1.Laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision
Zhenghua ZHANG ; Jieyong TIAN ; Mingfa GUO ; Meiqing XU
International Journal of Surgery 2017;44(5):-
Objective To investigate the feasibility and clinical effect of laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision.Methods Compared 80 cases underwent laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision with 68 patients receivesd laparoscopic and thoracoscopic Ivor Lewis esophagectomy with an abdominal small incision.The peri operative conditions and complications of the two groups were analyzed.Results There were no significant difference in the operation time [(263.3 ± 71.5) min vs (273.3 ± 73.7) min,t =-0.750,P =0.454],intraoperative blood loss [(246.9 ± 150.4) ml vs (252.9 ± 159.7) ml,t =-0.238,P =0.812],the number of lymph node dissection [(19.2 ±4.3) vs (19 ±4.5),t =0.272,P =0.786],gastrointestinal decompression time [(11 ± 3.4) d vs (11.9±3.3) d,t=-1.647,P=0.102],chest tube indwelling time [(6.6±2.7) d vs (6.3±2.6) d,t=0.544,P=0.587],postoperative hospitalization time [(13.2 ±3.4) d vs (14 ±3.4) d,t=-1.493,P=0.138] and rate of early gastric emptying dysfunction [6.25% (5/80) vs 4.41% (3/68),x2 =0.016,P =0.898].Comparing to patients in the small incision group,the visual analogue scale evaluation score of postoperative pain was lower in the groups without small incision (P < 0.05).There were no anastomotic fistula,thoracic gastric fistula,upper gastrointestinal bleeding and death during perioperative periods.Conclusion It is safe and feasible to treat middle and lower esophageal carcinoma with laparoscopic and thoracoscopic Ivor Lewis esophagectomy without an abdominal small incision,which can further reduce abdominal trauma,relieve postoperative pain and make the abdominal incision more beautiful.
2.The surgical safety analysis of elderly patients with thoracic esophageal squamous cell carcinoma
Gao WU ; Dazhong WEI ; Mingran XIE ; Jieyong TIAN ; Dongchun MA
China Oncology 2014;(2):151-156
Background and purpose: The incidence rate of elderly esophageal carcinoma patients is increasing year by year. In this study, the clinicopathologic factors, operational factors and postoperative complications were compared between the older and the younger elderly patients with thoracic esophageal squamous cell carcinoma (ESCC), and the influence of different surgical approaches to older elderly patients were analyzed. Methods: A retrospective review of 371 cases of elderly patients with thoracic esophageal squamous cell carcinoma (≥60 years) between Jan. 2006 and Dec. 2008 were performed. The patients were divided into two age groups. The patients over 75 years old named the older elderly group including 53 patients, and the patients between 60-74 years named the younger elderly group including 318 patients, the clinicopathological factors, operational factors, postoperative hospital mortality and average length of stay were compared. Meanwhile, according to different surgical approaches, the comparison of the left chest and right chest approach of operative time, blood loss and postoperative complication rate, and so on and so forth. Results: The older elderly group compared with the younger elderly group had more preoperative complications. Preoperative ASA classiifcation and postoperative complications, length of stay and hospital mortality rates were signiifcantly higher. The older elderly group over the right chest approach had less postoperative complications, especially pulmonary complications, the results were statistically signiifcant.(13.0%vs 40.0%,P<0.05) Conclusion: The patients over 75 years old with thoracic esophageal squamous cell carcinoma have a higher risk during the operation, we can choose relatively simpler operation approach to reduce the incidence of postoperative complications, especially pulmonary complications.
3.Prognostic value of the number of negative lymph nodes in non-small cell lung cancer without lymphatic metastasis after pulmonary resection
Mingran XIE ; Shibin XU ; Xinyu MEI ; Zhenghua ZHANG ; Jieyong TIAN ; Jun WANG ; Dongchun MA
Chinese Journal of Clinical Oncology 2014;(7):439-443
Objective:This study aims to investigate the correlation between the number of resected lymph nodes (LNs) and the prognosis of patients with node-negative non-small cell lung cancer (NSCLC). Methods:A retrospective review of 305 patients with NSCLC, who received curative resection between January 2004 and December 2009, was conducted. All patients were proved without lymph node involvement histopathologically. The prognostic impact of the number of negative LNs and the clinicopathologic factors were analyzed. Results:The overall median survival time and the 1-, 3-, and 5-year overall survival rates were 60.0 months, 76.1%, 59.3%, and 47.1%, respectively. Survival analysis confirmed that the number of negative LNs, T staging and the stations of the mediasti-nal lymph nodes dissected were showed to be independent prognostic factors. Patients with a high number of negative LNs had better overall survival than patients with a low number of negative LNs (P<0.05). The patients with dissected LNs counts of more than 11 for cases with pTl~2 tumor (P<0.05) and more than 16 for cases with pT3 tumor (P<0.05) had better long-term survival outcomes. The post-operative complication rate was 12.1%, which was not significantly correlated with the number of dissected lymph nodes (P>0.05). Conclusion:The number of negative lymph nodes is an independent prognostic predicting factor for node-negative NSCLC. Sufficient dissection of LNs is recommended to improve the survival of the patients with node-negative NSCLC.
4. A comparative study of the short-term efficacy and long-term efficacy of systematic lymph node dissection and elective lymph node dissection in patients with early esophageal cancer
Hanran WU ; Changqing LIU ; Mingfa GUO ; Xinyu MEI ; Jieyong TIAN ; Meiqing XU
Chinese Journal of Surgery 2018;56(9):706-711
Objective:
To investigate the feasibility, safety, short-term efficacy and long-term efficacy of elective lymph node dissection in patients with early esophageal cancer.
Methods:
The study retrospectively evaluated 405 patients with cT1N0M0 esophageal carcinoma who received minimally invasive esophagectomy in the First Affiliated Hospital of University of Science and Technology of China between March 2007 and March 2013. Of those patients, 208 patients underwent systematic lymph node dissection (SLND) and 197 patients underwent elective lymph node dissection (ELND). The clinicopathologic factors, operational factors, postoperative complications, lymph node dissection and prognosis of patients were compared by independent sample
5.Recent progress on cGAS-STING pathway in tumor radiotherapy
Jieping QIU ; Jingjing CHENG ; Yawei BAO ; Jun XU ; Jieyong TIAN ; Dong QIAN
Chinese Journal of Radiation Oncology 2023;32(5):488-492
Radiotherapy is widely used in the treatment of primary and metastatic malignant tumors. It is traditionally believed that the killing effect of radiotherapy on tumor is based on the direct or indirect damage of ionizing radiation to DNA. In recent years, the anti-tumor role and mechanism of anti-tumor immune response induced by ionizing radiation have captivated widespread attention and achieved significant progress. Among them, Cyclic GMP-AMP synthase (cGAS)-stimulator of interference genes (STING) pathway is considered to be one of the key regulatory hubs. cGAS is a cytoplasmic DNA receptor that can bind to tumor-derived double-stranded DNA and activate the downstream STING, thereby activating anti-tumor immune response of the host. In view of the latest progress in this field, the important role and potential mechanism of cGAS-STING pathway in radiotherapy immune effect were mainly summarized, and the application prospect of targeting cGAS-STING pathway in radiotherapy sensitization was explored.
6.Comparison of the Recent Efficacy of Robot-assisted and Thoracic Laparoscopic Minimally Invasive Mckeown Radical Resection of Esophageal Cancer based on Propensity Score Matching
Tianci ZHANG ; Ligong YUAN ; Jieyong TIAN ; Xinhao LI ; Zhining HUANG ; Xianning WU
Journal of Sun Yat-sen University(Medical Sciences) 2024;45(2):310-318
ObjectiveTo explore the safety and efficacy of robot-assisted minimally invasive esophagectomy (robot-assisted minimally invasive esophagectomy, RAMIE) and thoracic laparoscopy combined with minimally invasive esophageal resection (minimal invasive esophagectomy, MIE). MethodsThe data of 188 patients treated with Da Vinci robot assisted minimally invasive esophageal resection (RAMIE) from April 2021 to December 2022 were analyzed. In the RAMIE group, 69 patients, 49 males and 20 female, age (67.2 ± 7.2); 119 in the MIME group, respectively, 89 males and 30 female, age (69.1 ± 7.0). At 1 ∶ 1, including 58 patients in the RAMIE group and 58 patients in the MIE group. The t-test, Wilcoxon rank-sum test, χ2 test, and so on. ResultsAfter PSM treatment, the clinical data between the two groups. There was no significant difference in operation time, postoperative tube days, and total number of lymph node dissection between the RAMIE and MIE groups (P <0.05); the RAMIE group was better in terms of intraoperative bleeding and the MIE group, statistically significant (P <0.05); the MIE group was better in drainage flow and lymph node dissection for three days (P <0.05). In terms of postoperative complications, there was no statistical difference between RAMIE and MIE groups (P>0.05). ConclusionThe recent efficacy of robot-assisted minimally invasive esophagectomy is comparable to that of thoracic laparoscopy and minimally invasive Mckeown esophagectomy; robotic-assisted minimally invasive esophagectomy can reduce intraoperative bleeding and have more advantages in left recurrent laryngeal nerve lymph node dissection.