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Nodal skip metastasis is not a predictor of survival in middle thoracic esophageal squamous cell carcinoma

Qingfeng ZHENG ; Shuoyan LIU ; Kunshou ZHU ; Feng WANG ; Zhen WANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2015;31(6):354-358. doi:10.3760/cma.j.issn.1001-4497.2015.06.009

Objective To investigate the relationship of nodal skip metastasis(NSM) and clinicopathological factors of middle thoracic esophageal squamous cell carcinoma patients.Methods Between January 1999 and December 2007,695 patients with middle thoracic esophageal squamous cell carcinoma who had lymph node metastasis were reviewed.All patients received McKeown esophagectomy.We retrospectively analyzed the clinical characteristics and NSM status.Survival rates were compared using the Kaplan-Meier method and Log-Rank test.Multivariate analysis were also performed to assess the element which affect the survival by Cox regression.Results NSM were present in 226 (32.5％) patients.No significant differences in age,gender,tumor differentiation and extent of lymph node dissection depth of tumor invasion were found between skip metastasis group and continuous metastasis group.The NSM group included more patients with earlier T stage and N stage.Univariate analysis displayed that NSM was beneficial for patients with middle thoracic esophageal tumors (P ＜ 0.001).Cox-proportional multivariate analysis showed NSM was not a significant prognostic factor in overall survival.The overall survival did not differ according to NSM status in subgroups with different N stage.T1-2 patients,no significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.059).T3-4 patients,significant difference of 5-year survival rate was found between skip metastasis group and continuous metastasis group(P =0.001).NSM patients were then separated into 3 groups based on the extent of metastasis lymph nodes:both cervical and abdominal NSM (n =45,19.9％),cervical NSM (n =120,53.1％) and abdominal NSM (n =61,27.0％).The number of metastasis lymph nodes was significantly different among the three groups.No survival differences were observed among the three groups.Conclusion NSM is more frequently in the earlier stage compared to continuous metastasis.Three field lymphadenectomy can reduce the recurrence of T3-4 patients,and improve the survival rate of five years.The presence of NSM does not predict prognosis.

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Impact on postoperative outcomes after red blood transfusion in coronary artery bypass graft surgey: a meta-analysis of current evidence

Jianzhou LIU ; Chaoji ZHANG ; Xiaofeng LI ; Zhuo HUANG ; Guotao MA ; Xingrong LIU ; Qi MIAO

Chinese Journal of Thoracic and Cardiovascular Surgery.2015;31(7):401-406. doi:10.3760/cma.j.issn.1001-4497.2015.07.006

Objective To systemically assess impact on postoperative outcomes after red blood cell transfusion(RBCT) in coronary artery bypass graft surgey.Methods A meta-analysis was performed on the comparison and synthesis of findings from included studies published from January 1980 to January 2014.Pooled odds ratio(OR) and 95 ％ confidence interval(CI) were calculated using RevManS.3 software.Sensitivity analysis was conducted and possible publication bias was tested as well.Results Seven retrospective studies including 71 228 patients(33 872 RBCT cases,37 356 control cases) were eligible for inclusion.The pooled analysis revealed difference in the 30-day mortality OR =1.85 (95％ CI:1.35-2.54),1-year mortality OR =2.02 (95 ％ CI:1.44-2.84),shock OR =2.92 (95 ％ CI:1.96-4.35),renal dysfunction OR =7.67 (95 ％ CI:1.44-40.94),mediastinitis OR =2.26 (95 ％ CI:1.72-2.97),and myocardial infarction OR =3.53 (95 ％ CI:2.89-4.29).Conclusion Perioperative RBCT can incresase the risk of postoperative mortality and complications in coronary artery bypass graft surgey.High-quality randomized case cohort studies are still needed for the further proof of the risk.

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Reoperation is not the risk factor for mortality after Sun's procedure for Stanford type A aortic dissection involving aortic arch

Lei CHEN ; Yipeng GE ; Junming ZHU ; Yongmin LIU ; Wei LIU ; Chengnan LI ; Lizhong SUN

Chinese Journal of Thoracic and Cardiovascular Surgery.2015;31(7):407-410. doi:10.3760/cma.j.issn.1001-4497.2015.07.007

Objective The aim of this study was to evaluate whether the reoperation is the risk factor for mortality after Sun's procedure(Total aortic arch replacement + frozen elephant trunk) for Stanford type A aortic dissection involving aortic arch.Methods Between February 2009 to February 2012,data from 383 patients who underwent Sun's procedure for Stanford type A aortic dissection involving aortic arch were collected retrospectively.35 patients had history of cardiac surgery.Of these patients,16 patients had underwent Bentall procedure,7 patients ascending aortic replacement,4 patients Wheat surgery,4 patients aortic valve replacement,2 patents Bentall combined with mitral valve replacement or plasty,1 patient bivalve replacement,1 patient atrial septal defect repair,1 patient coronary artery surgery.All the risk factors related to mortality were analyzed by univariate statistical analysis.Significant univariate variables were entered into multiple logistic analysis.Results Total 31 patients died in the hospital and the mortality was 8.07％.Of the 35 patients with history of cardiac surgery,3 patients died and the mortality was 8.33％.Univariate analysis showed that symptom onset before surgery less than 1 week,preoperative limb ischemia,combining with coronary artery surgery and cardiopulmonary bypass time longer than 300 minutes in the operative were risk factors for mortality.After these factors were entered into multiple logistic regression analysis,the result showed that symptom onset before surgery less than 1 week (P =0.038,OR =2.43),cardiopulmonary bypass time longer than 300 minutes(PP ＜0.001,OR =12.05) were final independent risk factors for mortality.Reoperation was not the independent risk factor for mortality.The intensive care unit and mechanical ventilation length of reoperation group was (2.09 ± 1.89) days and(30.09 ±33.42) hours respectively,while that of primary group was(2.71 ±3.01) days (P =0.25) and(33.86 ±40.98) hours(P =0.61) respectively.The incidence of postoperative bleeding of reoperation group was 3.03％,while that of primary group was 1.88％ (P =0.50).Conclusion Reoperation was not the independent risk factor for mortality after Sun's procedure for Stanford type A aortic dissection involving aortic arch and the morbidity was also not higher than primary surgery.For these patients,sun' s procedure should be advocated.

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Experimental research of Pioglitazone on inhibiting intimal hyperplasia in vein grafts

Ludong LIANG ; Shikang LI ; Zhicun LAN ; Tianming HUO ; Qiangxin HUANG ; Jueyu ZHANG ; Jun PENG

Chinese Journal of Thoracic and Cardiovascular Surgery.2015;31(7):422-424. doi:10.3760/cma.j.issn.1001-4497.2015.07.011

Objective To study the effect of Pioglitazone(PIO) on intimal hyperplasia after vein graft and its potential mechanism.Methods 32 male Sprague-Dawley rats were randomly divieded into two groups,one admisnistrated with PIO(3 mg· kg-1 · d-1) and the other with saline.A week later,the right common carotid arteries were reconstructed using homolateral external jugular veins in rats.The drugs treatment was continued after surgery for 2 or 4 weeks until grafted veins were harvested.The neointima thickness was measured by Computer image analysis software.To observe the activation of ERK1/2 pathway,the western blot were performed.In vitro,human great saphenous vein smooth muscle cells were co-cultured with PIO,and cells proliferation was detected by the CCK-8 assay.The TUNEL staining was performed to determine apoptosis.Results PIO treatment significantly attenuated intimal thickening compared with the the control group both at second [(8.56 ± 1.64) μm vs (25.44 ± 0.89) μm,P ＜ 0.01] and fourth week [(10.51 ± 1.47) μm vs (35.69 ± 1.07) μm,P ＜ 0.01)] after veins graft.Also PIO inhibited the ERK1/2 activation in grafted veins.In vitro,PIO significantly reduced PDGF-induced cells proliferation and increased cells apoptosis.Conclusion PIO effectively improved intimal hyperplasia in grafted veins perhaps associated with its ability to suppress vascular smooth muscle cells proliferation and enhance cell apoptosis,and might be related to the down regulation of ERK1/2 activity.

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Review and clinical experience of 101 cases of endovascular placement of stent-grafts

Zonghong LIU ; Bo SUN ; Dongyun QIU ; Hongyu LIU

Chinese Journal of Thoracic and Cardiovascular Surgery.2014;30(12):730-732. doi:10.3760/cma.j.issn.1001-4497.2014.12.007

Objective To summarize the clinical experience and significance of 101 cases of thoracic endovascular aortic repair(TEVAR).Methods From October 2008 to August 2013,101 patients received endovascular repair.Among the cases,81 patients were male,and 20 were female.Before operation,all patients underwent thoracoabdominal aortic CTA examination,there were 5 cases of traumatic aortic diseases,10 cases of severe aortic penetrating ulcer,86 cases of Stanford type B aortic dissection.All patients follow up with CTA 1 weeks,3 months,half a year,and annually postoperatively.Postoperative complications,efficacy,morphology and its vascular stent were observed.Results All cases received TEVAR,there were 90 cases of simple repair of aortic lumen (89.11％),11 cases of brachiocephalic vessels bypass (10.89％),2 cases of death (1.98％),1 case of type Ⅰ endoleak(0.99％),3 cases of the application of lumbar cistern drainage(2.97％),1 case of severe stress ulcer(0.99％),1 patient died after surgery with paraplegia,acute renal failure,stroke,lower limb artery embolization,dissection rupture.Conclusion Thoracic endovascular aortic repair has obvious advantage,risks and complications incidence of preoperative period is low,the technology is worth popularizing widely,but needed to pay attention to strictly control the indications of operation and ensure the brain blood supply.

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Effects of miR-429 on the inhibits of cell proliferation in the human lung adenocarcinoma cell line SPC-A1

Hanbo LE ; Wangyu ZHU ; Xiaoguang LIU ; Jianying HE ; Dongdong CHEN ; Liyun XU ; Yongkui ZHANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2014;30(12):733-735. doi:10.3760/cma.j.issn.1001-4497.2014.12.008

Objective To assess the impact of miR-429 on lung adenocarcinoma cell SPC-A1 growth inhibition.Methods Pre-miRTM miR-429 precursor was synthesized and transfected to the SPC-A1 cells by liposome; qRT-PCR assay was used to quantify the miR-429 expression levels; The proliferation of SPC-A1 cells was evaluated by Cell Counting Kit-8 (CCK8).The cell apoptosis was evaluated by Annexin V Assay; The cell cycles of each group were assayed by flow cytometry;Western-blot was used to analyze the expression of cylines.Results The expression level of miR-429 was highly induced after transfection (P ＜ 0.001) ;CCK-8 assay showed the cell proliferation activity of pre-miR-429 group was lower than that of blank and control group 48h and 72 h after transfection(P =0.0167,0.0383,P =0.0320,0.0465),whereas the apoptosis rate had no significant difference between pre-miR-429 and control 24h after transfection by Annexin V Assay(P ＞ 0.05) ; The flow cytometry at 48h after transfection showed that miR-429 decreased the percentage of cells in G1 phase,but increased in S phase,indicating the cell cycle arrest at S phase(P =0.0010,0.0010 ; P =0.0068,0.0133) ; however,the expression level of Cyclin E in pre-miR-429 group had no difference compared with control.Conclusion miR-429 could inhibit cell proliferation and promote cell cycle arrest of lung adenocarcinoma cell SPC-A1.miR-429 may play a potential tumor suppressor role in lung adenocarcinoma cell SPC-A1.

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The result of endoscopic vein harvesting in patients undergoing coronary artery bypass grafting

Jun RAN ; Yunhu SONG

Chinese Journal of Thoracic and Cardiovascular Surgery.2016;32(8):467-469. doi:10.3760/cma.j.issn.1001-4497.2016.08.006

Objective To evaluate clinical results of endoscopic vein harvesting(EVH) in patients who underwent coronary artery bypass grafting(CABG).Methods From July 2013 to October 2014,500 patients who underwent isolate CABG in our institution were divided into two groups:EVH group (n =250) and open vein harvesting(OVH) group(n =250).The surgical result and perioperative complications were compared between the two groups.Results The procedures were completed successfully in all the patients in both groups.There was no significant difference existed in the length of the harvested vein and vein injury between the two groups(P ＞ 0.05).Similar results were obtained in the in-hospital mortality.Compared to group OVH,group EVH showed significantly shorter harvesting time,smaller incision,and lower rates of perioperative leg complications (P ＜ 0.01).Group EVH had a less bed staying time after operation and a shorter post-operation hospital stay (P ＜ 0.05).EVH group achieved an improved patient satisfaction and postoperative pain when compared with OVH in CABG(P ＜0.05).Conclusion EVH can provide adequate vein graft for CABG,and also significantly reduce wound related complications when compared with OVH.EVH is recommended for vein harvesting to improve patient satisfaction.

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Double layered anastomosis in thoracoscopic and laparoscopic esophagectomy

Yong YUAN ; Yang HU ; Zhu WU ; Yongfan ZHAO ; Longqi CHEN

Chinese Journal of Thoracic and Cardiovascular Surgery.2016;32(8):470-473. doi:10.3760/cma.j.issn.1001-4497.2016.08.007

Objective To summarize the experience of double layered anastomosis in thoracoscopic and laparoscopic esophagectomy,and to explore its impact on the postoperative anastomotic complications.Methods Patients with thoracoscopic and laparoscopic esophagectomy from September 2014 to Auguest 2015 were retrospectively included.The cervical anastomosis were conducted by hand-sewn double layered anastomosis on the posterior wall of the gastric remnant,with the anastomotic configuration of end-to-side.The patients' general information and postoperative complications were recorded and analyzed.Results 45 patients with esophageal squamous cell carcinoma were included.The major postoperative complications were gastric dilatation(6/45,13.3％),hoarseness(5/45,11.1％),anastomotic leak/gastric necrosis(2/45,4.4％),anastomotic stricture(0/45,0).All patients were discharged from hospital with no perioperative death.Conclusion Hand-sewn double layered anastomotic technique could be safely used in thoracoscopic and laparoscopic esophagectomy,which could assure the security of the anastomosis.The anastomotic complication rates for this technique are rare enough to be recommended,as compared with other anastomotic methods reported in the literatures.

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Proceedings in surgical treatment of sternoclavicular joint infection

Dong XIE ; Ke FEI ; Chang CHEN ; Haifeng WANG ; Gening JIANG

Chinese Journal of Thoracic and Cardiovascular Surgery.2016;32(8):506-508. doi:10.3760/cma.j.issn.1001-4497.2016.08.021

Septic arthritis of the sternoclavicular joint(SCJ) is a rare condition and accounts for 0.5％-1.0％ of septic arthritis.SCJ infections often require surgical intervention.Diabetes mellitus,rheumatoid arthritis,intravenous drug use,intraarticular injection and immunosuppressive disorders are predisposing factors.Staphylococcus aureus and Pseudomonas aeruginosa are the most common bacteriologies.Early diagnosis of SCJ infection requires a high index of suspicion and a confirmatory CT or MRI scan.The characteristic imaging features include intramedullary and soft tissue gas,sequestra,soft tissue swelling and destruction or widening of joint space.Management strategies have ranged from conservative antibiotic therapy to en-bloc resection of the sternoclavicular joint with or without ipsilateral pectoralis major muscle transposition.The shoulder function in most patients were well preserved.

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The clinical application of nonintubated video assisted thoracic surgery

Yi LIU ; Zhiqiang XUE

Chinese Journal of Thoracic and Cardiovascular Surgery.2016;32(8):509-512. doi:10.3760/cma.j.issn.1001-4497.2016.08.022

Video assisted thoracic surgery(VATS) was rapidly developed in recent years.It's been widely accepted because it was minimally invasive and the patients were fast recovery with a survival rate similar to routine thoracotomy patients.However,more and more attention was paid to the side effect of general anesthesia with double cavity intubation during the surgery.Nonintubated thoracoscopic surgery for lung cancer was progressively developed.This surgery method decreases the side effect compared to general anesthesia with double cavity intubation.However,more surgical difficulty,additional surgical risk and prolonged surgery time were all inevitable become disadvantages of this new method.The less side effect of general anesthesia for patients and the more challenge for thoracic surgeon was brought simultaneous by this new method.More clinic trial should be implemented in validating the advantages and disadvantages.

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