.020), and abnormally elevated fibrinogen (Fbg) (χ²=9.184, P=0.002) and D-dimer (χ²=9.184, P=0.002) were associated with a poor prognosis. And the multivariate model confirmed preoperative D-dimer was an independent prognostic factor for the patients with NSCLC(OR=1.274, 95%CI: 1.040-1.559, P=0.019).

Preoperative prolongation of PT and INR, and elevation of Fbg and D-dimer are associated with decreased survival in NSCLC patients, and preoperative plasma D-dimer level is an independent prognostic factor of survival in patients with NSCLC after complete resection.