Objective To investigate the clinical characteristics and risk factors for perioperative lung surgery patients with SARS‐CoV‐2 Omicron variant infection. Methods The clinical data of patients who underwent lung surgery at the Department of Thoracic Surgery, Renmin Hospital of Wuhan University from December 1, 2022 to January 9, 2023 were retrospectively analyzed. The patients were divided into an infection group and a non-infection group according to whether they were infected with SARS-CoV-2. And the clinical data of two groups were collected and compared. Multiple linear regression analysis was used to explore the risk factors affecting the time of hospitalization. Results A total of 70 patients were enrolled in this study, including 36 (51.4%) males and 34 (48.6%) females at a median age of 61.0 (49.0, 66.8) years. There were 28 patients in the infection group and 42 patients in the non-infection group. The proportion of preoperative abnormal coagulation function and the risk of postoperative pulmonary infection in perioperative patients infected with SARS-CoV-2 were higher than those in the non-infection group (P<0.05). Subgroup analysis found that patients with preoperative SARS-CoV-2 infection were more likely to have pulmonary infection after surgery, but did not prolong the time of hospitalization or increase the risk of severe disease rate. The patients with postoperative SARS-CoV-2 infection had worse clinical prognosis, including longer time of hospitalization (P=0.004), higher ICU admission rate (P=0.000), higher lung infection rate (P=0.003) and respiratory failure rate (P=0.000). Multiple linear regression analysis showed that gender and extent of surgery were independent risk factors for prolonged hospitalization time. Conclusion Preoperative infection with SARS-CoV-2 Omicron variant will increase the risk of pulmonary infection, but it will not affect the clinical prognosis. However, postoperative infection with SARS-CoV-2 Omicron variant will still prolong the time of hospitalization, increase the ICU rate, and the risk of pulmonary complications.
ObjectiveTo explore the technical feasibility, safety, and short- and long-term efficacy of totally portal minimally invasive thoracoscopic diaphragmatic folding assisted by a stapler for the treatment of symptomatic diaphragmatic eventration in adults. MethodsAretrospective study was conducted on patients with symptomatic diaphragmatic eventration who underwent totally portal minimally invasive thoracoscopic stapler-assisted diaphragmatic folding from August 2021 to February 2025. Surgical time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and complications were recorded. One month postoperatively, diaphragmatic position, lung function [forced expiratory volume in one second (FEV1), forced vital capacity (FVC) ], and symptom relief were assessed, with extended follow-up to 36 months to monitor long-term efficacy. ResultsA total of 7 patients were included, comprising 3 (42.9%) males and 4 (57.1%) females, with an age range of 34 to 66 years and a mean age of (56.4±12.5) years. All surgeries were successfully completed without conversion to open thoracotomy or intraoperative complications. The average surgical time was (44.29±11.47) minutes, intraoperative blood loss was (25.71±33.09) mL, and the postoperative length of stay was (2.00±0.58) days. One-month follow-up showed that the diaphragmatic position returned to normal anatomical levels, FEV1 improved from preoperative (1.93±0.33) L to (2.36±0.47) L, and the effective rate of clinical symptom relief reached 100.0%. Long-term follow-up (36 months) showed: (1) Pain scores decreased from (1.14±0.38) points at one month postoperatively to (0.14±0.38) points at three months postoperatively, remaining at 0 points at six months and thereafter; (2) All patients had stable diaphragmatic positions with no recurrence; (3) FEV1/FVC was ≥80% at three months postoperatively, with three assessable patients at six months maintaining ≥80%; (4) SpO2 remained ≥95% throughout, with no hypoxic events. ConclusionTotally portal minimally invasive thoracoscopic stapler-assisted diaphragmatic folding is a minimally invasive procedure with rapid recovery, significantly improving lung function and stabilizing diaphragmatic anatomical position. Follow-up at 36 months showed complete pain relief, no recurrence, and long-term stability of lung function, making it a safe and effective surgical option for treating symptomatic diaphragmatic eventration in adults. Long-term efficacy still requires validation with a larger sample size.
Surgery is a classic traditional method for the treatment of early-stage esophageal cancer, and it is also recognized as an effective first-choice method in the medical community. With the development of endoscopic technology, esophagus-preserving comprehensive treatment of esophageal cancer has almost the same or even better effects in some aspects in the treatment of early esophageal cancer than surgery. Many clinical guidelines have also recommended it as the first-choice treatment for early esophageal cancer. The room for surgical treatment of esophageal cancer has been further compressed. This article discusses the comprehensive treatment model of esophageal cancer from the perspective of thoracic surgery, aiming to find a new position of thoracic surgery in the treatment of esophageal cancer.
ObjectiveTo explore the short-term efficacy and safety of pembrolizumab combined with chemotherapy in the neoadjuvant treatment of non-small cell lung cancer. MethodsThe clinical data of 11 male patients with non-small cell lung cancer who underwent pembrolizumab combined with neoadjuvant chemotherapy in the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from December 2019 to June 2021 were retrospectively analyzed. The average age of the patients was 52.0-79.0 (62.0±6.9) years. The imaging data and pathological changes before and after neoadjuvant treatment were compared, and adverse reactions during neoadjuvant treatment were recorded. Objective remission rate (ORR) and main pathological remission rate (MPR) and pathological complete remission rate (pCR) were the main observation endpoints. ResultsAfter preoperative neoadjuvant therapy with pembrolizumab combined with platinum or paclitaxel, all patients successfully underwent thoracoscopic radical resection of lung cancer. The ORR was 72.7%, and the MPR was 81.8%. Among them, 45.5% of patients achieved pCR. The main adverse reactions were hypoalbuminemia, decreased appetite and nausea. The mortality rate within 30 days after surgery was 0, and no tumor metastasis was observed. ConclusionPembrolizumab combined with neoadjuvant chemotherapy is safe and feasible to treat non-small cell lung cancer, and the short-term efficacy is beneficial.