Objective To investigate the characteristics and risk factors of abdominal lymph node metastasis in thoracic esophageal squamous cell cancer.Methods The clinical data of 586 patients with thoracic esophageal cancer who underwent surgery via transabdominal and transthoracic approaches between June 2009 and June 2014 at the Sichuan Cancer Hospital were retrospectively analyzed.All the patients received resection of esophageal cancer and lymph node dissection, and the transabdominal right thoracic approach or cervico-thoracicabdominal triple incision was selected according to the condition of patients.No.18, 19, 20 lymph nodes were dissected seperately and No.16, 17 and lesser curvature lymph nodes were separated.All the specimens of lymph nodes were detected by regular pathological examination.Measurement data with normal distribution were presented as x ± s and count data were described as rate.Comparisons of rate between 2 specimens and among the multiple specimens were respectively analyzed using the chi-square test and partition of chi-squared.The multivariate analysis was done using the logistic regression.Results The number of lymph node dissected in 586 patients was 12 524 with an average number of 20 ± 11 per case, and the rate of lymph node metastasis was 55.63％ (326/586).The number of mediastinal lymph node dissected was 7 012 with an average number of 12 ± 5 per case, and a rate of mediastinal lymph node metastasis was 40.96％ (240/586).The number of abdominal lymph node dissected was 5 512 with an average number of 9 ± 8 per case, and a metastasis rate was 31.74％ (186/586).The abdominal lymph node metastasis rate of the upper, middle and lower thoracic esophageal cancer were 13.73％ (14/102), 31.51％ (92/292) and 41.67％ (80/192), respectively, showing a significant difference among the above 3 indexes (x2 =25.91, P ＜ 0.05).The lymph node metastasis rate in No.16, 17, 18,19, 20 and lesser curvature lymph nodes were 12.80％ (75/586), 16.89％ (99/586), 1.71％ (10/586),0.68％ (4/586), 1.71％ (10/586) and 2.05％ (12/586), respectively, with a significant difference among the above 6 indexes (x2 =287.95, P ＜ 0.05).The results of univariate analysis showed that the tumor location,surgical procedure, T stage, N stage, G stage, pathological stage and mediastinal lymph node metastasis were risk factors affecting abdominal lymph node metastasis of thoracic esophageal cancer (x2 =24.02, 23.97, 37.87,136.85, 38.79, 7.70, 154.27, P ＜ 0.05).The tumor in the lower thoracic portion, N3 stage and stage Ⅳ were independent risk factors affecting abdominal lymph node metastasis of thoracic esophageal cancer in the multivariate analysis (RR =5.80, 2.36, 2.76, 95％ confidence interval: 1.022-1.813, 1.317-3.950, 1.652-12.351, P ＜ 0.05).Conclusions Abdominal lymph node metastasis is common in thoracic esophageal cancer in which No.16 and 17 lymph nodes predominate, and it is easy to occur in patients with lower thoracic esophageal cancer, and advanced N stage and pathological type.

Objective This study was performed to assess the clinical feasibility of video-assisted mediastinoscopic lymphadenectomy in the treatment of resectable lung cancer.Methods Between March 2011 and May 2012,we retrospectively analyzed the data from 56 patients who underwent video-assisted mediastinoscopic lymphadenectomy(VAMLA).In patients receiving tumour resection subsequently,radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.Results Mean operative time of video-assisted mediastinoscopic lymphadenectomy was(42.0 ± 13.5) min(range of 26-86 min).Mean number of resected lymph nodes was 12.4 ± 6.7 (range of 5-24).In video-assisted mediastinoscopic lymphadenectomy,the rates of lymph node dissection of stations 2,4,5,7,8 were 54.5％,92.7％,58.2％,100％,61.8％,respectively,there was no operative mortality and morbility.90.9％ patients achieved radical dissection.Conclusion Video-assisted mediastinoscopic lymphadenectomy is a clinically feasible procedure and provides more accurate staging of mediastinal node in lung cancer patients.It also plays an important role in minimal invasive surgery and neoadjuvant therapy.

OBJECTIVETo evaluate the association of signal transducer and activators of transcription 3 (STAT3) -1096G/C polymorphism in promoter region with the susceptibility to HBsAg positive hepatocellular carcinoma (HCC).

METHODSA total of 632 patients with HCC and 723 HBV-infected subjects without HCC treated at Changhai Hospital of Shanghai from 2009 to 2012 were included in this case-control study. The polymorphism of STAT3 -1096 G/C was genotyped by Fluorescent probe-Real time quantitative PCR. Univariate analysis was used to calculate the odds ratio (OR) and its 95% confidence interval (CI).

RESULTSThe frequency of genetic allele STAT3 -1096G/C (GC+CC) of control group and case group were 61.83% (447/723) and 60.60% (383/632), while difference of HCC risk was not found among different genotypes (OR = 0.95, 95%CI: 0.76-1.18). When stratified by sex, the frequency of genetic allele STAT3 -1096C (GC+CC) of control group and case group were 62.18% (314/505) and 61.75% (331/536) in men, 61.01% (133/218) and 54.17% (52/96) in women, respectively, while difference of HCC risk was not found among different genotypes (OR = 0.98, 95%CI: 0.77-1.26; OR = 0.76, 95%CI: 0.47-1.26, respectively). When stratified by HBV genotypes, the frequency of genetic allele STAT3 -1096C (GC+CC) of control group and case group were 61.45% (110/179) and 53.13% (34/64) in HBV genotype B, 62.87% (276/439) and 60.27% (226/375) in HBV genotype C, respectively, while difference of HCC risk was not found among different genotypes (OR = 0.71, 95%CI: 0.40-1.26; OR = 0.90, 95%CI: 0.68-1.19, respectively).

CONCLUSIONSTAT3 -1096G/C polymorphism was not associated with the susceptibility to HCC for the HBV-infected subjects without HCC.

Aged ; Alleles ; Carcinoma, Hepatocellular ; Case-Control Studies ; China ; Disease Susceptibility ; Female ; Genetic Predisposition to Disease ; Genotype ; Hepatitis B ; Hepatitis B virus ; Humans ; Liver Neoplasms ; Male ; Odds Ratio ; Polymorphism, Genetic ; Polymorphism, Single Nucleotide

BACKGROUNDThe prevalence of lung cancer in the elder increases gradually recently, and lung cancer has become the main cause of cancer-related death. The aim of this study is to analyse the operative indication, complication, perioperative management and surgical measures, results and specificity for lung cancer in the elderly patients.

METHODSOne hundred and thirty-seven elderly patients with lung can-cer, aged from 70 to 83 years old with mean age of 74 were analysed. Of the 137 cases, 13 patients were in the stage I, 76 in stage II, 48 in stage III. Surgical procedures included pneumonectomy for 4 patients, lobectomy for 122 patients, segmentectomy and wedge resection for 7 patients, sleeve lobectomy for 19 patients, bronchoplastic procedure and pulmonary artery reconstruction for 2 patients. Video-assisted thoracic surgery was performed in 13 cases for segmentectomy and wedge excision

RESULTSThere was no operative death. The resection rate was 97.1%, and postoperative complication rate was 29.9%. The follow-up rate was 88.3% . The 1-, 2-, 3-year survival rate was 62%, 35%, 28% respectively.

CONCLUSIONSElderly patients with lung cancer can obtain good therapeutic results and prognosis undergoing surgical therapy, but the operative indications will be limited. Exquisite surgical technique and application of respirator after operation may expand the operative indications.

Objective To analyze the incidence of urinary stone formation in the contralateral kidney of unilateral nephrectomy patients.Methods 1048 patients,including 596 males and 452 females,underwent unilateral nephrectomy from June 2010 to June 2016.Their age ranged from 16-87 years old (mean 58.7 years old).532 patients combined with components of metabolic syndrome and 213 patients with metabolic syndrome.164 patients had a previous history of urolithiasis.The incidence of urinary stone formation in the contralateral kidney after nephrectomy was recorded and analyzed.The urolithiasis incidences in different gender,age,comorbidity and history of urolithiasis patients after uninephrectomy were compared.Results All patients were followed up within 0.5 to 6 years (mean 3.2 years).89 patients suffered from urinary stones in the contralateral kidney after uninephrectomy.The incidence of urinary stone formation in the contralateral kidney was 8.5％ (89/1048),which was higher than that in general population of China.1％-5％.The urolithiasis incidence was 9.1％ (54/596)in male patients and 7.7％ (35/452)in female patients after nephrectomy.The incidence of urinary stone formation was 8.6％ (3/35)in patients aged under 30 years old,12.5％ (34/272) in patients aged 30-49 years old,7.3％ (37/504) in patients aged 50-69 years old,6.3％ (15/237)in patients aged 70 and over.The incidence of urinary stone formation was 12.2％ (65/532) in patients with components of metabolic syndrome after nephrectomy and 19.7％ (42/213) in patients with metabolic syndrome,while the incidence was 4.7％ (24/516)in patients without components of metabolic syndrome.In patients with history of urolithiasis,the incidence was up to 30.5％ (50/164) after nephrectomy,while 4.4％ (39/884)in patients without history of urolithiasis.Conclusions The incidence of urinary stone formation in the contralateral kidney of uninephrectomy patients was higher,especially in patients with metabolic syndrome or urolithiasis history.Patients after unilateral nephrectomy are more vulnerable to urolithiasis.

Since the outbreak of corona virus disease 2019(COVID 19), the epidemic has spread rapidly, which brings great challenge to the surgical diagnosis, treatment and management of lung neoplasm Sichuan International Medical Exchange &Promotion Association organized thoracic surgery experts to sum up experiences from experts in major hospital, and formulated the Guidance suggestion on surgical diagnosis, treatment and management of lung neoplasm during the outbreak of COVID-19 to provide references for thoracic surgeons.

OBJECTIVETo compare the efficacy between total ureterectomy and partial ureterectomy in treatment of ureteral carcinoma.

METHODSThe clinical data and follow-up results of 102 patients with ureteral urothelial carcinoma from August 1996 to August 2011 were analyzed retrospectively. According to surgical procedures, the patients were divided into total ureterectomy group (61 cases) and partial ureterectomy group (41 cases). The subsequent bladder cancer incidence, ureteral carcinoma recurrence rate, distant metastasis rate and survival rate were compared between two groups. The prognostic factors of ureteral carcinoma were analyzed by multivariable Cox regression.

RESULTSNineteen patients (31.1%) suffered subsequent bladder cancer in total ureterectomy group, and 10 (24.4%) in partial ureterectomy group(χ² = 0.550, P = 0.458). Ten patients (16.4%) re-suffered contralateral ureteral carcinoma in total ureterectomy group, and 6 (14.6%) in partial ureterectomy group, 2 (4.9%) ipsilateral and 4 (9.7%) contralateral (χ² = 0.057, P = 0.811). Eight patients (13.1%) occurred distant metastasis in total ureterectomy group, and 3 (7.3%) in partial ureterectomy group (χ² = 0.360, P = 0.549). Twenty patients died of carcinoma in total ureterectomy group, and 18 in partial ureterectomy group. The median survival time was 78 months in total ureterectomy group, and 75 months in partial ureterectomy group. The 1-year, 3-year and 5-year survival rates in total ureterectomy group were 97.8%, 76.8% and 63.6%, and in partial ureterectomy group were 93.0%, 66.9% and 58.8%. The multivariable Cox regression analysis revealed that tumor stage (RR = 2.468, P = 0.009) and local lymph node status (RR = 3.081, P = 0.020) were independent prognostic factors of ureteral carcinoma. The 5-year survival rate of Ta-2 stage tumor was 73.4%, and of T3-4 stage was 42.8%.

CONCLUSIONSTumor stage and local lymph node status are key prognostic factors of ureteral carcinoma. The efficacy between total ureterectomy and partial ureterectomy in treating early stage of low ureteral carcinoma is similar. Partial ureterectomy can be used in selective patients.

Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Ureter ; surgery ; Ureteral Neoplasms ; surgery

Early diagnosis of lung cancer is of great significance for reducing mortality and improving survival. Traditional methods of early diagnosis of lung cancer have their own limitations. The exhaled breath can reflect the disease state of the body, which has great potential in the early diagnosis of lung cancer. In this paper, the diagnosis of lung cancer and the application of exhaled breath detection technology in the diagnosis of lung cancer were reviewed.

OBJECTIVEThoracoscopic esophagectomy has gained worldwide popularity. This study compared the perioperative outcomes and lymphadenectomy after thoracoscopic esophagectomy in semi prone position and open esophagectomy.

METHODSSixty-two consecutive patients after thoracoscopic esophagectomy were compared with 62 patients who underwent open esophagectomy. Outcomes included surgical time, blood loss, length of hospital stay, 30-day mortality, complications and gained lymph nodes.

RESULTSThe mean length of hospital stay of the thoracoscopic group was 12.4 ± 7.4 days, and 13.6 ± 6.7 days in the open esophagectomy group (P > 0.05). The median total operation time and median thoracic operation time were 270 and 130 min, the median total blood loss and median thoracic blood loss were 300 and 180 ml in the thoracoscopic group, while the results in open esophagectomy group were 290, 150 min and 300, 180 ml. The median total operation time and median thoracic operation time were of statistically significant difference (P < 0.01). But there were no significant differences between the two groups in total blood loss and thoracic blood loss (P > 0.05) . The numbers of obtained lymph nodes in the thoracoscopic group and open esophagectomy group were 20.5 and 16.9 (P < 0.01). Among them, the median numbers of mediastinal lymph nodes in the thoracoscopic group and open esophagectomy group were 12.4 and 8.8, the left recurrent laryngeal nerve lymph nodes were 1.8 and 1.0, and the right recurrent laryngeal nerve lymph nodes were 2.9 and 1.2 (P < 0.01 for all). There were 8 positive recurrent laryngeal nerve lymph nodes (12.9%) in the thoracoscopic group, while 5 in the open esophagectomy group (8.1%, P > 0.05). There were no peri-operative period death, heavy bleeding, or thoracic gastric fistula in both groups.

CONCLUSIONSThoracoscopic esophagectomy in semi prone position may achieve good surgical field exposure, therefore, to make esophagectomy, lymph node dissection and digestive tract reconstruction possible. These findings suggest that with further technical refinement, thoracoscopic esophagectomy may have the upper hand on reducing postoperative complications and performing mediastinal lymph node dissection.

Esophageal Neoplasms ; surgery ; Esophagectomy ; Humans ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; surgery ; Mediastinum ; Operative Time ; Postoperative Complications ; Prone Position ; Recurrent Laryngeal Nerve ; Thoracoscopy