Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Wenhao ^1,2 ,  ZHU Zijiang ² , PANG Yao ² , ZHU Xiaolei ²

1. Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;
2. The Second Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P.R.China;

Corresponding author：

ZHU Zijiang, Email: zhuzijiang2005@sina.com

Keywords：

Controlled hypotension; video-assisted thoracoscopic surgery; subcarinal lymph node

DOI：

10.7507/1007-4848.201705023

Video：

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Objective To evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer.Methods We analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared.Results The operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05).Conclusion Controlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less drainage volume, which is safe and effective.

Citation： WANG Wenhao, ZHU Zijiang, PANG Yao, ZHU Xiaolei. Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(4): 299-302. doi: 10.7507/1007-4848.201705023 Copy

1.	丁宁宁, 毛友生. 早期非小细胞肺癌淋巴结转移规律与清扫方式研究进展. 中国肺癌杂志, 2016, 19(6): 359-363.
2.	康晓征, 陈克能. 肺癌的纵隔淋巴结分期方法及意义. 中华胸心血管外科杂志, 2014, 30(3): 176-180.
3.	章智荣, 毛友生, 赫捷, 等. 临床 Ⅰ 期非小细胞肺癌淋巴结转移规律和清扫方式的探讨. 中华肿瘤杂志, 2014, 36(7): 536-540.
4.	崔岳, 杨晓军, 谢天鹏, 等. 非小细胞肺癌肺内淋巴结转移规律的临床研究. 中国胸心血管外科临床杂志, 2016, 23(10): 982-987.
5.	Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
6.	Higuchi M, Yaginuma H, Yonechi A, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg, 2014, 9: 88.
7.	马建强, 杨绍军, 李旭, 等. 全胸腔镜与传统开胸肺癌根治术的比较. 中国微创外科杂志, 2016, 16(9): 802-806.
8.	Aokage K, Yoshida J, Ishii G, et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer, 2010, 70(2): 163-167.
9.	李跃, 孙冰生, 张真发, 等. 非小细胞肺癌淋巴结阳性率与预后的临床分析. 中华医学杂志, 2011, 91(24): 1682-1686.
10.	Okada M, Tsubota N, Yoshimura M, et al. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg, 1999, 118(2): 270-275.
11.	Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
12.	马海波, 丁志丹, 曲戈, 等. 非小细胞肺癌隆突下淋巴结转移与临床病理特征的关系. 中国胸心血管外科临床杂志, 2013, 20(1): 70-73.
13.	管仲, 翁文俊, 章斌, 等. 非小细胞肺癌手术中隆突下淋巴结的选择性清扫. 江苏医药, 2015, 41(9): 1033-1035.
14.	Verhagen AF, Schoenmakers MC, Barendregt W, et al. Completeness of lung cancer surgery: is mediastinal dissection common practice? Eur J Cardiothorac Surg, 2012, 41(4): 834-838.
15.	Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res, 2013, 3(4): 475-483.
16.	Erbesler ZA, Bakan N, Karaören GY, et al. A Comparison of the effects of esmolol and dexmedetomidine on the clinical course and cost for controlled hypotensive anaesthesia. Turk J Anaesthesiol Reanim, 2013, 41(5): 156-161.
17.	Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.

1. 丁宁宁, 毛友生. 早期非小细胞肺癌淋巴结转移规律与清扫方式研究进展. 中国肺癌杂志, 2016, 19(6): 359-363.
2. 康晓征, 陈克能. 肺癌的纵隔淋巴结分期方法及意义. 中华胸心血管外科杂志, 2014, 30(3): 176-180.
3. 章智荣, 毛友生, 赫捷, 等. 临床 Ⅰ 期非小细胞肺癌淋巴结转移规律和清扫方式的探讨. 中华肿瘤杂志, 2014, 36(7): 536-540.
4. 崔岳, 杨晓军, 谢天鹏, 等. 非小细胞肺癌肺内淋巴结转移规律的临床研究. 中国胸心血管外科临床杂志, 2016, 23(10): 982-987.
5. Ramos R, Girard P, Masuet C, et al. Mediastinal lymph node dissection in early-stage non-small cell lung cancer: totally thoracoscopic vs thoracotomy. Eur J Cardiothorac Surg, 2012, 41(6): 1342-1348.
6. Higuchi M, Yaginuma H, Yonechi A, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg, 2014, 9: 88.
7. 马建强, 杨绍军, 李旭, 等. 全胸腔镜与传统开胸肺癌根治术的比较. 中国微创外科杂志, 2016, 16(9): 802-806.
8. Aokage K, Yoshida J, Ishii G, et al. Subcarinal lymph node in upper lobe non-small cell lung cancer patients: is selective lymph node dissection valid? Lung Cancer, 2010, 70(2): 163-167.
9. 李跃, 孙冰生, 张真发, 等. 非小细胞肺癌淋巴结阳性率与预后的临床分析. 中华医学杂志, 2011, 91(24): 1682-1686.
10. Okada M, Tsubota N, Yoshimura M, et al. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg, 1999, 118(2): 270-275.
11. Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg, 2000, 70(2): 358-365.
12. 马海波, 丁志丹, 曲戈, 等. 非小细胞肺癌隆突下淋巴结转移与临床病理特征的关系. 中国胸心血管外科临床杂志, 2013, 20(1): 70-73.
13. 管仲, 翁文俊, 章斌, 等. 非小细胞肺癌手术中隆突下淋巴结的选择性清扫. 江苏医药, 2015, 41(9): 1033-1035.
14. Verhagen AF, Schoenmakers MC, Barendregt W, et al. Completeness of lung cancer surgery: is mediastinal dissection common practice? Eur J Cardiothorac Surg, 2012, 41(4): 834-838.
15. Bajwa S, Kulshrestha A. Dexmedetomidine: an adjuvant making large inroads into clinical practice. Ann Med Health Sci Res, 2013, 3(4): 475-483.
16. Erbesler ZA, Bakan N, Karaören GY, et al. A Comparison of the effects of esmolol and dexmedetomidine on the clinical course and cost for controlled hypotensive anaesthesia. Turk J Anaesthesiol Reanim, 2013, 41(5): 156-161.
17. Degoute CS. Controlled hypotension: a guide to drug choice. Drugs, 2007, 67(7): 1053-1076.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of controlled hypotension for subcarinal lymph node dissection in patients with lung cancer undergoing video-assisted thoracoscopic surgery: A case control study

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