Objective:To investigate the application value of fluorescence imaging in single-port thoracoscopic anatomic segmentectomy.Methods:The clinical data of 280 patients (145 patients with fluorescence method and 135 patients with modified inflation-deflation method) who underwent thoracoscopic anatomic segmentectomy were retrospectively studied in the Anhui Chest Hospital from June 2020 to June 2021. There were 113 patients in the simple segmentectomy group and 167 patients in the complex segmentectomy group. The baseline data of the fluorescence method and the modified inflation-deflation method in the complex segmentectomy group were corrected by propensity score matching, and the perioperative results were compared between the groups.Results:There were no significant differences in segmental resection time, intraoperative blood loss, postoperative drainage, postoperative pain, postoperative extubation time, length of hospital stay, incidence of complications and cost of hand-holding between the fluorescence method and the modified method of the simple segmentectomy group.In the complex segmentectomy group, the time of segmental resection with the fluorescence method was significantly shorter than that with the modified inflation-deflation method( P<0.05), and other indexes had no significant difference. Conclusion:Fluorescence method single-port thoracoscopic anatomic segmentectomy has the same perioperative safety and short-term efficacy as modified inflation-deflation method, which can significantly shorten the operative time and improve the operative efficiency in complex anatomic segmentectomy.

Objective     To compare the short-term efficacy and long-term survival of patients with non-small cell lung cancer (NSCLC) treated by uniportal or three portal thoracoscopic radical resection. Methods     A total of 388 patients who underwent uniportal or three portal thoracoscopic radical resection of lung cancer in the Department of Thoracic Surgery of Anhui Chest Hospital from 2015 to 2016 were analyzed retrospectively. The patients were divided into two groups including an uniportal group and a three portal group according to the procedure. The clinicopathological features, perioperative data and long-term survival of the two groups were compared. Results     Finally, we included 205 patients with 105 males and 100 females at an average age of 58.73±10.93 years. There were 102 patients in the uniportal group and 103 patients in the three portal group. There was no statistical difference in clinicopathological features between the two groups (P>0.05). But compared with the three portal group, the uniportal group had less postoperative drainage, shorter postoperative catheterization time and postoperative hospital stay (P<0.05). There was no statistical difference in the number of lymph node dissection stations between the two groups (P=0.058). The pain score at 24 hours after operation in the uniportal group was significantly lower than that in the three portal group (P<0.001). There was no  statistical difference in the total incidence of complications and the incidence of pulmonary complications between the two groups (P=0.161 and P=0.275). The median survival period and the 1st, 3rd, and 5th year survival rate in the uniportal group was 63.0 months and 95.0%, 75.2%, 51.5%, respectively. The median survival period and the 1st, 3rd, and 5th year survival rate in the three portal group was 61.0 months and 89.3%, 70.9%, 50.5%, respectively. There was no satistical difference in the survival results between the two groups (P=0.440). Conclusion     Uniportal thoracoscopic radical resection of lung cancer is more minimally invasive and safe and effective in the treatment of NSCLC. It can make patients recover faster after operation.

Objective    To summarize the clinical experience of surgical resection of synchronous multiple ground-glass nodules (SMGN), and explore the individualized diagnosis and treatment strategy of SMGN. Methods    Clinical data of 84 patients with SMGN who underwent thoracic surgery in Anhui Chest Hospital from July 2016 to August 2018 were analyzed retrospectively, including 18 males (21.4%) and 66 females (78.6%), aged 32-80 (55.6±10.3) years. The results of operation and the information of GGNs were analyzed. Results    Except for 1 patient who was converted to thoracotomy due to extensive dense adhesion of thoracic, other patients underwent video-assisted thoracoscopic surgery successfully. All patients recuperated successfully after operation, without severe perioperative complications or death. Finally, 79 patients were diagnosed as malignant tumors (94.0%), and 5 patients of benign lesions (6.0%). A total of 240 GGNs were removed, among which there were 168 pGGNs, including 68 benign lesions (40.5%) and 100 malignant tumors (59.5%), and 72 mGGNs, including 2 benign nodules (2.8%) and 70 malignant tumors (97.2%). Nodules diameter (P<0.001), consolidation/maximum diameter of nodule ratio (P<0.001), vacuole sign (P<0.001), air bronchograms sign (P=0.001), spine-like process (P=0.001), pleural indentation sign (P<0.001), lobulation sign (P<0.001), and vascular convergence (P=0.002) were correlated with malignant tumor. Conclusion    Analysis of the imaging features of GGNs by thin-section CT scan and three-dimensional reconstruction is of great value in predicting the benign and malignant nodules, which can guide the surgical decision-making and preoperative planning. Through reasonable preoperative planning and following certain principles, simultaneous surgical treatment for SMGN is safe and feasible.

Objective:To explore the clinical characteristics of cryptococcus neoformans patients who suspected as lung cancer and treated with surgery, and to improve the diagnosis of the disease.Methods:A retrospective analysis on clinical data(including preoperative laboratory examination, chest CT imaging and postoperative pathology) of 21 cryptococcosis neoformans patients misdiagnosed as lung cancer in our hospital from February 2016 to July 2019.Results:Among the 21 patients, 17 cases were single nodules and 4 cases were multiple nodules, among which 15 cases were highly suspected malignancy. The postoperative pathological diagnosis was cryptococcal pulmonary granulomatosis. 14 patients were treated with antifungal therapy after surgery. No recurrence was found after postoperative follow-up.Conclusion:The clinical manifestations and imaging examination of pulmonary cryptococcus neoformans patients have no obvious specificity, and it is easy to be misdiagnosed as early lung cancer. The diagnosis can only be confirmed by the combination of various means such as regular follow-up, laboratory examination, percutaneous lung puncture or surgical biopsy.

Ethanol is one of the major risk factors for esophageal cancer.The main mechanisms of ethanol induced esophageal cancer include the direct carcinogenesis of acetaldehyde,the genetic polymorphism of enzymes related to alcohol metabolism,the carcinogenic effect of reactive oxygen species,the disorder of nutrient metabolism induced by ethanol,and the synergistic effect of ethanol and tobacco.

Mediastinal tissue is a very common predilection site for both benign and malignant diseases .It is not only lo-cated at many different origins within human body but the anatomical structure of mediastinal tissue is often very complicated . In addition to its location and structure , mediastinal tissue lacks a cavity channel , which communicates with outside environ-ment.The combination of all these factors cause extreme difficulty in terms of diagnosis .Because of the distinct treatments for different diagnosis results, the efficiency of treatment largely relies on the completion of diagnosis in a timely fashion , any delay often cause severe results.

Objective: To identify the long-term outcome of patients with myasthenia gravis (MG) after extended thymectomy, and to analyze the prognostic factors. Methods: The medical data and follow-up results in 72 patients with MG who underwent extended thymectomy in Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated with Anhui Medical University from January 2006 to October 2015 were retrospectively reviewed and analyzed. There were 32 male and 40 female patients, aging from 10 to 70 years with a mean age of 39.5 years. The outcome-related factors including gender, age while being operated on, duration of preoperative period, whether taking steroid before operation, modified Osserman classification, pathology type of thymus were analyzed by χ² test and multivariate regression analysis. Results: All patients were followed up from 6 to 75 months (median 37 months). Among them, 21 patients (29.2%) achieved complete stable remission, 18 patients (25.0%) experienced pharmacological remission, 20 patients (27.8%) improved, 9 patients (12.5%) reminded stable and 4 patients (5.6%) deteriorated. Both univariate and multicariate analysis revealed that duration of preoperative period (OR=22.871, 95% CI: 2.813 to 185.917, P=0.003) and Osserman classification (OR=0.103, 95% CI: 0.014 to 0.774, P=0.027) showed significantly associated with the surgical curative effect. Conclusions Extended thymectomy is an efective measure for MG. The duration of preoperative period and Osserman classification are prognostic factors for thymectomized MG. Those patients with generalized MG or whose duration of preperative period is less than 6 months are likely to have better prognosis.

Objective To investigate the correlation between the number of dissected lymph nodes ( LNs) and the prognosis of patients with node?negative Siewert type ⅡAEG. Methods 248 patients with Siewert type Ⅱ AEG treated in our hospital between January 1998 and December 2008 were retrospectively assessed. All cases underwent left transthoracic subtotal esophagogastrectomy with conventional two?field lymphadenectomy, and were histopathologically proved to be without lymph node involvement. The prognostic impact of the number of dissected LNs was analyzed. Results The overall median survival time and the 1?, 3?, and 5?year overall survival rates were 64 months, 80. 4%, 60. 8% and 51. 0%, respectively. Cox regression showed that the number of dissected LNs and the depth of tumor invasion were 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 more than 10 LN dissected for cases with pT1 tumor ( P<0.001) , and so did those with more than 15 LN dissected for cases with pT2?3 tumor (P=0.003, 0.018, respectively). Conclusion The number of negative lymph nodes and the depth of tumor invasion are independent prognostic factors for node?negative Siewert type ⅡAEG, and adequate lymph node dissection can improve the long?term survival.

Objective To investigate the correlation between the number of dissected lymph nodes ( LNs) and the prognosis of patients with node?negative Siewert type ⅡAEG. Methods 248 patients with Siewert type Ⅱ AEG treated in our hospital between January 1998 and December 2008 were retrospectively assessed. All cases underwent left transthoracic subtotal esophagogastrectomy with conventional two?field lymphadenectomy, and were histopathologically proved to be without lymph node involvement. The prognostic impact of the number of dissected LNs was analyzed. Results The overall median survival time and the 1?, 3?, and 5?year overall survival rates were 64 months, 80. 4%, 60. 8% and 51. 0%, respectively. Cox regression showed that the number of dissected LNs and the depth of tumor invasion were 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 more than 10 LN dissected for cases with pT1 tumor ( P<0.001) , and so did those with more than 15 LN dissected for cases with pT2?3 tumor (P=0.003, 0.018, respectively). Conclusion The number of negative lymph nodes and the depth of tumor invasion are independent prognostic factors for node?negative Siewert type ⅡAEG, and adequate lymph node dissection can improve the long?term survival.

OBJECTIVETo investigate the prognosis of patients with N1 non-small cell lung cancer, and to compare the clinicopathological features and survival between patients with unexpected N1 (cN0-pN1) and expected N1 disease (cN1-pN1) after operation for non-small cell lung cancer.

METHODSThis study retrospectively reviewed and analyzed the medical records of 183 patients who underwent surgery and pathologically diagnosed with N1 non-small cell lung cancer between January 2006 and December 2010. Among them, 78 patients had negative findings before surgery (cN0-pN1 group), and 105 patients had positive findings before surgery (cN1-pN1 group). The clinicopathological features, median survival time and 5-year survival rates between the two groups were analyzed.

RESULTSPatients in the cN1-pN1 group had greater pathologic T stage, larger tumors, greater number and stations of positive N1 lymph nodes, and greater percentage of pneumonectomy than those in the cN0-pN1 group (P < 0.05). For the patients with cN0-pN1, the MST was 47.0 months and the 1-, 3-, and 5-year OS were 85.9%, 57.4%, and 42.5%, respectively. For the patients with cN1-pN1, the MST was 30.0 months and the 1-, 3-, and 5-year OS were 74.3%, 44.6%, and 28.8%, respectively. There were significant differences in survival between the two groups (P < 0.05). The locoregional recurrence rate of cN0-pN1 group was lower than in the cN1-pN1group (P < 0.05). The multivariate analysis showed that T staging and N staging before surgery, lymph node metastasis to multiple N1 stations and adjuvant chemotherapy were independent prognostic factors.

CONCLUSIONSDifferent clinical features of N1 non-small cell lung cancer has certain heterogeneity. Patients with unexpected N1 disease show better survival and lower locoregional recurrence rate than did those with expected N1 disease.

Carcinoma, Non-Small-Cell Lung ; diagnosis ; Chemotherapy, Adjuvant ; Humans ; Lung Neoplasms ; diagnosis ; Lymph Nodes ; Lymphatic Metastasis ; Multivariate Analysis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Pneumonectomy ; Prognosis ; Retrospective Studies ; Survival Rate