Objective:This work presents the therapeutic advantage of induction therapy in patients withⅢA-N2 non-small cell lung cancer (ⅢA-N2 NSCLC). Methods:ⅢA-N2 NSCLC patients with ipsilateral mediastinal lymph node metastasis (>1 cm as shown by CT scan) who were admitted in our hospital between January 2008 and July 2013 were retrospectively analyzed. The response rates and survival outcomes of patients were presented and the prognostic factors were analyzed. Results:The 3-and 5-year overall survival (OS) rates were 57.7%and 34.2%, respectively, and the 3-and 5-year disease-free survival (DFS) rates were 37.9%and 30.5%, respec-tively. No significant differences in OS and DFS were observed between R0 and R1 resections (P=0.118; P=0.369), between groups who received neo-adjuvant chemo-radiotherapy and chemotherapy (P=0.771; P=0.953), between cases with and without clinical re-sponse (P=0.865;P=0.862), and among groups of different histological subtypes (P=0.685;P=0.208). However, patients with standard lobectomy or pathological nodal downstaging exhibited better OS (P=0.023 and P=0.024, respectively) and DFS (P=0.036 and P=0.025, respectively) than those who had extensive resections or persistent N2. Univariate analysis predicted better OS and DFS for both standard lobectomy and pathological nodal donwstaging. In addition, Cox multivariate analysis revealed that only pathological nodal downstaging could be considered as a favorable prognostic factor for DFS, while non-smoking and standard lobectomy are the corre-sponding variables for OS. Conclusion:Neo-adjuvant therapy with platinum-based doublet is feasible and useful in tumor and patho-logical nodal downstaging, which potentially improved resectability and survival rates in patients withⅢA-N2 NSCLC. Performing lo-bectomy or pathological nodal downstaging following induction therapy improved the patients' survival rate.

Objective To study the expression and clinical significance of thyroid transcription factor-1 (TTF-1) in stage Ⅰ non-small cell lung cancer (NSCLC) after operation and to 1 investigate the values in identification of the prognosis of stage Ⅰ NSCLC.Methods The expression of TTF-1 in 129 specimens of stage Ⅰ NSCLC was detected by immunohistochemistry.Results The positive rate of TTF-1 in stage Ⅰ NSCLC was 64.3％.There were significant differences in TTF-1 expression rate among pathological subtypes (x2 =25.231,P ＜ 0.001),different ages (x2 =4.581,P =0.032),sex (x2 =4.900,P =0.027) and differentiation degrees(x2 =11.519,P =0.019).Univariate analysis suggested that in the stage Ⅰ NSCLC patients,the median disease-free survival and overall survival of those positive for TTF-1 expression were superior to those negative:38.9 months versus 27.8 months (P =0.023) and 64.10 months versus 50.68months (P =0.013).Cox regression analysis suggested that TTF-1 expression,tumor differentiation degrees were independent factors affecting the prognosis of stage Ⅰ NSCLC.Conclusion Patients with TTF-1 positive expression often had better survival.Positive expression of TTF-1 and differentiation degree of tumor were independent prognostic factors to affect the prognosis of NSCLC.

Objective To summarize the clinical experience of surgical treatment of malignant tra-cheal tumor.Methods Two hundred and fifty-eight medical charts about surgical treatment of malignant tracheal tumor between July 1980 and July 2007 were retrospectively reviewed.The main histological type were adenoid cystic carcinoma (104/258) and squamous cell carcinoma (93/258).Operative methods in-cluded circumferential resection end to end anastomosis of trachea (n=157),carinal resection and re-construetion (n=51),sleeve pneumonectomy(n=22),windowing removal(n=23),tracheal allotrans-plantation(n=2),circumferential reflection and anastomosis of trachea with assistance of extracorporeal cir-culation (n=3).Results No patient died from operation in the 258 cases,and the overall 5-and 10-year survival rates were 64.O%(165/258)and 58.1%(150/258),respectively.The morbidity rate was 5.4%(14/258).Conclusiom Surgical excision is the most effective treatment of malimmnt tracheal tumor.Tracheal resection and carinal reflection are the main operative methods in the treatment of malignant tracheal tumor.Decreasing operative complications is the key of successfully surgical treatment.

Objective Explore a new method which application absorbable suture netting for chest wall reconstruction and observe the clinical effect.Methods For 23 cases of part of the rib resection,support the soft tissue using absorbable suture netting and observe the postoperative results.Results 23 patients have the postoperative respiratory stability and no abnormal breathing and chest wall collapse happened.And this method has a good effect to support the Chest wall.Conclusion Chest wall reconstruction using absorbable suture netting has the following advantages:easily obtained,easy to learn to promote,low prices and postoperative respiratory stability.We believe this method is a new technology deserved to be promoted in our country.

ObjectiveTo retrospectively investigate the clinical results of video-assisted thoracoscopic surgery for pulmonary pure ground-glass opacity.MethodsThe clinical data of 45 patients with pGGO underwent video-assisted thoracoscopic surgery were collected.The gender constitution,age,smoking status,surgical procedures,lesion size,histological types of tumor,lymph node metastasis and prognosis were retrospectively analyzed.ResultsThe numbers of females and non-smokers were significantly larger than those of males and smokers.All 45 patients underwent video-assisted thoracoscopic surgery.37 patients of solitary pGGO were all operated with cure intention.27 of the 37 patients received local resection ( wedge resection in 18 or segment resection in 9),and the other 10 patients underwent lobectomy.There are 8 patients of multiple nodes.Amongthese,6 were operated with cure intention,while 2 received VATS biopsy.Pathological examinations after operation revealed that there were 31 cases of bronchioloalveolar carcinoma and 14 cases of atypical adenomatous hyperplasia.And there was no lymph node metastasis.The diameters of bronchioloalveolar carcinoma lesions were significantly longer than those of atypical adenomatous hyperplasia lesions( P ＜ 0.05 ).Patients were followed up for 4 months to 6 years,and all survived without local recurrence and distant metastasis.ConclusionThe diameters of bronchioloalveolar carcinoma lesions are longer than those of atypical adenomatous hyperplasia lesions.Video-assisted thoracoscopic sublobectomy for pulmonary pure ground-glass opacity may achive excellent clinical results.Computed tomography-guided localization is a useful,safe procedure.

Objective To summarize the basic experience of robotic-assisted Thoracic Surgery using da Vinci Robotic system and to evaIuate its value in clinical application.Methods From Jan 2009 to Sep 2012,the clinical data of 25 patients who underwent robotic-assisted Thoracic Surgery using da Vinci Robotic system were analyzed.Results All 25 patients were successfully operated and no conversion to thoracotomy occurred,including 10 cases of pulmonary lobectomy,14 cases of rumor mainly in anterior mediastinum and a cases of esophageal carcinoma.The operative time of pulmonary lobectomy was 180-390min,mean(241 ± 90.98)min,the estimated blood loss was 150-300 ml,mean (195 ± 43.78)ml,and the post-operative 24 h drainage was 250-300 ml,mean(305 ± 28.38)ml.The operative time of rumor from thymus mainly in anterior mediastinum was 70-210 min,mean (116.36 ± 45.23)min,the estimated blood loss was 50-100 ml,mean (63.64 ± 23.36)ml,and the post-operative 24 h drainage was 20-270 ml,mean (123.64 + 69.93) ml.No other major complications were experienced,no peri-opermive mortality occurred.Conclusion Da Vinci robotic-assisted thoracic surgery is a feasible and safe surgical procedure with clear operation field,precise dissection,minimal trauma and fast recovery.

Objective This study was to analyze the early and long-term effect of completion pneumonectomy.Methods Retrospective analysis was made on the patients who underwent completion pneummonectomy in Shanghai Chest Hospital.Results There were totally 56 cases patients underwent completion pneumonectomy during January 2003 to July 2013.Among them,45 patients received CCP,and other 11 patients received RCP.CCP refers to the complete removal of lung tissue remaining after an initial ipsilateral partial pulmonary resection.RCP refers to the complete removal of residual lung due to the severe complications after pneumonectomy.The mortality and morbidity rate of CCP were 4.4％ and 33.3％ respectively.In the case of CCP,the incidence of benign lesions is significantly higher than the incidence of malignant tumor(80.0％ vs 27.5％,P =0.04).The mortality and morbidity rate of RCP were 27.3％ and 90.9％ respectively.In the case of RCP,higher postoperative mortality often occurs in aged patients (P =0.046) and patients with preoperatie mechanical ventilation (P =0.03).Overall five-year survival rate for patients with benign lesions was 80％,and for malignant lung cancer patients,the number was 30％.Survival time differs according to the TNM staging(a median of 60.0 months,35.0 months,10.0 months,stage Ⅰ,stage Ⅱ,stage Ⅲ,P ＜0.01),and survival rate was higher when the time interval(between the initial pulmonary resection and the completion pneumonectomy) ＞ 2 years(a median of 60.0 months,18.0 months,P ＜ 0.01).Conclusion Completion pneumonectomy is a high-risk surgery,especially RCP.Advanced age and preoperative mechanical ventilation are associated with higher postoperative mortality rate for RCP.As for CCP,higher postoperative risk exists in patients with benign lesions,but the survival rate is also higher.In patients with malignant lung tumor,survival rate is higher when the time interval (between the initial pulmonary resection and the completion pneumonectomy) ＞2 year.