ObjectiveTo compare the surgical efficacy of Da-Vinci robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). MethodsOnline databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP and CBM from inception to 18 February, 2022 were searched by two researchers independently. The references of related studies were also searched to re-enroll the potential studies. The quality of the studies was evaluated with Newcastle-Ottawa Scale (NOS). The meta-analysis was performed by RevMan 5.3. Results A total of 43 studies including 33 089 patients were enrolled in the final study. The NOS scores of the included studies were ≥6 points. The results of meta-analysis showed that the operation time was longer [MD=8.50, 95%CI (1.59, 15.41), P=0.020], the blood loss was less [MD=−46.58, 95%CI (−62.86, −30.29), P＜0.001], the dissected lymph nodes stations were more [MD=0.67, 95%CI (0.40, 0.93), P＜0.001], the dissected lymph nodes were more [MD=2.39, 95%CI (1.43, 3.36), P＜0.001], the conversion rate was lower [OR=0.52, 95%CI (0.46, 0.59), P＜0.001], the time of chest tube drainage was shorter [MD=−0.35, 95%CI (−0.58, −0.11), P=0.004], the length of hospital stay was shorter [MD=−0.32, 95%CI (−0.45, −0.19), P＜0.001], and the recurrence rate was lower [OR=0.51, 95%CI (0.36, 0.72), P＜0.001] in the RATS group than those in the VATS group. The rate of overall postoperative complications [OR=0.95, 95%CI (0.89, 1.01), P=0.110] and postoperative mortality rate [OR=0.85, 95%CI (0.62, 1.16), P=0.300] were not significantly different between the two groups. ConclusionCompared with VATS, although RATS prolongs the operation time, it does not increase the incidence of postoperative complications and mortality rates. Moreover, RATS can dissect more lymph nodes, effectively control intraoperative bleeding, shorten the duration of chest drainage tube indwelling and shorten the postoperative hospital stay to a certain extent.
Objective To systematically evaluate the efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis surgery versus thoraco-laparoscopy combined with McKeown surgery in the treatment of esophageal carcinoma. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI were searched by computer for the relevant literature comparing the efficacy and safety of Ivor Lewis surgery and McKeown surgery in the treatment of esophageal carcinoma from inception to January 2022. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of cohort studies, and the Cochrane risk of bias tool was used to evaluate the methodological quality of randomized controlled studies. Review Manager 5.4 software was utilized to perform a meta-analysis of the literature. ResultsA total of 33 articles were included, which consisted of 26 retrospective cohort studies, 3 prospective cohort studies and 4 randomized controlled trials. There were 11 518 patients in total, including 5 454 patients receiving Ivor Lewis surgery and 6064 patients receiving McKeown surgery. NOS score was≥7 points. Meta-analysis showed that, in comparison to the McKeown surgery, the Ivor Lewis surgery had shorter operative time (MD=–19.61, 95%CI –30.20 to –9.02, P<0.001), shorter postoperative hospital stay (MD=–1.15, 95%CI –1.43 to –0.87, P<0.001), lower mortality rate during hospitalization or 30 days postoperatively (OR=0.37, 95%CI 0.20 to 0.71, P=0.003), and lower incidence of total postoperative complications (OR=0.36, 95%CI 0.27 to 0.49, P<0.001). The McKeown surgery had an advantage in terms of the number of lymph nodes dissected (MD=–1.25, 95%CI –2.03 to –0.47, P=0.002), postoperative extubation time (MD=0.78, 95%CI 0.37 to 1.19, P<0.001) and 6-month postoperative recurrence rate (OR=1.83, 95%CI 1.41 to 2.39, P<0.001). The differences between the two surgeries were not statistically significant in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-overall survival (OS), and impaired gastric emptying (P>0.05). ConclusionCompared with McKeown surgery, Ivor Lewis surgery has shorter operative time, shorter postoperative hospital stay, lower mortality rate during hospitalization or 30 days postoperatively and lower incidence of total postoperative complications. However, in terms of the number of lymph nodes dissected, postoperative extubation time and 6-month postoperative recurrence rate, McKeown surgery has advantages. Both surgeries have comparable results in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-OS, and impaired gastric emptying.
Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.
Lung cancer is the leading cause of cancer-related deaths worldwide. Despite growing efforts for its early detection by screening populations at risk, the majority of lung cancer patients are still diagnosed in an advanced stage. In the last decade, the treatment of non-small cell lung cancer (NSCLC) has been improved significantly. Emerging options of targeted therapies and immunotherapies have shifted the management of lung cancer to a more personalized treatment approach, significantly influencing the clinical course and outcome of the disease. At present, molecular biomarkers are becoming a powerful tool for diagnosing cancer, predicting treatment response outcomes, and assessing prognosis. In this review, we summarized the biomarkers relevant to the diagnosis, prediction, and prognosis of NSCLC as well as promising novel predictive biomarkers in the future.
ObjectiveTo compare the mortality in lung cancer patients infected with coronavirus disease 2019 (COVID-19) versus other cancer patients infected with COVID-19. MethodsA computer search of PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI database was conducted to compare the mortality of lung cancer and other cancers patients infected with COVID-19 from the inception to December 2021. Two thoracic surgeons independently screened the literature, extracted data, and then cross-checked the literature. After evaluating the quality of the included literature, a meta-analysis was performed on the literature using Review Manager 5.4 software. ResultsA total of 12 retrospective cohort studies were included, covering 3 065 patients infected with COVID-19, among whom 340 patients suffered from lung cancer and the remaining 2 725 patients suffered from other cancers. Meta-analysis results showed that the lung cancer patients infected with COVID-19 had a higher mortality (OR=1.58, 95%CI 1.24 to 2.02, P<0.001). Subgroup analysis results showed that the mortality of two groups of patients in our country was not statistically different (OR=0.90, 95%CI 0.49 to 1.65, P=0.72). Whereas, patients with lung cancer had a higher mortality than those with other cancers in other countries (Brazil, Spain, USA, France, Italy, UK, Netherlands) (OR=1.78, 95%CI 1.37 to 2.32, P<0.001). ConclusionThere is a negligible difference in mortality between lung cancer and other cancers patients who are infected with COVID-19 in our country; while a higher mortality rate is found in lung cancer patients in other countries. Consequently, appropriate and positive prevention methods should be taken to reduce the risk of infecting COVID-19 in cancer patients and to optimize the management of the infected population.
ObjectiveTo evaluate the efficacy and safety of robot-assisted thymectomy (RATS) versus video-assisted thoracoscopic thymectomy (VATS). MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, Wanfang, VIP and CNKI databases were searched by computer from inception to February 2022. Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened. The Newcastle-OttawaScale (NOS) was used to evaluate the quality of included cohort studies, and Review Manager 5.4 software was utilized to perform a meta-analysis. ResultsA total of 16 retrospective cohort studies were included, covering a total of 1 793 patients (874 patients in the RATS group and 919 patients in the VATS group). The NOS scores of the included studies were≥7 points. Meta-analysis results revealed that RATS had less intraoperative bleeding (MD=−22.45, 95%CI −34.16 to −10.73, P<0.001), less postoperative chest drainage (MD=−80.29, 95%CI −144.86 to −15.72, P=0.010), shorter postoperative drainage time (MD=−0.69, 95%CI −1.08 to −0.30, P<0.001), shorter postoperative hospital stay (MD=−1.14, 95%CI −1.55 to −0.72, P<0.001) and fewer conversion to thoractomy (OR=0.40, 95%CI 0.23 to 0.69, P=0.001) than VATS; whereas, the operative time (MD=8.37, 95%CI −1.21 to 17.96, P=0.090), incidence of postoperative myasthenia gravis (OR=0.85, 95%CI 0.52 to 1.40, P=0.530), overall postoperative complications rate (OR=0.80, 95%CI 0.42 to 1.50, P=0.480) and tumour size (MD=−0.18, 95%CI −0.38 to 0.03, P=0.090) were not statistically different between the two groups. ConclusionIn the aspects of intraoperative bleeding, postoperative chest drainage, postoperative drainage time, postoperative hospital stay and conversion to thoracotomy, RATS has unique advantages over the VATS.
ObjectiveTo evaluate the short-term outcome of robot-assisted thoracoscopic surgery (RATS) for the treatment of posterior mediastinal neurogenic tumour. MethodsThe clinical data of consecutive patients with mediastinal neurogenic tumors who received RATS treatment completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from June 2016 to June 2022 were retrospectively analyzed. The tumors were preoperatively localized and evaluated using magnetic resonance imaging or enhanced CT. Results A total of 35 patients were enrolled, including 19 males and 16 females with a mean age of 34.9±7.1 years. All patients successfully completed the resection of posterior mediastinal neurogenic tumors under RATS, and no conversion to thoracotomy occurred during the operation. The average operative time was 62.3±18.0 min, docking time was 10.3±2.6 min, intraoperative bleeding was 33.9±21.6 mL, postoperative 24-hour chest drainage was 69.0±28.9 mL, postoperative chest drainage time was 2.0 (1.0, 3.0) d and the postoperative hospital stay was 3.0 (2.0, 4.0) d. Postoperative complications occurred in 3 patients, including 2 patients with transient Honor syndrome and 1 patient with transient anhidrosis of the affected upper limb. ConclusionRATS for posterior mediastinal neurogenic tumours is safe, effective and feasible, and allows the full benefit of the robotic surgical system to be exploited.
ObjectiveTo compare the clinical efficacy of different surgical approaches for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). MethodsThe clinical data of the patients with Siewert type Ⅱ AEG who received sugeries in the Department of Thoracic Surgery of Gansu Provincial People's Hospital from August 2014 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the surgical approach: a transabdominal group (transabdominal diaphragmatic esophageal hiatus approach) and a combined group (thoracoabdominal combined with right thoracic approach). Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term efficacy of the two groups. Results A total of 87 patients were enrolled. There were 48 patients (31 males and 17 females, with an average age of 60.85±8.47 years) in the transabdominal group, and 39 patients (25 males and 14 females, with an average age of 61.13±8.51 years) in the combined group. There was no statistical difference between the two groups in the baseline indicators such as gender, age, tumor size and stage (P>0.05). Compared with the combined group, the operation time, intraoperative blood loss, postoperative bed rest time, postoperative total drainage volume were shorter or less, and the visual analogue scale score on the 3rd day after surgery were lower in the transabdominal group (P<0.05). However, the total number of lymph nodes dissected, the number of thoracic lymph nodes dissected and the number of positive thoracic lymph nodes in the combined group were larger than those in the transabdominal group, and the differences were statistically significant (P=0.001). The median survival time in the combined group and transabdominal group was 25.85 months and 20.86 months, respectively. The 3-year overall survival rate of the combined group was higher than that of the transabdominal group (46.2% vs. 38.9%, χ2=5.995, P=0.014). However, there was no statistical difference between the two groups in the postoperative catheter time, esophageal and gastric resection margin distance, number of abdominal lymph nodes dissected, number of positive abdominal lymph nodes, or incidence of postoperative complications (P>0.05). ConclusionFor patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction, thoracoabdominal combined with right thoracic approach is safe and effective, and has advantages in thoracic lymph node dissection, bringing more benefits to the patients, so it is recommended to be popularized in clinical practice.
ObjectiveTo compare the short- and long-term effects of R4 versus R3+R4 endoscopic thoracic sympathicotomy (ETS) for acrohyperhidrosis. MethodsWe retrospectively analyzed the clinical data of patients with acrohyperhidrosis admitted to the Department of Thoracic Surgery of Gansu Provincial Hospital for surgical treatment from April 2014 to April 2021. The patients were divided into two groups according to the methods of ETS, including a R4 group and a R3+R4 group. Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term outcomes of the two groups. ResultsA total of 155 eligible patients were included. There were 60 patients in the R4 group, including 23 males and 37 females, with a mean age of 22.55±2.74 years. There were 95 patients in the R3+R4 group, including 40 males and 55 females, with a mean age of 23.14±3.65 years. There were no statistical differences between the two groups in terms of baseline indicators such as gender, age and positive family history (P>0.05). Total operative time was 38.67±5.20 min in the R4 group and 40.05±5.18 min in the R3+R4 group; intraoperative bleeding was 7.25±3.25 mL in the R4 group and 7.95±3.90 mL in the R3+R4 group; postoperative hospital stay was 1.28±0.52 d in the R4 group and 1.38±0.57 d in the R3+R4 group, the differences between the two groups in the above indicators were not statistically significant (P>0.05). Postoperative hand hyperhidrosis symptoms were significantly relieved in both groups, and the complete remission rate was better in the R3+R4 group than that in the R4 group (98.0% vs. 93.3%), but the difference was not statistically significant (P=0.358). The R3+R4 group was superior to the R4 group in terms of the relief of plantar hyperhidrosis symptoms, patient satisfaction and quality of life index at 6 months postoperatively (P<0.05). There was no statistical difference in the overall incidence of compensatory hyperhidrosis at 12 months postoperatively between the two groups (P=0.867), but the incidence of compensatory hyperhidrosis was higher in the R3+R4 group than that in the R4 group (72.6% vs. 70.0%). ConclusionThe perioperative outcomes of R4 and R3+R4 ETS are similar, but R3+R4 ETS has a higher rate of symptomatic relief of acrohyperhidrosis, and patients have a better postoperative quality of life. R3+R4 ETS is a reliable option for the treatment of acrohyperhidrosis. However, patients need to be informed that this procedure may increase the risk of compensatory hyperhidrosis.
ObjectiveTo evaluate the short-term outcomes and hospital costs of robot-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer. MethodsThe clinical data of patients who underwent lobectomy or sublobar resection for non-small cell lung cancer completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial Hospital from June 2016 to June 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a RATS group and a VATS group. The clinical data of the two groups were compared. ResultsA total of 516 patients were enrolled. There were 254 patients in the RATS group, including 103 males and 151 females, with a mean age of 60.0±4.2 years, and 262 patients in the VATS group, including 126 males and 136 females, with a mean age of 59.5±4.3 years. All patients in both groups successfully completed radical lung cancer surgery with no perioperative death. In terms of intraoperative bleeding (63.4±13.3 mL vs. 92.5±23.5 mL), postoperative drainage time (4.1±0.9 d vs. 4.7±1.2 d), postoperative hospital stay time (5.6±1.1 d vs. 6.7±1.4 d), number of lymph nodes dissected (17.9±2.1 vs. 13.9±1.4) and groups of lymph nodes dissected (5.4±0.8 groups vs. 4.4±1.0 groups), the RATS group had an advantage, and the difference was statistically significant (P<0.05). In terms of operative time and total postoperative chest drainage, the VATS group had an advantage, and the difference was statistically significant (P<0.05). There was no statistical difference between the two groups in terms of postoperative complications or intraoperative conversion to thoractomy (P>0.05). The total hospitalization, surgical and total consumables costs of the RATS group were higher than those in the VATS group (P<0.05). In terms of other costs and consumables costs (one-time costs of purely high-value consumables after deduction of robot-specific costs), the VATS group was higher than the RATS group (P<0.05). ConclusionRATS offers technical and short-term efficacy advantages, but comes with the disadvantage of high costs. Thoracic surgeons can make full use of the features of the robotic surgery system, exploiting its potential to continuously improve and optimize techniques and reduce the use of high-value consumables, thus achieving efficiency and cost reductions and allowing robotic surgery to reach more patients.