Abstract: Objective To summarize the method and effective result of thoracoscopic intrapleural perfusion hyperthermochemotherapy(TIPHC) for treating malignant pleural effusion caused by lung cancer. Methods Fiftyeight patients with malignant pleural effusion caused by lung cancer were randomly divided into therapeutic group(30 cases) and control group(28 cases) between February 1999 and March 2005. Pleural biopsy and TIPHC under general ansthesia with unilateral ventilation were performed in the therapeutic group, and intrapleural injection of cisplatin was administered in control group after drainage of pleural effusion. The effect on malignant pleural effusion， the change for the concentration of carcinoembryonic antigen(CEA)， cytokeratin-19 fragments (CYFRA21-1)， neuronspecific enolase (NSE) and the side effect were compared before and after the treatment. Results The therapeutic group achieved total response rate of 100.0%, but only 53.6% in control group, with significant difference(χ 2=3.863, Plt;0.05). Furthermore, the concentration of CEA， CYFRA21-1， NSE in therapeutic group dramatically descended than control group(t=2.562,Plt;0.05). But there was no significant difference in side effect (Pgt;0.05). The pathological diagnosis of all the patients were determined in the therapeutic group. Conclusion TIPHC has the advantage of both diagnosis and treatment of malignant pleural effusions. It is safe and effective, and also able to determine the diagnosis. Furthermore, it offers the superiority of small wound， best visualization and convenient pleural biopsy.
ObjectiveTo systematically review the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for patients with non-small cell lung cancer (NSCLC). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 9, 2016), Web of Science, CNKI, VIP, WanFang Data and CBM databases to collect clinical studies about RATS vs. VATS for patients with NSCLC from inception to October 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 14 cohort studies involving 19 921 patients were included; among them, 4 322 cases were in the RATS group, and 15 599 were in the VATS group. The results of meta-analysis showed that the operation time (MD=22.90, 95%CI 9.97 to 35.84, P<0.000 5) was longer in the RATS group than the VATS group. However, the conversion rate (OR=0.72, 95%CI 0.44 to 1.18, P=0.20), the incidence of postoperative complications (OR=1.06, 95%CI 0.96 to 1.17, P=0.28), intraoperative blood loss (MD=2.75, 95%CI –8.39 to 13.89, P=0.63), postoperative hospitalization time (MD=–0.00, 95%CI –0.02 to 0.02, P=0.99) and in-hospital mortality rate (OR=0.60, 95%CI 0.35 to 1.05, P=0.07) were not significant differences between both groups.ConclusionThe current meta-analysis indicates that the efficacy and safety of RATS and VATS for NSCLC is equivalence, however the operation time for RATS is longer. Due to the limited quantity and quality of inclued studies, the above conclusions still need to be verified by more high quality studies.