Background and objective Postoperative complications (PCs) are contributing factors to patient mortality following lung resection.In this retrospective study,the Clavien-Dindo classification was used to analyze the current incidence of PCs and identify the risk factors of different grades of PCs.Methods A total of 966 lung cancer patients who underwent lobectomy in our department between June 2013 and December 2014 were retrospectively enrolled.Patients were divided into two groups depending on the occurrence of PCs.2he PCs were classified into four grades through the Clavien-Dindo classification,and the related risk factors of different grades were evaluated.Results Approximately 15.0％ (145/966) of patients had PC (total incidence:39.3％,380/966).Among the 380 cases with PCs,the proportions of Clavien-Dindo grade Ⅰ,grade Ⅱ,grade lⅢ and grade Ⅳ or above complications were 6.8％,75.3％,15.0％ and 2.9％,respectively.Binary Logistic regressions showed that preoperative forced expiratory volume in one second (FEV1),diffusion capacity for carbon monoxide of the lung (single breath)(DLco SB),and preoperative combined chronic obstructive pulmonary disease were the significant independent factors for PCs.FEV1 in preoperative pulmonary function was the significant risk factor for complications at Clavien-Dindo grade Ⅰ,grade Ⅱ,grade Ⅲ,and above.Conclusion Clavien-Dindo grade Ⅱ complications are the most common complications within 30 days after lung cancer lobectomy.FEV1 is closely related to the occurrence of PCs and may potentially be one of the practical variables to assess the risk of occurrence of P Cs.

Background and objective Diagnostic modes may play an important role in treatments, but minimal in-formation is available regarding their relationship in patients with lung cancer. hTis study may contribute to decision making in clinics and public health centers.MethodshTe records of 505 hospitalized surgical patients with lung cancer at the Department of hToracic Surgery, West China Hospital of Sichuan University from January 2013 to December 2013 were retrospectively reviewed. hTe patients were categorized into physical examination group (PEG, 131 patients) and symptomatic group (SG, 374 patients). Surgical approach, pathological stage, and diagnostic mode were analyzed.Results Low-dose computed tomography (46.6%, 61/131) and computed radiography (51.1%, 67/131) were used as key diagnosis methods in 131 patients in PEG. hTe percentage of hospitalized surgical patients with lung cancer detected via physical examination in the city (35.4%, 80/229) was also signiifcantly higher than in the township (18.1%, 50/276) (P<0.001). hTe ratio of stage I lung cancer detected via physi-cal examination in the city (46.8%, 59/126) was signiifcantly higher than that in the township (27.3%, 33/121) (P=0.001). hTe proportion of patients who underwent VATS lobectomy was signiifcantly higher in PEG (73.3%, 96/131) than that in SG (44.4%, 166/374) (P<0.001), and the ratio of patients at stage I was signiifcantly higher in PEG (70.2%, 92/131) than that in SG (41.4%, 155/374) (P<0.001).Conclusion hTe use of physical examination is more prevalent in cities than that in towns, and its combination with mini-invasive surgical treatment contributes to early diagnosis of patients with lung cancer.

Background and objective hTere are incresing lung cancer patients detected and diagnosed at the in-termediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health con-sciousness. hTe aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary compli-cations in stage I non-small cell lung cancer (NSCLC) patients, based on routine laboratory tests, basic characteristics, and in-traoperative variables in hospital.Methods hTe 421 patients atfer lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratiifed into complica-tion group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications atfer lobectomy in 30 days.Results Of them, 64 (15.2%) patients were ifnally identiifed and selected into the complication group, compared with 357 (84.8%) in non-complication group: pneumonia (8.8%, 37/421) was the primary complication, and other main complications included atelectasis (5.9%, 25/421), pleural effusion (≥middle) (5.0%, 21/421), persistent air leak (3.6%, 15/421); hTe operation time (P=0.007), amount of blood loss (P=0.034), preoperative chronic obstructive pulmonary disease (COPD) (P=0.027), white blood cell (WBC) count (P<0.001), neutrophil-lymphocyte ratio (NLR) (P<0.001) were signiif-cantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078,P<0.001) and WBC count (OR=1.451, 95%CI: 1.212-1.736,P<0.001) were independent risk factors for postoperative cardio-pulmonary complications.Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD, may be the independent risk factors of the occurrence of postopera-tive cardio-pulmonary complications.

Background and objective Postoperative pulmonary complications (PPCs),especially postoperative pneumonia (POP),directly affect the rapid recovery of lung cancer patients after surgery.Peak expiratory flow (PEF) can reflect airway patency and cough efficiency.Moreover,cough impairment may lead to accumulation of pulmonary secretions which can increase the risk of PPCs.The aim of this study is to investigate the effect of preoperative PEF on PPCs in patients with lung cancer.Methods Retrospective research was conducted on 433 lung cancer patients who underwent lobectomy at the West China Hospital of Sichuan University from January 2014 to December 2015.The associations between preoperative PEF and PPCs were analyzed based on patients' basic characteristics and clinical data in hospital.Results Preoperative PEF value in PPCs group (280.93±88.99) L/min was significantly lower than that in non-PPCs group (358.38±93.69) L/min (P＜0.001).According to the binary logistics regression analysis,PEF and operative time were independent risk factors for PPCs.Further,ROC curve showed that PEF=320 L/min was the cut-off value for predicting the occurrence of PPCs (AUC=0.706,95％CI:0.661-0.749).The incidence of PPCs in PEF≤320 L/min group (26.6％) was significantly higher than that in PEF＞320 L/min group (9.4％)(P＜0.001).Conclusion Preoperative PEF and PPCs are correlated,and PEF maybe used as a predictor of PPCs.

Objective    To review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects. Methods    A total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed. Results    Included patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2卤4 680.3 mL vs. 4 911.2卤3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2卤2.7 d) was shorter than that of the non-surgical treatment group (12.3卤6.8 d, P=0.204). Conclusion 聽 聽The treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.

BACKGROUND: Oscillatory positive expiratory pressure (OPEP) training is a kind of breathing exercise with Acapella. The clinical value of OPEP has been widely discussed in chronic obstructive pulmonary disease, bronchiectasis as well as pulmonary cyst. However, few studies have explored the application of OPEP in surgery lung cancer patients underwent lobectomy. Thus, the aim of this study is to explore the impact of the application of OPEP device (acapella) in lung cancer patients undergoing video-assisted thorascopic surgery (VATS). METHODS: Sixty-nine patients receiving VATS lobectomy in Department of Thoracic Surgery, West China Hospital, Sichuan University from September 15, 2017 to January 15, 2018 were randomly divided into the acapella group (AG) or the control group (CG). The patients in the AG received oscillating positive expiratory pressure training and the CG underwent standard perioperative treatment. The differences of morbidity, pulmonary function, quality of life were compared between the two groups. RESULTS: Thirty-five patients were assigned to the AG and thirty-four patients were assigned to the CG. The incidences of postoperative pulmonary complications (PPCs) and atelectasis (2.9%, 0.0%) in the AG were significantly lower than that in the CG (20.6%, 14.7%)(P=0.03, P=0.03). The duration of total hospital stay and postoperative hospital stay in the AG (10.86±5.64, 5.09±4.55) d were significantly shorter than that in the CG (10.86±5.64, 5.09±4.55) d (P=0.01, P=0.01). The drug cost in the AG (4,413.60±1,772.35) ¥ were significantly lower than that in the CG (6,490.35±3,367.66) ¥ (P=0.01). The patients in the AG had better forced expiratory volume in the first second and peak expiratory flow [(1.50±0.32) L,(252.06±75.27) L/min] compared with the CG [(1.34±0.19) L, (216.94±49.72) L/min] (P=0.03, P=0.03) at discharge. CONCLUSIONS The application of OPEP device during the perioperative period was valuable in decreasing PPCs and enhancing recovery for lung cancer patients receiving VATS lobectomy.
Adult ; Aged ; Female ; Forced Expiratory Volume ; Humans ; Lung ; physiopathology ; surgery ; Lung Neoplasms ; physiopathology ; surgery ; Male ; Middle Aged ; Perioperative Period ; Pneumonectomy ; Quality of Life ; Thoracic Surgery, Video-Assisted

Background and objective Surgical procedure is the main method of treating lung cancer.Meanwhile,postoperative pneumonia (POP) is the major cause of perioperative mortality in lung cancer surgery.The preoperative pathogenic airway bacterial colonization is an independent risk factor causing postoperative pulmonary complications (PPC).This cross-sectional study aimed to explore the relationship between preoperative pathogenic airway bacterial colonization and POP in lung cancer and to identify the high-risk factors of preoperative pathogenic airway bacterial colonization.Methods A total of 125 patients with non-small cell lung cancer (NSCLC) underwent thoracic surgery in six hospitals of Chengdu between May 2015 and January 2016.Preoperative pathogenic airway bacterial colonization was detected in all patients via fiber bronchoscopy.Patients' PPC,high-risk factors,clinical characteristics,and the serum surfactant protein D (SP-D) level were also analyzed.Results The incidence of preoperative pathogenic airway bacterial colonization among NSCLC patients was 15.2％ (19/125).Up to 22 strains were identified in the colonization positive group,with Gram-negative bacteria being dominant (86.36％,19/22).High-risk factors of pathogenic airway bacterial colonization were age (≥75 yr) and smoking index (≥≥400 cigarettes/year).PPC incidence was significantly higher in the colonization-positive group (42.11％,8/19) than that in the colonization-negative group (16.04％,17/106)(P=0.021).POP incidence was significantly higher in the colonization-positive group (26.32％,5/19) than that in the colonization-negative group (6.60％,7/106)(P=0.019).The serum SP-D level of patients in the colonization-positive group was remarkably higher than that in the colonization-negative group [(31.25±6.09)vs (28.17±5.23)] (P=0.023).The incidence of preoperative pathogenic airway bacterial colonization among NSCLC patients with POP was 41.67％ (5/12).Ihis value was 3.4 times higher than that among the patients without POP (OR=3.363,95％CI:1.467-7.711).Conclusion An intimate correlation was observed between POP and pathogenic airway bacterial colonization in lung cancer.The high-risk factors of pathogenic airway bacterial colonization were age and smoking index.

Objective    To analyze the causes and potential risk factors of re-catheterization after failure of no urinary catheter in patients undergoing lung cancer surgery. Methods    The clinical data of 1 618 patients without urinary catheter indwelling during the perioperative period of thoracic surgery in our hospital from 2013 to 2019 were retrospectively analyzed, including 791 males and 827 females, with a median age of 58 years, ranging from 27 to 85 years. And the risk factors for re-insertion after failure of urinary catheter were investgated. Results    The rate of catheter re-insertion was 1.5% (24/1 618). Compared with patients without re-insertion, patients with re-insertion had longer operation time [120.0 (95.0, 130.0) min vs. 120.0 (115.0, 180.0) min, P=0.015] and more intraoperative fluid infusion [800.0 (600.0, 1 100.0) mL vs. 1 150.0 (725.0, 1 350.0) mL, P=0.008]. Further multivariate analysis found that the operation time (OR=1.014, P=0.004, 95%CI 1.005-1.024) and intraoperative fluid infusion (OR=1.001, P=0.022, 95%CI 1.001–1.002) were independent risk factors for re-insertion. Conclusion    The rate of catheter re-insertion in lung cancer patients is relatively low, and conventional no placement of catheter is safe and feasible after lung cancer surgery. Increasing operation time or intraoperative infusion volume may increase the risk of catheter re-insertion after lung cancer surgery.