Traditional open esophagectomy is associated with significant mortality and morbidity.Some researches have suggested that the incidence of the complications may be decreased with minimally invasive esophagectomy which has equivalent survival rate compared with open esophagectomy.It may become a tendency of esophageal surgery.This article reviewed the progress of minimally invasive esophagectomy.

Objective To study the isolation and phenotype of peripheral blood pDC 1 and pDC 2 in rhesus monkey.Methods Peripheral blood monoclear cells (PBMCs) were isolated from healthy, SIV-negative rhesus monkeys (M.mulatta) using Ficoll-Hypaque density separation. DC precursors were identified and were sorted by 3 color rare-event cytometric flow analysis using human monoclonal antibodies cross reactive with rhesus monkey. Results DC subsets were identified within the lineage- HLA-DR+ fraction of PBMCs and maintained activities. Myeloid DC (pDC 1) showed the phenotype lineage-, HLA-DR+ and BDCA 1+; Lymphoid DC (pDC 2)showed the phenotype lineage-, HLA-DR+ and CD123+ (IL-3R?+).Conclusions We have identified the rhesus monkey pDC 1 and pDC 2 similar to those from human beings. Identification of pDC 1 and pDC 2 is an important first step towards testing of these important immunomodulatory APC in the therapy of allograft rejection in non-human primates.

Objective To present the technique of super-minimally invasive bilateral thoracoscopic extended thymectomy,and evaluate the early clinical results by using of this technique.Methods Twenty-three patients with myasthenia gravis (MG) with thymoma underwent with super-minimally invasive bilateral thoracoscopic extended thymectomy in our institution between July 2014 and January 2016.Two operate-poles are 5mm trocar,one is three intercostal space at the anterior axillary line,and the other is four intercostal space at the midclavicular line.A 10 mm trocar is inserted through the 6th intercostal space in the mid axillary line.The perioperative variables and outcomes were collected and analysed retrospectively.Results In the 23 patients who underwent Super-Minimally invasive bilateral thoracoscopic extended thymectomy,the mean operation time was (163.2 ± 14.4) min and the average blood loss was (148.2 ± 39.5) ml.The chest tube duration was (4.14 ± 0.27) days.There were no mortalities.Conclusion Our preliminary report showed that Super-Minimally invasive bilateral thoracoscopic extended thymectomy for mediastinal tumour resection was a promising and safe technique with regard to short-term clinical outcome.

Esophageal cancer is one of the common malignant tumors in China.Although it is currently treated by multidisciplinary treatment,esophageal cancer's prognosis is still poor.The occurrence of esophageal cancer is closely related to the metabolism of trace element zinc.Zinc deficiency can induce the development of esophageal cancer by inducing inflammatory reaction and microRNAs imbalance.Zinc ion can play an important role in esophageal cancer by regulating the activity of ion channel.The formed zinc finger protein can function as an oncogene or a tumor suppressor gene in esophageal cancer.Zinc metabolism is accompanied by complex biological changes in the pathogenesis of esophageal cancer,and multiple mechanisms interact and are closely linked.The article reviews the research results of recent years on the mechanism of zinc deficiency,zinc ion-regulated ion channel and zinc finger protein in the development of esophageal cancer.

Objective     To analyze the risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer patients. Methods     The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. According to different length of hospital stay (LOS), 771 patients were divided into two groups, a normal LOS group and a PLOS group. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the PLOS group, there were 220 patients including 72 females and 148 males with a median age of 60 years, whose LOS was no less than 8.0 days. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results     Univariate analysis showed that risk factors for PLOS included male, arrhythmias and atrioventricular block, smaller FVC%, unilateral pneumonectomy, operation and anesthesia duration, intraoperative blood loss and number of lymph node dissection in the operation (P<0.05). Multivariate logistic regression analysis showed that the age ≥75 years (OR=4.100, 95%CI 1.677 to 10.026), unilateral pneumonectomy (OR=2.563, 95%CI 1.473 to 4.460), FVC% < 89.05% (OR=1.500, 95%CI 1.020 to 2.206), numbers of lymph node dissection≥ 13.5 (OR=1.826, 95%CI 1.262 to 2.642), operation duration≥126.5 min (OR=1.858, 95%CI 1.200 to 2.876) and arrhythmia (OR=2.944, 95%CI 1.380 to 6.284) were independent risk factors of PLOS (all P<0.05). Conclusion     LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection, arrhythmia and operation duration. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after lobectomy for lung cancer patients.

BACKGROUND: To summarize the clinical features of patients with pulmonary embolism after lobectomy and to explore the methods of diagnosis and treatment of pulmonary embolism after lobectomy. METHODS: The clinical data of 6 patients with pulmonary embolism after lobectomy between July 2007 and July 2017 were retrospectively analyzed. RESULTS: Of the 6 patients, 3 died within 24 h of onset and 3 patients were cured and discharged. CONCLUSIONS Pulmonary embolism after lobectomy is a rare postoperative complication in thoracic surgery. It is difficult to diagnose and has a high mortality rate. Preoperative thromboembolic risk assessment and postoperative prevention are important.
Aged ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; Postoperative Complications ; diagnosis ; etiology ; therapy ; Pulmonary Embolism ; diagnosis ; etiology ; therapy ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; adverse effects

Objective    To explore the risk factors and short-term clinical effect of conversion to open thoracotomy during thoracoscopic lobectomy for lung cancer patients. Methods    We retrospectively analyzed the clinical data of 423 lung cancer patients who were scheduled for thoracoscopic lobectomy between March 2011 and November 2015.There were 252 males and 171 females at median age of 60 (24-83) years. According to the patients who were and were not converted to thoracotomy, they were divided into a conversion group (378 patients) and a video-assisted thoracic surgery group (a VATS group, 45 patients). Then, clinical data of two groups were compared, and the risk factors and short-term clinical effect of unplanned conversions to thoracotomy were analyzed. Results    Lymph nodes of hilar or/and interlobar fissure closely adhered to adjacent vessels and bronchi was the most common cause of unexpected conversions to thoracotomy in 15 patients (33.3%), followed by sleeve lobectomy in 11(24.4%) patients, uncontrolled hemorrhage caused by intraoperative vessel injury in 8 patients, tumor invasion or extension in 5 patients, difficulty of exposing bronchi in 3 patients, close adhesion of pleural in 2 patients, incomplete interlobar fissure in 1 patient. Conversion did translate into higher overall postoperative complication rate (P=0.030), longer operation time (P<0.001), more intraoperative blood loss (P<0.001). In the univariable analysis, the type of operation, the anatomical site of lung cancer, the lymph node enlargement of hilar in CT and the low diffusion capacity for carbon monoxide (DLCO) were related to conversion. Logistic regression analysis showed that the independent risk factors for conversion were sleeve lobectomy (OR=5.675, 95%CI 2.310–13.944, P<0.001), the lymph node enlargement of hilar in CT (OR=3.732, 95%CI 1.347–10.341, P=0.011) and DLCO≤5.16 mmol/(min·kPa)(OR=3.665, 95%CI 1.868–7.190, P<0.001). Conclusions    Conversion to open thoracotomy during video-assisted thoracic surgery lobectomy for lung cancer does not increase mortality, and it is a measure of reducing the risk of surgery. Therefore, with high-risk patients who may conversion to thoracotomy, the surgeon should be careful selection for VATS candidate. And, if necessary, the decision to convert must be made promptly to reduce short-term adverse outcome.

Objective    To explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery. Methods    Seventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups. Results    There were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05). Conclusion    It is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.

Objective To investigate the relationship between clinical features and lymph node metastasis in lung adenocarcinoma patients with T1 stage. Methods We retrospectively analyzed the clinical data of 253 T1-stage lung adenocarcinoma patients (92 males and 161 females at an average age of 59.45±9.36 years), who received lobectomy and systemic lymph node dissection in the Second Affiliated Hospital of Harbin Medical University from October 2013 to February 2016. Results Lymph node metastasis was negative in 182 patients (71.9%) and positive in 71 (28.1%). Poor differentiation (OR=6.988, P=0.001), moderate differentiation (OR=3.589, P=0.008), micropapillary type (OR=24.000, P<0.001), solid type (OR=5.080, P=0.048), pleural invasion (OR=2.347, P=0.024), age≤53.5 years (OR=2.594, P=0.020) were independent risk factors for lymph node metastasis. In addition, in the tumor with diameter≥1.55 cm (OR=0.615, P=0.183), although the cut-off value of 1.55 cm had no significant difference, it still suggested that tumor diameter was an important risk factor of lymph node metastasis. Conclusion In lung adenocarcinoma with T1 stage, the large tumor diameter, the low degree of differentiation, the high ratio of consolidation, and the micropapillary or solid pathological subtypes are more prone to have lymph node metastasis.

Objective    To analyze and compare the perioperative efficacy difference between full-port Da Vinci robotic surgery and thoracoscopic surgery in patients with mediastinal tumor resection. Methods    The data of 232 patients with mediastinal tumors treated by the same operator in the Department of Thoracic Surgery of the Second Affiliated Hospital of Harbin Medical University were included. There were 103 (44.4%) males and 129 (55.6%) females, with an average age of 49.7 years. According to the surgical methods, they were divided into a robot-assisted thoracic surgery (RATS) group (n=113) and a video-assisted thoracoscopic surgery (VATS) group (n=119). After 1 : 1 propensity score matching, 57 patients in the RATS group and 57 patients in the VATS group were obtained. Results    The RATS group was better than the VATS group in the visual analogue scale pain score on the first day after the surgery [3.0 (2.0, 4.0) points vs. 4.0 (3.0, 5.0) points], postoperative hospital stay time [4.0 (3.0, 5.5) d vs. 6.0 (5.0, 7.0) d] and postoperative catheterization time [2.0 (2.0, 3.0) d vs. 3.0 (3.0, 4.0) d] (all P<0.05). There was no statistical difference between the two groups in terms of intraoperative blood loss, postoperative complications, postoperative thoracic closed drainage catheter placement rate or postoperative total drainage volume (all P>0.05). The total hospitalization costs [51 271.0 (44 166.0, 57 152.0) yuan vs. 35 814.0 (33 418.0, 39 312.0) yuan], operation costs [37 659.0 (32 217.0, 41 511.0) yuan vs. 19 640.0 (17 008.0, 21 421.0) yuan], anesthesia costs [3 307.0 (2 530.0, 3 823.0) yuan vs. 2 059.0 (1 577.0, 2 887.0) yuan] and drug and examination costs [9 241.0 (7 987.0, 12 332.0) yuan vs. 14 143.0 (11 620.0, 16 750.0) yuan] in the RATS group was higher than those in the VATS group (all P<0.05). Conclusion    Robotic surgery and thoracoscopic surgery can be done safely and effectively. Compared with thoracoscopic surgery, robotic surgery has less postoperative pain, shorter tube-carrying time, and less postoperative hospital stay, which can significantly speed up the postoperative recovery of patients. However, the cost of robotic surgery is higher than that of thoracoscopic surgery, which increases the economic burden of patients and is also one of the main reasons for preventing the popularization of robotic surgery.