OBJECTIVETo compare the short-term efficacy and long-term survival between Sweet and Ivor-Lewis esophagectomy for patients with middle-lower esophageal squamous cell carcinoma.

METHODSClinicopathologic data of 1 308 patients with middle-lower esophageal squamous cell carcinoma undergoing Sweet or Ivor-Lewis procedures in our department from January 2007 to December 2014 were retrospectively analyzed, including 1 021 patients of Sweet operation (Sweet group) and 287 patients of Ivor-Lewis operation(Ivor-lewis group). Lymph node clearance, lymphatic metastasis, postoperative complication morbidity and long-term survival were compared between the two groups.

RESULTSThere were no significant differences in baseline data between the two groups(all P>0.05). There were more lymph nodes resected during the Ivor-Lewis procedure compared with the Sweet procedure (20.8 vs.19.3, P=0.030). Compared with Ivor-Lewis group, the incidence of wound infection in Sweet group was significantly lower[(3.2%(33/1 021) vs. 8.0%(23/287), P=0.000]. Sweet group had a significantly lower rate of delayed gastric emptying[1.9%(19/1 021) vs. 5.2%(15/287), P=0.002] and significantly shorter hospital stay (14.7 days vs. 17.2 days, P=0.029). With respect to other postoperative complications, such as pulmonary complications, cardiac events, anastomotic leakage, vocal cord palsy, chylothorax and pyothorax, the differences between the two groups were not statistically significant. The 5-year survival rate was not significantly different between the two group (54.0% vs. 56.9%, P=0.873). Stratified analysis based on TNM staging showed that no significant difference of 5-year survival rate was found between the two groups in stageI( and stageIII( patients (P>0.05), while the 5-year survival rate of stageII( patients in Sweet group was significantly lower than that in Ivor-Lewis group (56.4%% vs. 70.4%, P=0.039).

CONCLUSIONSFor patients with middle-lower esophageal squamous cell carcinoma, Sweet procedure has certain superiority regarding the incidence of wound infection and delayed gastric emptying compared with the Ivor-Lewis procedure. Ivor-Lewis esophagectomy can harvest more lymph nodes. The 5-year survival rate of these two procedures is similar. Sweet procedure is still valuable in clinical practice, especially for stageI( and stageIII( patients, while it requires thorough considerations for stageII( patients.

Anastomotic Leak ; Antineoplastic Protocols ; Carcinoma, Squamous Cell ; mortality ; surgery ; Esophageal Neoplasms ; mortality ; surgery ; Esophagectomy ; adverse effects ; methods ; Gastroparesis ; etiology ; Humans ; Incidence ; Length of Stay ; Lymph Node Excision ; statistics & numerical data ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; statistics & numerical data ; Postoperative Complications ; etiology ; Recovery of Function ; Retrospective Studies ; Surgical Wound Infection ; etiology ; Survival Rate ; Treatment Outcome

Objectives:To examine the prognostic significance of WHO classification of lung adenocarcinoma in 2021 in patients with stage Ⅰ pulmonary adenocarcinoma.Methods:The clinical data of 829 patients who underwent surgery from January 2015 to September 2016 at Department of Thoracic Surgery, Zhongshan Hospital of Fudan University and had a postoperative pathologically confirmed diagnosis of stage Ⅰ lung adenocarcinoma were analyzed retrospectively. There were 389 males and 440 females, aged (60±11) years (range: 32 to 90 years), including 570 cases with solid nodules, 259 cases with ground-glass nodule. The survival curve was plotted using the Kaplan-Meier method and compared by the Log-rank test. The Cox proportional hazards regression model was used to identify prognosis factors on overall survival (OS), and recurrence-free survival (RFS).Results:Among the 829 patients, 470 cases were acinar predominant type, 165 cases were papillary predominant type, 90 cases were lepidic predominant type, 62 cases were solid predominant type, and 42 cases were micropapillary type. Compared with the solid nodule group, the proportion of patients with lepidic predominant type was higher in the ground glass nodule group (20.5%(53/259) vs. 6.5%(37/570), χ2=35.922, P<0.01), while the proportion of micropapillary (1.2%(3/259) vs. 6.8%(39/570), χ2=11.961, P<0.01) and solid predominant type (1.5%(4/259) vs. 10.2%(58/570), χ2=19.172, P<0.01) was lower. Survival analysis of 829 patients showed that patients with the lepidic predominant had the best prognosis, those with acinar and papillary predominant were worse, and patients with solid and micropapillary predominant had the worst prognosis (all P<0.01). The independent prognosis factors associated with postoperative recurrence were T2 stage ( HR=1.631, 95% CI: 1.030 to 2.583, P=0.037), pathologic subtype ( P=0.036), presence of a micropapillary component ( HR=1.764, 95% CI: 1.143 to 2.722, P=0.010), and solid nodule in CT picture ( HR=18.690, 95% CI: 7.587 to 46.043, P<0.01). Subgroup analysis showed that in both solid and ground-glass nodules, the presence of a solid-type component was a prognosis factor for overall survival, and the presence of a micropapillary component was a prognosis factor for recurrence-free survival. Conclusions:The presence of micropapillary and solid component, in addition to histological subtype, are prognosis factors for patients with stage Ⅰ lung adenocarcinoma. For patients with stage Ⅰ lung adenocarcinoma, the combination of pathological subtype and T-stage is more valuable and reliable for prognosis.

Objectives:To examine the prognostic significance of WHO classification of lung adenocarcinoma in 2021 in patients with stage Ⅰ pulmonary adenocarcinoma.Methods:The clinical data of 829 patients who underwent surgery from January 2015 to September 2016 at Department of Thoracic Surgery, Zhongshan Hospital of Fudan University and had a postoperative pathologically confirmed diagnosis of stage Ⅰ lung adenocarcinoma were analyzed retrospectively. There were 389 males and 440 females, aged (60±11) years (range: 32 to 90 years), including 570 cases with solid nodules, 259 cases with ground-glass nodule. The survival curve was plotted using the Kaplan-Meier method and compared by the Log-rank test. The Cox proportional hazards regression model was used to identify prognosis factors on overall survival (OS), and recurrence-free survival (RFS).Results:Among the 829 patients, 470 cases were acinar predominant type, 165 cases were papillary predominant type, 90 cases were lepidic predominant type, 62 cases were solid predominant type, and 42 cases were micropapillary type. Compared with the solid nodule group, the proportion of patients with lepidic predominant type was higher in the ground glass nodule group (20.5%(53/259) vs. 6.5%(37/570), χ2=35.922, P<0.01), while the proportion of micropapillary (1.2%(3/259) vs. 6.8%(39/570), χ2=11.961, P<0.01) and solid predominant type (1.5%(4/259) vs. 10.2%(58/570), χ2=19.172, P<0.01) was lower. Survival analysis of 829 patients showed that patients with the lepidic predominant had the best prognosis, those with acinar and papillary predominant were worse, and patients with solid and micropapillary predominant had the worst prognosis (all P<0.01). The independent prognosis factors associated with postoperative recurrence were T2 stage ( HR=1.631, 95% CI: 1.030 to 2.583, P=0.037), pathologic subtype ( P=0.036), presence of a micropapillary component ( HR=1.764, 95% CI: 1.143 to 2.722, P=0.010), and solid nodule in CT picture ( HR=18.690, 95% CI: 7.587 to 46.043, P<0.01). Subgroup analysis showed that in both solid and ground-glass nodules, the presence of a solid-type component was a prognosis factor for overall survival, and the presence of a micropapillary component was a prognosis factor for recurrence-free survival. Conclusions:The presence of micropapillary and solid component, in addition to histological subtype, are prognosis factors for patients with stage Ⅰ lung adenocarcinoma. For patients with stage Ⅰ lung adenocarcinoma, the combination of pathological subtype and T-stage is more valuable and reliable for prognosis.

Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

Objective:To investigate the effect and quality of life after anterior chest wall reconstruction with titanium plate and mesh due to manubrium tumor resection.Methods:A retrospective analysis was performed from January 2012 to December 2016, a total of 13 patients with primary(11cases) or secondary(2 cases) manubrium tumor, aged 41-72 years(medium aged as 56), underwent oncological resection, following by immediate chest wall reconstruction with titanium plate and titanium mesh. The quality of life was evaluated by EuroQol five dimensions questionnaire (EQ-5D) and EQ-5D visual analogue scale (ED-VAS) before and 3 months after operation. Computed tomographic scan was taken 3 months after operation.Results:All the patients received successful operation. During the perioperative period, 12 cases recovered well without any complications, 1 patient experienced mild paradoxical movement within 9 days after operation and then recovered. The median follow-up period after surgery was 25 months (range from 7 to 41). Computed tomographic scans for the 13 patients showed neither dislocation nor deformation of the titanium plate and mesh 3 months after operation. One patient with chondrosarcoma died as a result of relapse 11 months after surgery. In pain/discomfort dimension, the pre-operation score was 1.85±0.80 and the post-operation score was 1.15±0.38, showing a significant difference( P=0.013). There was no significant difference in scores of other four dimensions between pre- and post-operation( P>0.05). The total score of EQ-5D decreased significantly after the operation (7.08±2.02 vs 5.45±0.52, P=0.010). The pre- and post-operation ED-VAS score was 85.69±7.58 and 92.54±2.53, with a significant difference( P=0.008). Conclusions:The immediate reconstruction of chest wall with titanium plate and mesh after oncological manubrium resection is effective and safe with improvement of the quality of life.

Radiation therapy and immune checkpoint inhibitors(ICI) have a synergistic effect on anti-tumor,which involves a series of complex mechanisms of effects with the immune system,and can improve the clinical outcomes of cancer patients.However,the mechanism by which radiation therapy combined with ICI synergistically modulates the immune response may also trigger treatment-related adverse events.In view of the increasing number of clinical studies and practices of combination therapy,it is necessary to pay attention to the risk of adverse events in combination therapy of radiotherapy and ICI,so as to evaluate the safety of combination therapy.