Objective To investigate the perioperative differences between video-assisted thoracoscopic surgery (VATS) and thoracotomy after neoadjuvant therapy in patients with non-small cell lung cancer (NSCLC). Methods Clinical data of NSCLC patients who underwent VATS or thoracotomy after neoadjuvant therapy at Shanghai Pulmonary Hospital from June 2020 to May 2022 were retrospectively collected. Perioperative outcomes were compared between the two groups. Results A total of 260 patients were enrolled, 184 (70.8%) patients underwent VATS and 76 (29.2%) patients underwent thoracotomy. After propensity matching, there were 113 (62.4%) patients in the VATS group and 68 (37.6%) patients in the thoracotomy group. VATS had similar lymph node dissection ability and postoperative complication rate with thoracotomy (P>0.05), with the advantage of having shorter operative time (146.00 min vs. 165.00 min, P=0.006), less intraoperative blood loss (50.00 mL vs. 100.00 mL, P<0.001), lower intraoperative blood transfusion rate (0.0% vs. 7.4%, P=0.003), less 3-day postoperative drainage (250.00 mL vs. 350.00 mL, P=0.011; 180.00 mL vs. 250.00 mL, P=0.002; 150.00 mL vs. 235.00 mL, P<0.001), and shorter postoperative drainage time (9.34 d vs. 13.84 d, P<0.001) and postoperative hospitalization time (6.19 d vs. 7.94 d, P=0.006). Conclusion VATS after neoadjuvant therapy for NSCLC is safer than thoracotomy and results in better postoperative recovery.
Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.
Abstract： Objective To evaluate video-assisted thoracic surgery（VATS）and minimal incision thoracotomy（MIT）lobectomy for early stage non-small cell lung cancer patients and the impact upon postoperative quality of life（QOL）. Methods A prospective randomized controlled trial was conducted. From January 1, 2008 to December 10, 2011, the qualified patients with early stage NSCLC were recruited and randomized to VATS group （57 patients）and MIT group（49 patients）, totally 106 patients，57 males and 49 females, aged 57.60 years. The quality of life was assessed using Lung Cancer Symptom Scale （LCSS） before operation and at 1,3,6,9,12 months after operation. Results There were no significant differences between the 2 groups in age, sex, the location of tumor, tumor pathologic stage, pathological types, postoperative complications, tumor size, operative time, operative bleeding and air leak days. There were no symptoms after operation at the VATS group worse than the leve before operation. Five major symptoms, including appetit（1.04±0.71 vs.2.00±0.83, F=6.357，P=0.021）, fatigue （4.55±1.17 vs.10.19±2.10, F=4.721，P=0.043）, dyspnea（2.18±0.86 vs.10.26±2.05, F=10.020，P=0.005）, normal activity（5.16±1.70 vs.17.60±3.17, F=12.319，P=0.002）at the MIT group were deteriorated significantly at 1 month after the operation （P＜0.05）. Conclusion The VATS will lead to better quality of life for the patients with early stage NSCLC after surgery and lead to a smooth postoperative recovery.
Objective To compare clinical outcomes and safety between minimally invasive mitral valve replacement via right minithoracotomy （mini-MVR） and traditional mitral valve replacement （MVR）. Methods Clinical data of 68 patients with valvular heart diseases who underwent mini-MVR from February 2009 to December 2011 in Wuhan Asia Heart Hospital were retrospectively analyzed. There were 36 males and 32 females in this mini-MVR group with their mean age of 34.2±11.2 years. Preoperatively， there were 21 patients with mitral stenosis （MS）， 17 patients with mitral insufficiency （MI）， 30 patients with MS and MI， and 19 patients with tricuspid insufficiency （TI）. Another 200 patients with valvular heart diseases who underwent traditional MVR during the same period were included as the control group. There were 86 males and 114 females in the control group with their mean age of 49.4±13.2 years. Preoperatively， there were 85 patients with MS， 66 patients with MI， 49 patients with MS and MI， and 76 patients with TI. Hospital mortality， aortic crossclamp time， length of intensive care unit （ICU） stay， postoperative chest tube drainage， reexploration for bleeding and postoperative morbidities were compared between the two groups. Results There was no in-hospital death in the mini-MVR group. There was no statistical difference in hospital mortality， cardiopulmonary bypass time， incidence of reexploration for bleeding， postoperative arrhythmias， dialysis-requiring acute renal failure and wound infection between the two group （P＞0.05）. Aortic crossclamp time of the mini-MVR group was significantly longer than that of the control group. But postoperative mechanical ventilation time （10.2±3.1 h vs. 15.2±7.1 h， P=0.008）， chest tube drainage（92.0±28.0 ml vs. 205.0±78.0 ml， P=0.000）， blood transfusion （0.8±1.6 U vs. 1.9±2.1 U， P=0.006）， length of ICU stay （14.0±8.0 h vs. 26.0±12.0 h， P=0.003） and length of hospital stay （14.8±4.6 d vs. 19.7±3.2 d， P=0.006）of the mini-MVR group were significantly shorter or less than those of the control group. Conclusion The safety of mini-MVR is comparable to that of traditional MVR without causing higher postoperative morbidities， while the postoperative recovery after mini-MVR is better than traditional MVR.
Objective To find out the best time and investigate the indications for conversion to horacotomy in completely thoracoscopic lobectomy. Methods Between Sep. 2006 and Feb. 2009, 172 patients including 88 male and 84 female with the median age of 58.9 years, underwent completely thoracoscopic lobectomy. Postoperative pathology showed that there were 133 cases of primary lung cancer, 7 cases of lung cancer metastasis and other malignant tumors, and 32 cases of benign diseases. Among them, 46 patients had the tumor on the right upper lobe (RUL), 23 on the right middle lobe (RML), 31 on the right lower lobe (RLL), 36 on the left upper lobe (LUL) and 36 on the left lower lobe (LLL). Three incisions were made in all operations. The procedures of systematic lymphadenectomy and anatomic lobectomy were similar with routine thoracotomy. If there was mediastinal lymph node adhesion, metastasis or bleeding, the incision would be extended to 12-15 cm and the surgery would be converted to thoracotomy. According to whether the maximum tumor dimension was above 5 cm or under 3 cm, the patients were divided into two groups. At the same time, we also divided the patients into two groups based on whether thoracotomy was performed. The data of both two groups were compared respectively. Results All surgeries were carried out safely with no serious complications or perioperative deaths. The average surgical duration was 185 minutes, and the average blood loss was 213 ml. Thirteen operations were converted to thoracotomy with a conversion rate of 7.6%. Among them, 9 were interfered by lymph nodes and bleeding happened in 4 operations. Lobectomy was performed on 12 patients and pneumonectomy was performed on 1 patient after thoracotomy. For the 16 cases of tumor with its dimension larger than 5 cm, the average operation time was 187 minutes and the average blood loss was 203.8 ml, while for the 98 cases of tumor with its dimension smaller than 3 cm, the average operation time was 202 minutes and the average blood loss was 231.3 ml. The difference between these two groups was not statistically significant. Among the 13 cases of conversion to thoracotomy, the mean age of the patients was 68.7 years old and the average tumor dimension was 23.8 mm. For the 159 cases without thoracotomy, the average age was 59.3 years old and the tumor dimension averaged 27.8 mm. There was a significant difference between them (P=0.016). Conclusion Interference by lymph nodes and bleeding are the most important causes of conversion to thoracotomy in completely thoracoscopic lobectomy while size of tumor, fused fissure or plural adhesions can be always managed thoracoscopically.
ObjectiveTo explore the safety and effectiveness of video-assisted thoracoscopic surgery (VATS) pneumonectomy for bronchiectasis.MethodsThe clinical data of 164 patients undergoing VATS pneumonectomy or open thoracotomy for bronchiectasis in our hospital from March 2002 to July 2012 were retrospectively analyzed. Patients were divided into two groups according to different surgical methods: a thoracotomy group (122 patients, 63 males, 59 females) and a thoracoscopic surgery group (42 patients, 15 males, 27 females). Surgical and follow-up indicators were compared between the two groups.ResultsThere was no difference between the two groups in the blood loss, operation time, perioperative mortality or complication. However patients undergoing VATS had shorter length of postoperative stay than those undergoing thoracotomy (6.9±2.6 d vs. 8.1±3.1 d, P=0.030). In the thoracoscopic surgery group, 3 patients were lost to follow-up and in the thoracotomy group, 5 patients were lost to follow-up. In a median follow-up of 51 months (ranging from 2 to 116 months), 36 patients (92.3%) fully recovered with no sputum or haemoptysis and 3 (7.7%) partially recovered with a reduced sputum or haemoptysis in the thoracoscopic surgery group; 105 (89.7%) fully recovered with no sputum or haemoptysis, 10 (8.5%) partially recovered with a reduced sputum or haemoptysis while 2 (1.7%) without any improvement in the thoracotomy group with no statistical difference (P=0.700).ConclusionVATS pneumonectomy for bronchiectasis is equivalent to thoracotomy in terms of safety and effectiveness, and can be used as an alternative surgical procedure for the treatment of bronchiectasis.
Objective To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.
ObjectiveTo investigate clinical outcomes and safety of transesophageal echocardiography (TEE)-guided occlusion of infundibular ventricular septal defect (VSD) via minithoracotomy. MethodsClinical data of 21 pediatric patients with infundibular VSD who underwent TEE-guided occlusion via minithoracotomy in Children's Hospital of Hebei Province from January to June 2013 were retrospectively analyzed. There were 10 male and 11 female patients with their age of 8-24 (16±8) months and body weight of 9±3 kg. The size of VSD was 4.5±2.5 mm. TEE was used to evaluate the position of the occluder, its influence on the atrioventricular valves and aortic valve, and the presence of residual shunt. ResultsThere was no perioperative death or complication. VSD occlusion was successfully performed in 20 out of 21 patients (95.2%). One patient received conversion to open VSD repair under extracorporeal circulation because VSD size was too big. Mean time of delivery of occluders was 32±16 minutes, the size of the occluders was 5±3 mm, and length of hospital stay was 6-8 days. All the patients were followed up for 3-6 months after discharge. During follow-up, echocardiography showed clear echo and normal position of the occluders, and there was no mild or more severe residual shunt or valvular regurgitation. ConclusionTEE-guided occlusion of infundibular VSD via minithoracotomy is easy to perform and safe with satisfactory clinical outcomes.
ObjectiveTo compare the safety and clinical outcomes of isolated aortic valve replacement (AVR)through right anterior minithoracotomy (RAMT)and conventional median sternotomy. MethodsFrom March 2006 to March 2013, 169 patients underwent isolated AVR in Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine. Among them, 42 patients received AVR via RAMT (RAMT group)including 30 males and 12 females with their age of 59.31±8.30 years. And 127 patients received AVR via conventional median sternotomy (conventional surgery group)including 89 males and 38 females with their age of 60.02±5.93 years. There were 75 patients with aortic valve stenosis (AS), 42 patients with aortic regurgitation (AR)and 52 patients with AS+AR. Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in preoperative clinical characteristics between the 2 groups. All the patients successfully received isolated AVR. 153 patients received mechanical prosthesis and 16 patients received bioprosthetic valves. Fifty-two patients received 21 mm valves, and 117 patients received 23 mm valves. Cardiopulmonary bypass time and aortic cross-clamping time of RAMT group were significantly longer than those of conventional surgery group (P < 0.001). But mechanical ventilation time, length of postoperative ICU stay and hospital stay of RAMT group were significantly shorter than those of conventional surgery group (P < 0.001). Postoperative thoracic drainage, intraoperative and postoperative blood transfusion of RAMT group were significantly less than those of conventional surgery group (P < 0.001). In conventional surgery group, 2 patients underwent reexploration for bleeding and 2 patients had wound infection postoperatively. Two patients died postoperatively, both in conventional surgery group, including 1 patient with low cardiac output syndrome and multiple organ dysfunction syndrome, and another patient with prosthetic valve endocarditis secondary to sternal wound infection. ConclusionCompared with conventional median sternotomy, RAMT is safe and efficacious for patients undergoing isolated AVR with minimal surgical injury, better postoperative recovery and cosmetic outcomes.
Abstract: Objective To investigate the feasibility of the diagnosis and treatment of pleurallung diseases by minithoracotomy and videoassisted thoracic surgery(VATS) under local anesthesia. Methods From February 2002 to March 2005,30 cases were performed by thoracotomy under local anesthesia,which were divided into two groups including minithoracotomy group and VATS group according to the different approaches; inithoracotomy group was used just for the biopsy of thicken pleura and diffuse pulmonary diseases on the state of open pneumothorax, and VATS group was for the diagnosis and treatment of malignant effusion and recurrent pneumothorax on the state of closed pneumothorax,all of them were ompleted under local anesthesia. Results Minithoracotomy group: biopsy of pleura were performed on 13 cases, 10 cases of which has been diagnosed with metastasis, one case was amyloidosis of pleura, two cases were proliferation of pleura.Three cases on diffuse pulmonary diseases were done for biopsy, 2 of which were pulmonary interstitial fibrosis, 1 of which was pulmonary tuberculosis (type Ⅱ). VATS group: Except one was converted to general anesthesia and minithoracotomy to resect the lesion due to heavy pleural adhesion, other patients who had thicken pleura and diffuse pulmonary diseases were performed operation for biopsy, bullarectomy was done on recurrent pneumothorax,and pleurodesis was done on ntractable pleuaral effusion under local anesthesia. 4 cases on pleural effusion were done by diagnostic thoracoscope under local anesthesia, 1 of which was liverrelated pleural effusion. 14 cases has been done by remedial thoracoscope, 8 cases of which malignant pleural effusion were done for pleurodesis, the other cases which have recurrent pneumothorax were given bullaectomy and pleurodesis. Spontaneous breathing and hemodynamics was maintained well during the operation. There was neither severe complication nor mortality in two groups. Conclusion Videoassisted thoracoscopic resection of peripheral pulmonary nodule and biopsy of pleura through minithoracotomy can be performed safely under local anesthesia. The novel approach will be the cost-effective procedure for management of pulmonary nodules in the present time.