Complete video-assisted thoracic surgery (cVATS) for lung cancer has the advantages of significantly minimal trauma, markedly light postoperative pain and rapid post-operative recovery, which has been increasingly applied in clinic.Its main operation methods consist of lobectomy, segmentectomy, pneumonectomy and sleeve lobectomy.cVATS for lung cancer can achieve the same radical tumor resection and lymph node dissection as the open thoracotomy, which contributes to a satisfactory long-term outcome.

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Objective To investigate the feasibility,safety and curative effect of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity.Methods We retrospectively evaluated 357patients with esophageal carcinoma who received minimally invasive esophagectomy(MIE) in our center between October 2011 and March 2014.Of those 357 patients,219 underwent MIILE and 138 underwent MIME.The clinicopathologic factors,operational factors,postoperative complications and postoperative recurrence were compared.Results The 2 groups were similar in terms of age,sex,American Society of Anesthesiologists grade,tumor location,preoperative staging.The MILLE approach was associated with no significant decrease in surgical blood loss.Duration of operation,chest tube duration,hospitalization expenses and postoperative stay relative to the MIME approach(P ＞ 0.05).There was no significant difference between the 2 groups in postoperative complications(P ＞0.05).The MIILE approach was associated with significantly fewer anastomotic fistula,RLN injury,anastomotic stensis than the MIME approach(P ＜0.05).Conclusion Our MIILEtechnique can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.

Objective:To investigate the feasibility, safety, and short-term effect of minimally invasive McKeown esophagecto-my. Methods: We conducted a retrospective evaluation of 88 patients with esophageal carcinoma who received minimally invasive esophagectomy in our center from October 2013 to April 2014. Among the 88 patients, 46 patients underwent total endoscopy McKe-own esophagectomy (TEME) and 42 patients underwent thoracoscope combined with laparotomy Mckeown esophagectomy (TLME). The clinicopathologic factors, operational factors, and postoperative complications of the two approaches were compared. Results:The two groups were similar in terms of age, sex, American Society of Anesthesiologists grade, tumor location, preoperative staging, and co-morbidity. The TEME approach was associated with a significant decrease in abdominal blood loss and postoperative pain relative to the TEME approach (P<0.05). No significant differences were found between the two groups in terms of histologic type, postoperation TNM staging, abdominal operation time, intensive care unit stay, chest tube duration, postoperative stay, the number of total lymph nodes dissected or the stations of the total lymph nodes dissected, and lymph metastasis rate (P>0.05). The total morbidity and total re-spiratory complications in the TEME group were lower than those in the TLME group (P<0.05). Incidences of pneumonia, arrhythmia, wound infection of minor complications, and pneumonia of major complications were relatively low in the TEME approach. Conclu-sion:Our TEME technique can be safely and effectively performed for cervical anastomosis during esophageal surgeries to achieve fa-vorable early outcomes.

Background and purpose: The incidence rate of elderly esophageal carcinoma patients is increasing year by year. In this study, the clinicopathologic factors, operational factors and postoperative complications were compared between the older and the younger elderly patients with thoracic esophageal squamous cell carcinoma (ESCC), and the influence of different surgical approaches to older elderly patients were analyzed. Methods: A retrospective review of 371 cases of elderly patients with thoracic esophageal squamous cell carcinoma (≥60 years) between Jan. 2006 and Dec. 2008 were performed. The patients were divided into two age groups. The patients over 75 years old named the older elderly group including 53 patients, and the patients between 60-74 years named the younger elderly group including 318 patients, the clinicopathological factors, operational factors, postoperative hospital mortality and average length of stay were compared. Meanwhile, according to different surgical approaches, the comparison of the left chest and right chest approach of operative time, blood loss and postoperative complication rate, and so on and so forth. Results: The older elderly group compared with the younger elderly group had more preoperative complications. Preoperative ASA classiifcation and postoperative complications, length of stay and hospital mortality rates were signiifcantly higher. The older elderly group over the right chest approach had less postoperative complications, especially pulmonary complications, the results were statistically signiifcant.(13.0%vs 40.0%,P<0.05) Conclusion: The patients over 75 years old with thoracic esophageal squamous cell carcinoma have a higher risk during the operation, we can choose relatively simpler operation approach to reduce the incidence of postoperative complications, especially pulmonary complications.

Objective The aim of this retrospective study was to analyze the role of surgery in the management of limited-stage-Ⅱ small cell lung cancer.Methods A retrospective review of 82 patients with limited-stage Ⅱ small cell lung cancer between January 2001 and December 2009 was performed.The prognostic impact of different therapy and the clinicopathologic factors were analyzed.Using SPSS 16.0 statistical software for data analysis.Log-rank test for the difference of survivale rate.Using the Cox model for muliti-factor survival analysis.Chi-square test for local recurrence and distant metastasis rate.Results The overall median survival time and the 1-,3-,and 5-year overall survival rates were 27.0 months,62.1％,35.9％,and 21.0％,respectively.Median survival was 34.0 months in surgical patients vs 16.0 months in nonsurgical patients (P =0.000).Median survival after lobectomy or pneumonectomy was significantly longer than after wedge resection (P =0.048).However,survival after wedge resection was still significantly longer than survival in nonsurgical patients(P =0.024).Survival analysis confirmed that the operation,chemotherapy and radiotherapy were showed to be independent prognostic factors.The local-regional recurrencer rates of lobectomy or pneumonectomy group was lower than wedge resection group(P =0.030).The distant metastasis rates of lobectomy or pneumonectomy group was lower than nonsurgical grou (P =0.021).Conclusion This study suggests that lobectomy or pneumonectomy combined with adjuvant radio-chemotherapy should be recommended for patients with limited-stage Ⅱ small cell lung cancer.

Recently,the main treatment for esophageal cancer remains curative resection combined with adjuvant chemoradiotherapy.With the application of minimally invasive esophagectomy (MIE) in the surgical treatment in recent years,patients with esophageal cancer who received MIE are proved to have less postoperative complications,better quality of life,and better surgical effect.However,different operation methods of MIE have different advantages and disadvantages,that makes the clinical promotion of MIE need further clinical experience,surgical techniques and procedures.The long-term effect of MIE remains to be further verification.

Objective:This study aims to investigate the correlation between the number of resected lymph nodes (LNs) and the prognosis of patients with node-negative non-small cell lung cancer (NSCLC). Methods:A retrospective review of 305 patients with NSCLC, who received curative resection between January 2004 and December 2009, was conducted. All patients were proved without lymph node involvement histopathologically. The prognostic impact of the number of negative LNs and the clinicopathologic factors were analyzed. Results:The overall median survival time and the 1-, 3-, and 5-year overall survival rates were 60.0 months, 76.1%, 59.3%, and 47.1%, respectively. Survival analysis confirmed that the number of negative LNs, T staging and the stations of the mediasti-nal lymph nodes dissected were showed to be independent prognostic factors. Patients with a high number of negative LNs had better overall survival than patients with a low number of negative LNs (P<0.05). The patients with dissected LNs counts of more than 11 for cases with pTl~2 tumor (P<0.05) and more than 16 for cases with pT3 tumor (P<0.05) had better long-term survival outcomes. The post-operative complication rate was 12.1%, which was not significantly correlated with the number of dissected lymph nodes (P>0.05). Conclusion:The number of negative lymph nodes is an independent prognostic predicting factor for node-negative NSCLC. Sufficient dissection of LNs is recommended to improve the survival of the patients with node-negative NSCLC.

Objective To investigate the correlation between the number of resected lymph nodes(LNs) and the prognosis of patients with node-negative esophageal carcinoma.Methods A retrospective review of 429 patients receiving esophagectomy with morden two-field lymphadenectomy for cancer between January 1998 and December 2008 was performed.All patients were proved without lymph node involvement histopathologically.The prognostic impact of the number of negative LNs and the clinicopathologic factors were analyzed.Results The overall median survival time was 63.0 months,and the 1-,3-,and 5-year overall survival rates were 78.5％,64.0％ and 51.2％,respectively.Survival analysis confirmed that the number of negative LNs and the depth of tumor invasion were showed to be independent prognostic factors.Patients with a high number of negative LNs had better overall survival than patients with a low number of negative LNs(P ＜ 0.05).The patients had better long-term survival outcomes with dissected LNs counts of more than 15 for cases with pT1 tumor(P ＜ 0.05),and more than 20 for cases with pT2-3 tumor(P ＜ 0.05).Conclusion The number of negative lymph nodes is an independent prognostic predicting factor for node-negative esophageal carcinoma.Sufficient dissection of LNs is recommended to improve the survival of patients with node-negative esophageal carcinoma.

Objective: To explore the status of lymph node metastasis of middle third thoracic esophageal squamous cell carcinoma and its influence on the prognosis and to seek the reasonable range of lymphade-nectomy. Methods: A total of 129 patients who underwent curative esophagectomy with modern two-field lymphadenectomy of middle third thoracic esophageal squamous cell carcinoma were reviewed. Results: The lymph node metastasis rate was 56.6% and the upper mediastinal lymph node metastasis rate was 43.4%. The lymph node metastasis ratio (positive nodes/total dissected nodes, LMR) was 11.3%. Paraesophageal lymph nodes, lymph nodes near the right recurrent nerve, the left gastric and infracadnal lymph nodes were most commonly involved when the tumor was located in the middle thoracic esophagus. Tumor differentiation, the depth of tumor invasion and the length of tumor were influencing factors for lymph node metastasis. The 5-year survival of N_0, N_1 (LMR≤20%) and N_1 (LMR>20%) patients were 50.4%, 31.0% and 6.8%, respective-ly, with a significant difference among the three groups (P=0.000). Conclusion: LMR was one of the key fac-tors affecting the prognosis, of esophageal cancer. Patients with middle third thoracic esophageal carcinoma should be treated with radical surgery with modern two-field lymphadenectomy.