Objective To investigate the clinical features and surgical treatment of chest aggressive fibromatosis.Methods Twenty-five patients with aggressive fibromatosis treated from September 1998 to May 2014 in the Department of Thoracic Surgery of Cancer Hospital of Chinese Academy of Medical Sciences were included in this study.Results The 25 patients, including 12 males and 13 famales, had an average age of 38 (range 15-76 years).The initial manifestations included chest pain (9 patients, 36.0%) and shortness of breath (1 patient).In 13 patients (52.0%) the tumor was found in a physical examination.Two patients ( 8.0%) were detected during an operation for lung disease.The tumor was located in the left chest wall in 15 patients, and located on the right side in 10 patients.Among them, the most common locations were the left front chest wall and the right front chest wall.The operation method affects the prognosis. Radiological imaging and needle biopsy did not make a correct diagnosis, and the diagnosis of aggressive fibromatosis was confirmed by pathology using immunohistechmistry after surgery.13 patients underwent tumor resection, 9 cases had expanded resection, 3 patients had palliative resection.Six cases received radiotherapy after surgery.The median follow-up time was 101.5 months.Currently , all of the 25 patients are still alive, but 5 cases had local recurrence after surgery, among them, 4 patients received tumor resection, and one patient underwent expanded resection.Conclusions Aggressive fibromatosis is a low-grade malignant tumor.The diagnosis of aggressive fibromatosis needs to be confirmed by pathology using immunohistechmical staining after surgery.Although this tumor is liable to relapse, its prognosis is favorable. Radical surgery is the most important treatment for patients to get a higher quality of life and long-term survival without recurrence.

Objective To investigate the clinical features and surgical treatment of chest aggressive fibromatosis.Methods Twenty-five patients with aggressive fibromatosis treated from September 1998 to May 2014 in the Department of Thoracic Surgery of Cancer Hospital of Chinese Academy of Medical Sciences were included in this study.Results The 25 patients, including 12 males and 13 famales, had an average age of 38 (range 15-76 years).The initial manifestations included chest pain (9 patients, 36.0%) and shortness of breath (1 patient).In 13 patients (52.0%) the tumor was found in a physical examination.Two patients ( 8.0%) were detected during an operation for lung disease.The tumor was located in the left chest wall in 15 patients, and located on the right side in 10 patients.Among them, the most common locations were the left front chest wall and the right front chest wall.The operation method affects the prognosis. Radiological imaging and needle biopsy did not make a correct diagnosis, and the diagnosis of aggressive fibromatosis was confirmed by pathology using immunohistechmistry after surgery.13 patients underwent tumor resection, 9 cases had expanded resection, 3 patients had palliative resection.Six cases received radiotherapy after surgery.The median follow-up time was 101.5 months.Currently , all of the 25 patients are still alive, but 5 cases had local recurrence after surgery, among them, 4 patients received tumor resection, and one patient underwent expanded resection.Conclusions Aggressive fibromatosis is a low-grade malignant tumor.The diagnosis of aggressive fibromatosis needs to be confirmed by pathology using immunohistechmical staining after surgery.Although this tumor is liable to relapse, its prognosis is favorable. Radical surgery is the most important treatment for patients to get a higher quality of life and long-term survival without recurrence.

Background and objectiveLung cancer is a malignancy with high morbidity and mortality rates world-wide. Surgery is the preferred treatment for non-small cell lung cancer. hTis study aims to investigate the effects of video-as-sisted thoracoscopic surgery (VATS) lobectomy, VATS segmentectomy, and open thoracotomy on pulmonary function in the early postoperative stage and compare the difference among three groups.MethodsPulmonary function data of patients were collected from September 2015 to February 2016 in Department of hToracic Surgical Oncology, Cancer Hospital Chinese Academy of Medical Sciences. hTe patients were categorized according to operation methods into three groups, namely, VATS segmentectomy, VATS lobectomy, and open thoracotomy groups. Pulmonary function was assessed 1 day before the surgery, 3 days atfer the surgery, and 3 months atfer the surgery. Statistical analysis was performed with SPSS 20.0 through single-factor analysis of variance.Results Pulmonary function 3 days atfer the surgery was compared among the three groups. hTere was a signiifcant difference in forced vital capacity (FVC), FVC%, forced expiratory volume in one second (FEV1), FEV1%, peak ex-piratory lfow (PEF), maximal voluntary ventilation (MVV), transfer factor for carbon monoxide of lung (TLCO) and TLCO%(P values were as follows: 0.033, 0.042, 0.029, 0.045, 0.039, 0.021, 0.018, 0.024). hTe comparison of pulmonary function of 3 groups at the time of 3 months atfer operation showed that there was a signiifcant difference among three groups in FVC,FVC%, FEV1, FEV1%, PEF, MVV, TLCO, TLCO% (P values were as follows: 0.019, 0.024, 0.044, 0.021, 0.037, 0.029, 0.045, 0.017).ConclusionNo matter in the early stage atfer surgery or at the time of 3 months atfer surgery, the patients’ pulmonary function in VATS segmentectomy is better than the data of VATS lobectomy group, and the pulmonary function data of VATS lobectomy patients recovered better than the open thoracotomy group.

Objective To evaluate the safety and effectiveness of endoscopic mucosal resection with circumferential incision(EMR-CI)and endoscopic submucosal dissection(ESD)for the rectal neuroendocrine neoplasm(RNEN).Methods Databases such as PubMed,the Cochrane Library,Embase,Web of Science,SinoMed,China National Knowledge Infrastructure(CNKI),Wanfang Data and Weipu database were searched by computer.The retrieval time limit was Nov.22,2022.The Chinese and English literatures on the efficacy of EMR-CI vs ESD in treatment of RNEN patients were collected.According to inclusion and exclusion criteria,the included literatures were screened,extracted data,and evaluated the methodological quality by Newcastle-Ottawa scale(NOS),Meta-analysis was performed using Rev Man 5.3 software.Results Seven clinical control studies were included,including 199 cases in the EMR-CI group and 443 cases in the ESD group.Results of Meta-analysis of validity outcome indicators,there was no significant difference in histological complete resection rate between the EMR-CI group and the ESD group(O(R) = 0.56,95%CI:0.30～1.02,P = 0.060);The endosopic complete resection rate of EMR-CI was similar to that of ESD with no significant difference(O(R) = 0.33,95%CI:0.09～1.17,P = 0.090);The size of lesions removed by EMR-CI was smaller than that of ESD with significant difference(WMD =-0.86,95%CI:-1.33～-0.40,P = 0.000);The time EMR-CI required to remove the lesion was significantly shorter than that of ESD(WMD =-12.48,95%CI:-16.42～-8.54,P = 0.000).The positive rate of horizontal resection margin of EMR-CI was similar to that of ESD,with no significant difference(O(R) = 1.74,95%CI:0.64～4.75,P = 0.280);The positive rate of vertical resection margin was significantly higher than that of ESD(O(R) = 2.41,95%CI:1.09～5.32,P = 0.030).Due to the low local recurrence rate and distant metastasis rate,Meta-analysis couldn't be compared.Safety outcome index showed that,there were no significant differences in the incidence of total complications,bleeding and perforation among groups.Conclusion In the treatment of RNEN,EMR-CI can achieve the endosopic complete resection,histological complete resection and positive rate of horizontal resection margin similar to ESD without increasing surgical complications and significantly saving surgical time.However,attention should be paid to the differences between EMR-CI and ESD in positive rate of vertical resection margin.

Objective The objective of this study was to explore the association between human papillomavirus( HPV) and prognosis of lung cancer by meta-analysis. Methods The PubMed,Embase and Cochrane literature databases studies were searched using a combination of subject terms and free words. As of October 2018,a total of 123 related documents were obtained. After screen-ing the literature according to inclusion and exclusion criteria,the basic information of the study,HPV detection methods,lung cancer patients,hazard ratio(HR)values and 95% confidence interval(CI)were extracted from each study. The meta-analysis of random effects models was used to evaluate the correlation between HPV infection and prognosis in patients with lung cancer. Heterogeneity was assessed using the Q test and I2statistics,and publication bias was tested using Egger′s linear regression test and Begg′s rank cor-relation test. Results The study finally included 11 articles(9 in Asia,2 in Europe and US),and 1439 patients with lung cancer. Meta-analysis using a random-effects model showed no significant association between HPV infection and prognosis of lung cancer (HR=0. 90,95% CI:0. 71~1. 13). A stratified analysis of lung cancer pathological subtypes showed that the prognosis of patients with HPV-infected lung adenocarcinoma was significantly better than that in patients without HPV-infected lung adenocarcinoma (HR=0. 65,95% CI:0. 49~0. 85). Sensitivity analysis was performed by sequentially removing the included studies,and the results were not statistically significant. The results of Egger′s test(P=0. 708)and Begg′s test(P=0. 784)suggest that there is no publica-tion bias in this study. Conclusion HPV infection may be related to the prognostic of patients with lung adenocarcinoma. More basic and clinical studies are needed to further explore the association between HPV infection and lung adenocarcinoma as well as the corre-sponding mechanisms in the future.

Objective:To explore the feasibility, safety and effectiveness of anatomical partial lobectomy.Methods:The clinical data of 3 336 patients with lung nodules underwent anatomical partial lobectomy in our center from November 2013 to November 2019 were retrospectively analyzed. We set the safety margin distance according to the imaging feature of the lesion. The surgeons then anatomically detached the major vessels and bronchus in this region, resected the targeted lung tissue along the plane, and completed the resection of anatomical pulmonary lobe and clean and sampling of systemic lymph nodules.Results:A total of 668 cases were multiple nodules and 2 668 cases were solitary pulmonary nodules. According to the postoperative pathological results, 283 cases were benign, 1 197 cases were preinvasive lesions (including 38 cases of atypical adenomatous hyperplasia, 445 cases of adenocarcinoma in situ and 714 cases of minimally invasive adenocarcinoma), 1 713 cases were invasive adenocarcinoma, 73 cases were non-adenocarcinoma and 70 cases were metastatic carcinoma. Among 1 786 invasive primary lung cancers, 11 cases received preoperative neoadjuvant chemotherapy, and their postoperative pathologic diagnoses were stage ypIA. Other 1 775 cases who did not receive postoperative neoadjuvant treatment included 1 587 cases in stage ⅠA, 112 cases in stage ⅠB, 3 cases in stage ⅡA, 18 cases in stage ⅡB, 37 cases in stage ⅢA, 9 cases in stage ⅢB, 9 cases in stage Ⅳ. The average operation time was (127.3±55.3) minutes, and the mean postoperative hospital stay was (4.8±2.4) days. The incidence rate of complications (grade>2) was 1.1%(38/3 336), and no death occurred during 30 days after operation.Conclusion:Anatomic partial lobectomy has good clinical applicability, safety and effectiveness, which is worthy of clinical application and recommendation.

Objective Video?assisted thoracoscopic ( VATS ) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node ( LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. Methods The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1,2009 to July 30,2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. Results One hundred and twenty?nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another pared 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P>0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 ( P<0.001) . The average dissected LN stations was 3.2 vs. 3.6 ( P=0.038) . The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 ( P=0.012) . The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P=0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41. 1% in the VATS group versus 42. 6% in the conventional group ( P=0.801) . The cardiopulmonary complication rate was 25.6% vs. 27.1% ( P=0.777) . The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P=0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P=0.049) but longer operating time (161.3 min vs. 127.8 min, P<0.01). Conclusions In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to unskillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.

Objective To explore the clinical characteristics of patients with bilateral synchronous multiple primary non?small cell lung cancer ( NSCLC) and identify the prognostic indicators associated with survival. Methods From January 2010 to December 2014, clinicopathological data of 96 patients with bilateral synchronous multiple primary NSCLC, who met the modified Martini?Melamed criteria and underwent radical surgical resection, were retrospectively reviewed. Survival was estimated using the Kaplan?Meier method, and the clinical parameters associated with survival were analyzed using a log?rank test. Cox proportional hazards regression models were used to identify the risk factors for this cancer. Results Of the 96 patients, two patients who died of severe postoperative complications were excluded, and 94 patients were analyzed. Of the 94 cases, a two?stage operation was performed in 93 patients, while a single?stage bilateral surgery was performed in only one patient using video?assisted thoracic surgery ( VATS) . 79 patients had 2 tumors and the other 15 patients had 3 or more tumors. There were 82 patients with synchronous tumors located in different lobes and 12 patients had at least two tumors located in the same lobe. Seventy?six patients were found to have multiple lung adenocarcinoma and 12 patients had multiple squamous cell
carcinoma ( SCCs) . Five patients had adenocarcinoma and SCC, and one patient had adenocarcinoma and adenosquamous carcinoma simultaneously. Univariate analysis showed that the large maximum tumor diameter, highest pT stage and lymph node involvement were associated with an unfavorable DFS ( P<0.01 for all ) , while female gender, small maximum tumor diameter, early highest pT stage and pN0 were associated with a better overall survival ( OS) . Multivariate analysis showed that highest pT stage and lymph node metastasis were independent prognostic factors for DFS and OS. Patients with a lower highest pT stage and negative lymph node metastasis had longer DFS and OS ( P<0. 05 for both ) . Conclusions The diagnosis for patients with bilateral synchronous multiple primary NSCLCs should be made very carefully. Two stage surgical treatment is safe, reasonable and effective for patients with bilateral synchronous multiple primary NSCLCs in a relatively early stage. The highest pT stage and pN status are important predictors for long?term survival. Adequate pulmonary tissue resection with complete resection of multiple nodules and systematic lymphadenectomy are suggested.

Objective:To explore the feasibility, safety and effectiveness of anatomical partial lobectomy.Methods:The clinical data of 3 336 patients with lung nodules underwent anatomical partial lobectomy in our center from November 2013 to November 2019 were retrospectively analyzed. We set the safety margin distance according to the imaging feature of the lesion. The surgeons then anatomically detached the major vessels and bronchus in this region, resected the targeted lung tissue along the plane, and completed the resection of anatomical pulmonary lobe and clean and sampling of systemic lymph nodules.Results:A total of 668 cases were multiple nodules and 2 668 cases were solitary pulmonary nodules. According to the postoperative pathological results, 283 cases were benign, 1 197 cases were preinvasive lesions (including 38 cases of atypical adenomatous hyperplasia, 445 cases of adenocarcinoma in situ and 714 cases of minimally invasive adenocarcinoma), 1 713 cases were invasive adenocarcinoma, 73 cases were non-adenocarcinoma and 70 cases were metastatic carcinoma. Among 1 786 invasive primary lung cancers, 11 cases received preoperative neoadjuvant chemotherapy, and their postoperative pathologic diagnoses were stage ypIA. Other 1 775 cases who did not receive postoperative neoadjuvant treatment included 1 587 cases in stage ⅠA, 112 cases in stage ⅠB, 3 cases in stage ⅡA, 18 cases in stage ⅡB, 37 cases in stage ⅢA, 9 cases in stage ⅢB, 9 cases in stage Ⅳ. The average operation time was (127.3±55.3) minutes, and the mean postoperative hospital stay was (4.8±2.4) days. The incidence rate of complications (grade>2) was 1.1%(38/3 336), and no death occurred during 30 days after operation.Conclusion:Anatomic partial lobectomy has good clinical applicability, safety and effectiveness, which is worthy of clinical application and recommendation.

Objective Video?assisted thoracoscopic ( VATS ) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node ( LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. Methods The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1,2009 to July 30,2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. Results One hundred and twenty?nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another pared 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P>0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 ( P<0.001) . The average dissected LN stations was 3.2 vs. 3.6 ( P=0.038) . The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 ( P=0.012) . The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P=0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41. 1% in the VATS group versus 42. 6% in the conventional group ( P=0.801) . The cardiopulmonary complication rate was 25.6% vs. 27.1% ( P=0.777) . The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P=0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P=0.049) but longer operating time (161.3 min vs. 127.8 min, P<0.01). Conclusions In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to unskillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.