Objective To compare the effect of mediastinal lymph node dissection by video -assisted thora-coscopic surgery (VATS)with thoracotomy in the treatment of lung cancer.Methods 96 patients with non -small cell lung cancer were collected.Patients undergoing VATS were matched with those undergoing thoracotomy in terms of gender,age,clinical tumor stage,tumor location and surgical procedure.Results After matching,48 patients in VATS group and 48 patients in open group were eligible for analysis.In the VATS and open groups,the mean total numbers of dissected lymph nodes were (27.2 ±7.4)and (28.8 ±10.6)(P =0.507),the numbers of N1 nodes were (9.4 ±4.0)and (8.3 ±4.6)(P =0.323).And the number of N2 nodes was similar between the VATS and open group [(18.5 ±6.9)vs (21.3 ±9.9),P =0.201].No significant differences were observed between the two groups(all P >0.05 ).But the days of the postoperation and the chest tube indwelling in thoracotomy group were (8.1 ±3.9)and (7.3 ±4.4)days,which in the VATS group were (6.8 ±3.5)and (5.6 ±3.5),the VATS group had more advantages than the thoracotomy group(P <0.05).The intraoperative blood loss more than 400mL and peri-operative blood transfusion rate of the thoracotomy group were 27.38% and 25.00%,those of the VATS group were 7.03% and 8.60% respectively,which in thoracotomy group were higher than the VATS group.Conclusion Under-go our retrospective study,after mature VATS to treat lung cancer,with regard to the number of the dissected lymph nodes,VATS lobectomy can achieve complete mediastinal lymph node dissection compared with the traditional approach.There are more advantages by VATS in the complications.

Objective To investigate the positive detective rate of interlobar node in the operation of non-small cell lung cancer (NSCLC), and to compare the effect of interlobar node dissection by video-assisted thoracoscopic surgery (VATS) with thoracotomy in treatment of lung cancer. Methods 108 patients with NSCLC who received the surgery by the same group of thoracic surgeons were collected from Aug 2012 to Mar 2016 in Guangdong Medical University Affiliated Kaiping Central Hospital. The positive transfer and detective rates of interlobar node in patients with different clinical and pathological stage were analyzed. Then the patients were divided into traditional open thoracotomy group and VATS group according to the operation mode, meanwhile, the number of interlobar nodes dissection in the two groups were compared. Results The positive transfer rates of the interlober nodes in patients with different clinical stage were ⅠA 5.7 % (2/35),ⅠB 5.0 % (1/20), ⅡA 14.3 % (3/21), ⅡB 13.3 % (2/15), ⅢA 29.4 % (5/17); For patients with different pathological T stage were T1A 8.3 % (2/24), T1B 9.1 % (2/22), T2A 12.9 % (4/31), T2B 14.3 % (2/14), T3 21.4 %(3/14), T4 33.3 % (1/3), and over-all transfer rate was 13.0 % (14/108). In pathology stage and pathology T stage, the number of interlober nodes had no statistical difference in traditional open thoracotomy group and VATS group (all P>0.05). Conclusions Even in the early clinical stage, the transfer of interlobar node may be positive. The transfer rate of interlobar node is correlated positively with pathology T stage. VATS can achieve the same effect in interlobar node dissection compared with the traditional approach.

BACKGROUNDTo investigate the clinical characteristics and diagnosis of lung cancer with paraneoplastic syndrome as initial symptom.

METHODSThe clinical data of 168 cases of lung cancer with paraneoplastic syndrome as initial symptom were analysed from Jan. 1990, to Nov. 2002, in the hospital.

RESULTS(1) Among the patients with lung cancer in the hospital, 11.8% (168/1 426) had paraneoplastic syndrome as initial symptom. The ratio of male to female was 4.25:1. There were 138 cases aged above 45 (82.1%) and 116 with smoking history (69.0%). (2)There were 62 cases of small cell lung cancer (36.9%) and 102 non small cell lung cancer (60.7%) and 4 carcinoid (2.4%). Thirty-three cases (37.5%) were central type and 82 (48.8%) peripheral type and 23 (13.7%) diffuse type. (3) The patients with paraneoplastic syndrome included: 48 cases of osteoarthopathy (28.6%), 27 cachexia (16.1%), 23 cancerous fever (13.7%), 14 myasthenia (8.3%), 12 vegetative nerve hyperfunction (7.1%), 11 cerebellar cortex degeneration (6.5%), 9 acanthosis nigricans (5.4%), 8 cutaneous pigmentation (4.8%), 7 dermatomyositis (4.2%), 5 encephalopathy (3.0%), and 4 gynecomastia (2.4%). (4)The misdiagnosis rate of the first consultation was 44.6% (75/168). (5)Initial chest X-ray positive rate was 61.9% (104/168); initial CT positive rate was 78.6% (132/168). (6)One hundred and thirty-two cases accepted the treatment of lung cancer: 32 cases accepted pure operation, 8 cases accepted pure chemotherapy, 35 cases accepted operation and chemotherapy, 39 cases accepted chemotherapy and radiotherapy, 18 cases accepted operation and chemotherapy and radiotherapy. Totally 8 cases were dead and 17 cases had abandoned treatment. One hundred and seven cases had improvement after complex treatment of lung cancer, including 83 cases with improvement or disappearance of paraneoplastic syndrome, 18 cases with no change, and 6 cases exacerbated.

CONCLUSIONSThe lung cancer with paraneoplastic syndrome as initial symptom is difficult to diagnose because of its latent onset. The knowledge of paraneoplastic syndrome should be improved, chst X-ray or CT examination should be done for the high risk group of lung cancer with paraneoplastic syndrome, and these strategies could decrease misdiagnosis rate and increase diagnosis rate of lung cancer in early stage.