Objective To explore the clinical efficacy of laparoscopic extralevator abdominoperineal excision (laparoscopic ELAPE) for low rectal cancer with modified Lloyd-Davies lithotomy position and without turning position.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 27 patients with low rectal cancer who underwent laparoscopic ELAPE without turning position in the West China Hospital of Sichuan University from September 2013 to January 2015 were collected.The modified Lloyd-Davies lithotomy position was used in perineal resection.Observation indicators:(1) surgical situation;(2) postoperative recovery situation;(3) postoperative pathological examination situation;(4) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications,survival of patients and tumor recurrence or metastasis up to March 2017.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situation:A total of 27 patients received laparoscopic ELAPE without turning position,and operation time and volume of intraoperative blood loss were (198±51)minutes and (85±66)mL.Among 5 of 27 patients with intraoperative complications,1 with intestinal perforation received successful intraoperative repair,1with presacral haemorrhage received successful hemostasis by intraoperative gauze pressing,1 with left and right pelvic plexus injury didn't receive special treatment,1 with left pelvic plexus injury + left internal iliac vein injury didn't receive special treatment and were repaired in vascular injury repair,1 with right neurovascular bundle injury didn't receive special treatment of nerve injury and received successful hemostasis by ultrasonic scalpel.There was no perforation in the site of the tumor.Number of lymph node dissected was 14 (range,9-22),and number of lymph node dissected ≥ 12 and ＜ 12 were detected in 15 and 12 patients,respectively.(2)Postoperative recovery situation:time to anal exsufflation and time for fluid diet intake in 27 patients were respectively (78±21)hours and (83±21)hours.Of 27 patients,8 with postoperative complications were improved by conservative treatment,including 1 in Clavien-Dindo Ⅰ (volume of perineal exudation ＞ 100 mL) and 7 in Clavien-Dindo Ⅱ (3 with pulmonary infection,2 with chylous fistula,1 with perineal incision infection and 1 with hematuria).There was no death within 30 days postoperatively.The median duration of hospital stay of 27 patients was 7 days (range,6-8 days).(3) Postoperative pathological examination situation:of 27 patients,1 and 26 had respectively positive and negative circumferential margins and median distance of circumferential margin was 0.7 cm (range,0.1-1.1 cm).T stage:14,12 and 1 patients were respectively detected in T2,T3 and T4.N stage:18,6 and 3 patients were respectively found in N0,N1 and N2.(4) Follow-up and survival situations:25 of 27 patients were followed up for 2-32 months,with a median time of 24 months.During the follow-up,5 had complications after discharge from hospital.Of 5 patients,2 with persistent anal pain didn't receive special treatment and were not relieved,and 3 with sexual dysfunction didn't receive special treatment and were followed up or observed.Of 25 patients,2 died of tumor-related diseases,1 died of non-tumor-related disease and other 22 had survival.No local tumor recurrence was detected.Eight patients had tumor distant metastases,including 4 with pulmonary metastases,3 with hepatic metastases and 1 with brain metastasis.Conclusion Laparoscopic ELAPE by modified Lloyd-Davies lithotomy position without turning position is safe and feasible,with closing pelvic floor peritoneum in stage Ⅰ.

Purpose:To investigate the clinical features,diagnosis, surgical treament and prognosis of pleural mesothelioma. Methods:A retrospective study was conducted in a total of 10 cases of pleural mesothelioma hospitalized from January 1980 to June 2000. Results: None of the 10 patients had history of exposure to asbestos,and the clinical manifestation were chest pain and feeling of compression,cough,shortness of breath. Pleural thickening or nodules were found in radiography examaination with or without pleural effusion.Of 10 cases,4 cases were localized type and 6 cases were diffused type, 8 cases received surgery(5 cases received radical operation and 3 cases received palliative operation) Conclusions:Exposure to asbestos or not has no definite relations to pleural mesothelioma,cytology examination of pleural effusion is not very helpful in pathologic diagnosis due to low positive rate.CT scan and pleural needle biopsy are helpful preoperatively. Surgical operation is the optional treatment in localized type and the prognosis is good,but prognosis is poor in diffused type and multimodality therapy is emphasized.

BACKGROUNDPulmonary blastoma is a rare primary malignancy of the lung. It is now recognized in two forms: adult type pulmonary blastoma and childhood pleuropulmonary blastoma. The clinical characteristics, diagnosis and treatments of adult type pulmonary blastoma are discussed in this article.

METHODSThe clinical records of 5 patients with adult type pulmonary blastoma admitted in Cancer Center, Sun Yet-sen University from 1964 to 2004 were analyzed and the literature on pulmonary blastoma was reviewed.

RESULTSThree patients were male and two were female with the ages ranged from 22 years old to 70. Their symptoms consisted mainly of cough, hemoptysis and chest pain. The pulmonary blastomas were mainly manifested as a solitary parenchymal mass of the lung on chest radiograph and CT. None of these patients was diognosed by fibrobronchoscopy nor sputum cytology. Three patients underwent lobectomy, one underwent pneumonectomy, and these four patients underwent mediastinal lymph node resection also. The fifth one received wedge resection and postoperative chemotherapy. At the end of follow-up, three patients died and two was alive, and the survival time was from 6 months to 11 years.

CONCLUSIONSPulmonary blastoma is difficult to be diagnosed before operation. Surgery is the best therapeutic choice up to now. It has poor response to radiotherapy and chemotherapy. The prognosis of patient with pulmonary blastoma is variable.

OBJECTIVESTo identify predictors of survival following pneumonectomy for non-small cell lung cancer (NSCLC) and provide evidence for the revision of patient selection criteria.

METHODS81 cases of pneumonectomy for NSCLC from January 1990 to May 1996 at our hospital were reviewed retrospectively. There were 65 men (80.2%) and 16 women (19.8%), with a mean age 53.4 +/- 9.4 years (range 20 - 68 years). Predominant histological types included squamous cell carcinoma (54.3%), adenocarcinoma (24.7%), and squamoadenocarcinoma (17.3%). After follow-up for more than 5 years, data were examined using the chi-square test, Kaplan-Meier method, and Cox-mantel test. The possible factors affecting survival were tested with univariate and multivariate analysis.

RESULTSThe 5-year survival of N(0), N(1) and N(2) disease of NSCLC following pneumonectomy was (20.8 +/- 9.9)%, (15.4 +/- 10.0)% and (4.0 +/- 2.8)%, respectively. There was no perioperative death. The operative complications morbidity was 22.2%. Factors adversely affecting survival with univariate analysis included age over 60 years for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, peripheral location, tumor greatest dimension more than 10 cm, chest wall involvement and N(2) disease. Factors adversely affecting survival with multivariate analysis included cardiopulmonary complications, greatest tumor dimension more than 10 cm, chest wall involvement and N(2) disease.

CONCLUSIONSPneumonectomy provides survival benefit with a high operative complications morbidity. Old age (>/= 60 years) for right pneumonectomy, cardiopulmonary complications, adenocarcinoma, and N(2) disease may be negative prognostic factors of long-term survival. Patient selection should be based on cardiopulmonary evaluation and the stage of disease.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; mortality ; pathology ; surgery ; Female ; Humans ; Lung Neoplasms ; mortality ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Pneumonectomy ; Prognosis ; Retrospective Studies ; Survival Rate

OBJECTIVETo evaluate the value of mediastinoscopy in diagnosing unknown mediastinal disease and staging of lung cancers.

METHODSFrom October 2000 to August 2001, 41 patients were examined by cervical mediastinoscopy with or without anterior mediastinotomy for diagnostic and staging purposes. Of these 41 patients, 12 were for diagnosis of unknown mediastinal disease, 3 for diagnosis and staging of pulmonary nodule or mass clinically suspected to be malignancy and 26 for the staging of lung cancer.

RESULTSTen of 12 patients with unknown mediastinal disease were diagnosed pathologically as thymoma in 1, metastatic lesion from lung cancer in 1, metastatic thyroid carcinoma in 1, lymph node hyperplasia in 1, teratoma in 1, sarcoidosis in 1, inflammatory pseudotumor in 1 and tuberculosis in 3, giving a diagnostic rate of 83.3%. Of three patients with suspected malignancy, one was diagnosed as tuberculosis by cervical mediastinoscopy and the other two as lymphoma and pulmonary inflammatory pseudotumor by thoracoscopy and thoracotomy. The sensitivity and specificity of mediastinoscopy for the staging of mediastinal nodes in 26 lung cancers were 87.5% and 100%. Only one wound infection but no other major complication was found.

CONCLUSIONMediastinoscopy is a safe procedure which can accurately provide information on diagnosis and staging.

Adult ; Aged ; Female ; Humans ; Lung Neoplasms ; diagnosis ; Male ; Mediastinal Neoplasms ; diagnosis ; Mediastinoscopy ; Middle Aged ; Neoplasm Staging