Objective To summarize the clinical experience of surgical treatment for cervical and upper thoracic esophageal cancer (the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm), so as to enhance the surgery curative effect and reduce the occurrence of complications. Methods Clinical material of 142 patients with esophageal carcinoma in the neck and upper thorax in this hospital were retrospectively analyzed. Radical excision were taken for 122 patients, palliative excision were taken for 15 patients and exploration were taken for 5 patients, total excision rate was 96.5%. The main type of surgical reconstruction technique includes: simple replacement of esophagus with stomach, colon replacement of esophagus technique, jejunum replacement of esophagus, pectoral major muscleskin flap reconstruction; the right chestupper abdomenneck three incisions for the stomach replacement of esophagus technique, an entire throat excision+stomach replacement of esophagus, a tube stomach replacement of esophagus, left chestneck two incisions, stomach replacement of esophagus technique. Results There were 5 postoperative deaths, two of which died of pulmonary infection, one died of serious infection due to colon necrosis, one died of pulmonary infection due to esophagealtracheal fistula after palliative excision, one died of suffocation due to massive regurgitations. Tumor cells were discovered on the cancer edge of esophagus by pathology in 9 patients. Eight patients with carcinoma of the cervical and 21 patients with carcinoma of the upper thoracic esophagus were suffered from one or more kind of postoperative complications. Mainly complications consisted of the jejunum necrosis, the colon necrosis, the recurrent nerve damage, the lungs infection, the swallow function barrier, esophageal regurgitation. The total of 117(85.4%) survivals were followed up from 1 to 5 years, 20 patients were missed followup. The 1, 3, 5 years survival rate after surgical treatment were 72%,48% and 31% respectively. The 5 year survival rate of the patients in Ⅰ,Ⅱ,Ⅲ,Ⅳa stage were 82.3%, 61.2%, 25.0% and 5.0% respectively. Conclusion Further studies about operation mode, excision area, prevention for postoperative complication, preservation and reconstruction of normal function for patients suffering from the cervical and upper thoracic esophageal cancer (the distance between the upper margin of tumor and the inlet of chest is/or less than 3cm) is still expected.
ObjectiveTo summarize and analyze the clinical diagnosis, surgical treatment and prognosis of multiple pulmonary nodules (MPNs). Methods The clinical data of lung cancer patients who received surgical treatment in our hospital from 2018 to 2020 were collected. The short-term efficacy of surgical treatment for MPNs was analyzed. Results A total of 97 patients were enrolled, including 30 males and 67 females with an average age of 56.1±10.0 years at onset ill. There were 62 patients with double lesions, 22 patients with three lesions, 4 patients with four lesions, and 9 patients with more than four lesions. A total of 213 lesions were surgically treated, including 88 pure ground-glass nodules, 81 partially solid nodules, and 7 solid nodules. There were 87 simultaneous surgeries and 10 staged surgeries, with an average operation interval of 5.2 months. The pathological combination type included adenocarcinoma-adenocarcinoma in 96 (99.0%) patients, squamous cell carcinoma-squamous cell carcinoma in 1 (1.0%) patient, and no lymph node metastasis was found. The 2-year disease-free survival (DFS) rate was 92.1%, and the overall survival (OS) rate was 100.0%. Univariate analysis showed that high-risk lesion size>2 cm (P=0.316), residual lesions (P=0.782) and pathological combination type (P=0.913) had statistical effect on the 2-year DFS rate. Conclusion MPNs are mainly diagnosed with multiple primary lung cancers, and the pathological combination is mostly adenocarcinoma-adenocarcinoma combination. Imaging examination is of great help to the surgical approach selection, diagnosis and differential diagnosis of MPNs. During the operation, maximal preservation of lung function and complete resection of high-risk nodules should be taken as the principle, and the prognosis is satisfactory.
ObjectiveTo investigate the predictive value of volatile organic compounds (VOCs) on pulmonary nodules in people aged less than 50 years.MethodsThe 147 patients with pulmonary nodules and aged less than 50 years who were treated in the Department of Thoracic Surgery of Sichuan Cancer Hospital from August 1, 2019 to January 15, 2020 were divided into a lung cancer group and a lung benign disease group. The lung cancer group included 36 males and 68 females, with the age of 27-49 (43.54±5.73) years. The benign lung disease group included 23 males and 20 females, with the age of 22-49 (42.49±6.83) years. Clinical data and exhaled breath samples were collected prospectively from the two groups. Exhaled breath VOCs were analyzed by gas chromatography mass spectrometry. Binary logistic regression analysis was used to select variables and establish a prediction model. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve of the prediction model were calculated.ResultsThere were statistically significant differences in sex (P=0.034), smoking history (P=0.047), cyclopentane (P=0.002), 3-methyl pentane (P=0.043) and ethylbenzene (P=0.009) between the two groups. The sensitivity, specificity and area under the ROC curve of the prediction model with gender, cyclopentane, 3-methyl pentane, ethylbenzene and N,N-dimethylformamide as variables were 80.8%, 60.5% and 0.781, respectively.ConclusionThe combination of VOCs and clinical characteristics has a certain predictive value for the benign and malignant pulmonary nodules in people aged less than 50 years.
A team with strong cohesion and high execution is an important guarantee for conducting high-quality and sustainable clinical researches. Combined with the previous literature and the author’s view, this paper summarizes the key points of team building, which include a clear research direction, a balanced composition of team members, an outstanding team leader, the competence enhancement of team members, and a member-oriented management philosophy. Clear research direction is the premise of the existence and development of a team. Multi-level, multi-disciplinary membership can avoid potential conflicts of interest caused by homogeneity, and enable research to be refined and strengthened in interdisciplinary collisions. Team leader is the key to team development. The enhancement of team members’ competence is the cornerstone of team development. Adherence to member-oriented principle can form a true team culture. This paper aims to summarize and analyze the key points of clinical research team construction for peer reference.
The number of investigator initiated research (IIR) is increasing. But the recognition and management of IIR in China is still in its infancy, and there is a lack of specific and operable guidance for the implementation process. Based on our practical experiences, previous literature reports, and current policy regulations, the authors took prospective IIR as an example to summarize the implementation process of IIR into 14 steps, which are as the following: study initiation, ethical review, study registration, study filing, case report form design, database establishment, standard operating procedure making, investigator training, informed consent, data collection, data entry, data verification, data locking and data archiving.