Objective To investigate the effect of modular disscection of mediastinal lymphadenectomy in uniportal video-assisted thoracoscopic surgery (uniportal-VATS) for lung cancer radical resection and assess its safety and feasibility. Methods Data of 311 patients (171 males and 140 females, a mean age of 59.4±5.1 years) with non-small cell lung cancer (NSCLC) who received modular dissection of mediastinal lymphadenectomy in uniportal-VATS or three portal VATS (3P-VATS group) during March to December 2015 were retrospectively analyzed. There were 208 patients (110 males and 98 females, a mean age of 59.2±5.3 years) in the uniportal-VATS group and 103 patients (61 males and 42 femals, a mean age of 59.7±5.1 years) in the 3P-VATS group. The effects of lymph nodes (LNs) dissection and postoperative clinical data were compared between the two groups, especially for N2 LNs dissection. Results There were no perioperative death in two groups. The overall number of dissected stations and LNs in the uniportal-VATS group (7.3±1.0, 17.5±3.0) were similar with those in the 3P-VATS group (7.2±1.0, 17.7±2.7, P=0.208, P=0.596). The dissected stations (uniportal-VATS: 4.3±0.7, 3P-VATS: 4.3±0.6) and number (uniportal-VATS: 8.6±1.1, 3P-VATS: 8.5±1.1) of N2 LNs were both similar between the two groups (P=0.850, P=0.587). The chest tube duration and postoperative hospital stay of uniportal-VATS group (4.4±1.3 d and 9.2±0.9 d) were much shorter than those of 3P-VATS group (5.0±1.3 d and 9.8±2.0 d, both P<0.001). No significant difference was found in morbidity rate between the two groups (P>0.05). Conclusion Modular dissection of mediastinal lymphadenectomy could meet the requirment of radical resection and it is a safe and valid method which could be used during uniportal-VATS for radical resection of lung cancer.
Objective To investigate the clinical effect of non inflatable endoscope assisted lateral cervical lymph node dissection in elderly patients with thyroid cancer. Methods The clinical data of 61 patients with lateral cervical lymphadenectomy assisted by non inflatable endoscope from January 2016 to December 2020 were retrospectively summarized. There were 48 females and 13 males with an average age of (71±6.5) years (range, 65–82 years). The operative time, intraoperative blood loss, cases of accessory nerve injury, cases of phrenic nerve injury, total number of lateral neck dissection lymph nodes, postoperative lymphatic leakage, postoperative drainage volume and hospital stay were counted. Neck ultrasonography and thyroglobulin levels were measured during follow-up to assess recurrence. Results All patients successfully completed the non inflatable endoscopic assisted lateral cervical lymph node dissection, the operative time was 51–117 min, the average was (92±22.1) min, the intraoperative blood loss was about 80–150 mL, the average was (120±17.1) mL, the postoperative drainage was 190–670 mL, the average was (332±167.1) mL, the postoperative hospital stay was 5–13 d, the average was (9±2.3) d, the total number of lymph nodes was 11–23, the average was (16±4.7). There were 11 cases of hypoparathyroidism, 5 cases of temporary recurrent laryngeal nerve injury, 3 cases of accessory nerve injury and no case of phrenic nerve injury. One patient had local redness and swelling after removing the drainage tube. Lymphatic leakage occurred in 3 cases. There was no recurrence during the follow-up period. Conclusion Non inflatable endoscope assisted lateral neck lymph node dissection provides technical support for elderly patients with thyroid cancer, and the effect is exact, and the short and medium-term follow-up results are satisfactory.
ObjectiveTo analyze the predictive factors for central lymph node metastasis in papillary thyroid microcarcinoma (PTMC), and explore the treatment method for the patients with PTMC. MethodThe literatures were reviewed according to the results searched from PubMed in recent years. ResultsCentral lymph node metastases were common in the patients with PTMC. It was important for prophylactic central lymph node dissection so it might reduce the local recurrence and comfirm the clinical staging, further more provide the strategies for the postoperative therapy. ConclusionsLymphadenectomy is necessary for patients with lymph node metastasis. Prophylactic central lymph node dissection should be performed for patients without lymph node metastasis but with one risk factor or more.
ObjectiveTo summarize the efficacy and safety of Jindan Fuyan Granule in the treatment of refractory chylous leakage after neck lymph node dissection for thyroid cancer. MethodThe clinical data of thyroid cancer patients with refractory chylous leakage after neck lymph node dissection treated with Jindan Fuyan Granules in the Department of Head and Neck Surgery of Jiangsu Cancer Hospital from January to December 2023, were retrospectively collected. ResultsAfter treatment with Jindan Fuyan Granules on the basis of conventional treatment, the drainage volume of 3 patients with thyroid cancer after radical neck lymph node dissection was significantly reduced, from 100 mL to 2 mL, 1 285 mL to 5 mL, and 960 mL to 5 mL, respectively. After 3 days of treatment, the tubes were removed successfully. After discharge from the hospital, 3 patients were followed up for 3, 3, 4 months, respectively, showing satisfactory wound healing without chylous leakage or other discomfort. ConclusionsCombined with low-fat diet, drainage and other non-surgical treatment methods, Jindan Fuyan Granule has obvious effect on treating refractory chylous fistula after neck lymph node dissection, which can be used as a non-surgical treatment option. However, the efficacy needs to be further verified.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
Objective To classify the postoperative complications (POCs) in patients receiving esophagectomy and find risk factors of different grades of complications. Methods We retrospectively analyzed the clinical data of 298 patients with esophageal cancer who underwent esophagectomy from January 2012 to August 2015 in our hospital. According to the postoperative complications, they were divided into two groups: the complication group (n=113) and the non-complication group (n=185). In the complications group, there were 86 males and 27 females with an average age of 61.42±7.81 years. There were 150 males and 35 females with an average age of 60.39±7.76 years in the non-complication group. The POCs were classified by Clavien-Dindo system. All possible factors influencing the occurrence of grade Ⅱ-Ⅴ POCs were analyzed. Univariate and multivariate analyses were used for seeking independent risk factors of POCs. Results The incidence of grade Ⅱ POCs was 29.87% (89/298), 5.37% (16/298) for grade Ⅲ and 2.68% (8/298) for grade Ⅳ and Ⅴ. The most common POC was lung infection with the incidence of 13.76%. Univariate and multivariate analyses showed the operation duration and the number of lymph node dissection were the independent risk factors of grade Ⅱ-Ⅴ POCs. Conclusion Postoperative lung infection is the major complication in patients receiving esophagectomy. The operation duration and the number of lymph node dissection are the independent risk factors of grade Ⅱ-Ⅴ POCs.
ObjectiveTo compare the postoperative chylothorax outcomes of robot-assisted thoracic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), analyze the risk factors for postoperative chylothorax after minimally invasive radical lung cancer resection and explore possible prevention and control measures. MethodsBetween June 2012 and September 2020, 1083 patients underwent minimally invasive pulmonary lobectomy and systematic lymph node dissection in our hospital, including 578 males and 505 females with an average age of 60.6±9.4 years. Patients were divided into two groups according to the operation methods: a RATS group (499 patients) and a VATS group (584 patients). After propensity score matching, 434 patients were included in each group (868 patients in total). Chylothorax and other perioperative indicators were compared between the two groups. Univariate and multivariate logistic regression analyses were performed to identify risk factors for postoperative chylothorax. ResultsOverall, 24 patients were diagnosed with chylothorax after surgery. Compared with the VATS group, the rate of chylothorax was higher (3.9% vs. 1.6%, P=0.038), the groups and numbers of dissected lymph nodes were more (both P<0.001), and the intraoperative blood loss was significantly less (P<0.001) in the RATS group. There was no statistical difference in the postoperative hospital stay (P=0.256) or chest tube drainage time (P=0.504) between the two groups. Univariate analysis showed that gender (P=0.021), operation approach (P=0.045), smoking (P=0.001) and the groups of dissected lymph nodes (P<0.001) were significantly associated with the development of chylothorax. Multivariate analysis showed that smoking [OR=4.344, 95%CI (1.149, 16.417), P=0.030] and the groups of dissected lymph nodes [OR=1.680, 95%CI (1.221, 2.311), P=0.001] were the independent risk factors for postoperative chylothorax. ConclusionCompared with the VATS, the rate of chylothorax after RATS is higher with more dissected lymph nodes and less blood loss. The incidence of chylothorax after minimally invasive radical lung cancer resection is higher in the patients with increased dissected lymph node groups and smoking history.
ObjectiveTo summarize the current status and advances of sentinel lymph node biopsy (SLNB) technique in breast cancer. MethodsThe pertinent domestic and overseas literatures were reviewed and the localization, harvest, status assessment, indications, and complications of SLNB were analyzed. ResultsSLNB could accurately locate and pick out sentinel lymph node (SLN) in breast cancer. The development on imaging examination and pathological techniques promoted the assessment of SLN, and the indications of SLNB were expanding. The complication rate of SLNB was low and the technique could accurately predict axillary lymph node staging and direct selective axillary lymph node dissection. ConclusionsSLNB has been an important method of surgical therapy in breast cancer, but the operation process needs to be further standardized to decrease the false negative rate. Continuative attentions shall be paid to the problems such as the false positive and controversial indications.
ObjectiveTo investigate the predictive value of recurrent laryngeal nerve lymph nodes (RLN) status for supraclavicular lymph node (SLN) metastasis in esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed the clinical data of 83 patients with esophageal squamous cell carcinoma who underwent McKeown three-field lymphadenectomy from January 2017 to April 2018 in our hospital, including 53 males and 30 females with an average age of 64.07±7.05 years.ResultsThe SLN metastasis rate of the patients was 24.1%. The rate in the thoracic and abdominal metastases positive (N1-3) group and negative (N0) group was 37.8% and 13.0%, respectively, with a statistical difference (P<0.05). The rate of SLN metastasis was significantly different between the RLN metastasis positive (RLN+) and negative (RLN–) groups (39.1% vs. 18.3%, P<0.05). One side of RLN metastasis could lead to SLN metastasis on the opposite side. No correlation between the SLN metastasis and age, gender, location, differentiation degree, maximum tumor diameter, T-staging or histologic type was observed (P>0.05). Multivariate analysis showed that lymph node metastasis in chest or abdomen was an independent predictor of SLN metastasis.ConclusionRLN+ is not the independent predictor for SLN metastasis. SLN should be dissected in N1-3 patients with esophageal squamous cell carcinoma without considering tumor location and T-staging. Bilateral SLN dissection should be recommended even if RLN metastasis is only unilateral.
ObjectiveTo identify the risk factors of central lymph nodal (CLN) metastasis in papillary thyroid carcinoma (PTC) and indicate central neck dissection. MethodsFifty cases were analyzed retrospectively. The BRAFV600E gene mutation was analyzed by sequencing and expression of VEGF-C was analyzed by using immunohistochemically. The clinicopathologic and molecular marker factors relating to CLN metastasis were analyzed. ResultsThe BRAFV600E gene mutation was found in 30 of 50 (60.0%) patients of PTC. Univariate analysis showed that BRAFV600E gene mutation of PTC patients was significantly correlated with high expression of VEGF-C (87.5% vs. 34.6%,P=0.000), not with clinicopathologic factors. High expression of VEGF-C was significantly correlated with CLN metastasis in PTC (87.5% vs. 57.7%, P=0.019). Multivariate analysis showed that invasion of the surrounding tissues (P=0.009,OR=9.082,95% CI:1.748-47.185) and the high expression of VEGF-C (P=0.009,OR=9.082,95% CI:1.748-47.185) were independent risk factors for the presence of CLN metastases. Conclusions①The BRAFV600E gene mutation for PTC patients is significantly correlated with high expression of VEGF-C, not with CLN metastasis in PTC. ②High expression of VEGF-C is significantly correlated with CLN metastasis in PTC. ③Tumor extrathyroidal extension, especially invasion of the surrounding tissues is significantly correlated with CLN metastasis in PTC.