Objective To investigate and evaluate the clinical features, diagnostic methods, surgical management and postoperative adjuvant therapy of thymic carcinoma so as to improve the treatment outcome. Methods Forty-three patients of thymic carcinoma , surgically intervened and pathologically confirmed in Peking Union Medical College Hospital through June 1961 to June 2004, were retrospectively analysed. Complete resection of the tumor was performed in 15 patients, partial or incomplete expiration in 23 , exploratory thoracotomy and biopsy in 5. Results All tumors were found inencapsulated and invading the surroundings,including pericardium, superior vena cava, left or right innominate vein, rnediastinal pleura, phrenic nerve and lung. In this series there was no perioperative death. Eight patients died within the first year postoperatively, 4 died within the second year postoperatively, 2 and 1 patients died in the 5th and 8th year postoperatively respectively. Through half to 18 years follow-up, according to the life table method, the 1,3,5 and 8 year survival rate were 68.29%, 56. 67%, 41.56% and 27. 71% respectively. Conclusions Thymic carcinoma is different from malignant thymoma in clinical manifestations, radiological features, pathological characteristics and prognosis, hence it is very important for thoracic surgeons to pay more attention to those differentiation. Chest CT is an effective method for diagnosis of thymic carcinoma. It is emphasized on that aggressive radical resection of the tumor with involved tissue or organs, even removal of superior vena cava and subsequent reconstruction of vessel, will effectively extend long-term survival. Postoperative radiotherapy and combination adjuvant chemotherapy, especially based on cisplatin, play a significant role in improvement of prognosis.
ObjectiveTo investigate clinical characteristics and surgical treatment of patients with non-malignant esophageal-tracheal/bronchial fistula.?Methods?We retrospectively analyzed clinical data of 12 patients with non-malignant esophageal-tracheal/bronchial fistula who underwent surgical repair in Peking Union Medical College Hospital from January 2002 to October 2011. There were 6 males and 6 females with a mean age of 49.8 years (ranging from 32 to 72 years). There were 7 patients with esophagotracheal fistula，1 patient with esophagobronchial fistula，2 patients with gastro-bronchial fistula after esophagectomy for esophageal cancer，and 2 patients with esophageal diverticulum bronchial fistula. Nine patients underwent surgical repair via right thoracotomy approach，and 3 patients via left thoracotomy approach. Seven patients underwent esophageal fistula and tracheal fistula repair，1 patient underwent esophageal fistula and bronchial fistula repair，2 patients underwent gastric fistula and bronchial fistula repair，1 patient underwent esophagectomy, gastroesophageal anastomosis and left lower lobectomy, and 1 patient underwent esophageal diverticulum repair and left lower lobectomy.?Results?All the patients recovered well from surgery with no perioperative complication or in-hospital death，and resumed oral intake 7-10 days after surgery. Three months to 1 year postoperatively, regular examinations including upper gastroenterography and fibrobronchoscopy found no sign of tracheal/bronchial stenosis or esophageal stenosis，and no patients needed stent implantation or dilatation treatment. All the patients were followed up from 3 months to 10 years and had a good quality of life during follow-up.?Conclusion?Excluding malignant etiology and determining the exact fistula location are key points of clinical diagnosis for esophageal-tracheal/bronchial fistula. Adequate preoperative nutritional support and 1-stage surgical repair can lead to satisfactory clinical outcomes.