BACKGROUND: Lung cancer has the highest mortality rate among all malignant tumors, and non-small cell lung cancer (NSCLC) accounts for about 80%-85% of all lung cancers. Lobectomy and lymph node dissection are one of the most important treatment methods, and lymph node dissection, as an important part, has attracted much attention. And its mode and scope of dissection may affect postoperative complications, particularly the occurrence of chronic cough. The aim of this study is to investigate the effect of lymph node dissection on postoperative chronic cough in patients with NSCLC undergoing lobectomy, and to provide clinical evidence for optimizing surgical strategy and reducing postoperative chronic cough. METHODS: A retrospective analysis was conducted on the clinical data of 365 NSCLC patients who underwent lobectomy at the First Affiliated Hospital of University of Science and Technology of China from December 2020 to December 2023. The relationship between clinical characteristics and postoperative chronic cough was analyzed. The Chinese version of the Leicester Cough Questionnaire (LCQ-MC) scores were collected from the patients at 2 time points: 1 day before surgery and 8 weeks after surgery. Patients were divided according to lymph node dissection methods, to explore the relationship between lymph node dissection and chronic cough after lobectomy. Additionally, patients were divided into chronic cough and non-chronic cough groups based on the presence of postoperative chronic cough, to investigate whether perioperative data, lymph node dissection methods, and lymph node dissection regions were influencing factors. RESULTS: Patients undergoing lobectomy were more likely to have chronic cough after surgery in the systematic lymph node dissection group than in the lymph node sampling group (P<0.05). LCQ-MC scale evaluation showed that the psychological, physiological, social and total score of the patients in systematic lymph node dissection group were significantly lower than those in lymph node sampling group (P<0.05). Multivariate analysis showed that anesthesia time, operation site, lymph node dissection method, whether to perform upper mediastinal lymph node dissection, number of upper mediastinal lymph node dissection, whether to perform lower mediastinal lymph node dissection and total number of lymph node dissection were independent risk factors for postoperative chronic cough in NSCLC patients (P<0.05). CONCLUSIONS When NSCLC patients underwent lobectomy, lymph node sampling was associated with a significantly lower risk of chronic cough than systematic lymph node dissection. Dissecting lymph nodes in the upper and lower mediastinal regions and the number of lymph nodes dissected may increase the risk of postoperative cough and reduce the quality of life of patients after surgery.
Humans ; Carcinoma, Non-Small-Cell Lung/surgery* ; Male ; Female ; Lung Neoplasms/surgery* ; Middle Aged ; Cough/etiology* ; Retrospective Studies ; Lymph Node Excision/methods* ; Aged ; Chronic Disease ; Postoperative Complications/etiology* ; Adult ; Lymph Nodes/surgery* ; Pneumonectomy/adverse effects* ; Chronic Cough

Objective:To evaluate the feasibility, safety, and short-term efficacy of robot-assisted unilateral axillary approach for partial or total thyroidectomy without inflation. Methods:A retrospective analysis was performed on the clinical data of 98 patients who underwent gasless unilateral axillary approach robot-assisted resection of bilateral thyroid lesions at Sun Yat-sen University Cancer Center between October 2022 and October 2024. Perioperative indicators were recorded and compared among patients undergoing different surgical approaches（total thyroidectomy vs. bilateral partial thyroidectomy） and with different body mass index（BMI） values, including operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of postoperative hoarseness, incidence of postoperative hypocalcemia, and other postoperative complications. Results:A total of 98 patients were included, of whom 78.57% were female, with a median age of 39 years（interquartile range[IQR]: 35-49） and a median BMI of 24.08 kg/m²（IQR: 21.43-25.98）. The median intraoperative blood loss was 32.14 mL（IQR: 20.00-50.00）, the median operative time was 130.0 minutes（IQR: 104.80-150.30）, and the median hospital stay was 2.01 days（IQR: 1.00-2.00）. The most common postoperative complication was transient hypocalcemia, with an incidence of 16.32%. There were no cases of permanent recurrent laryngeal nerve palsy or conversion to open surgery. Compared with the non-total thyroidectomy group, the total thyroidectomy group had a significantly longer operative time（135.10±33.28 min vs 120.30±30.53 min, P=0.033）. Subgroup analysis based on BMI showed no statistically significant differences in operative time, hospital stay, drainage volume, or incidence of hypocalcemia between patients with BMI≥25 kg/m² and those with BMI<25 kg/m². Conclusion:The gasless unilateral axillary approach for robot-assisted partial or total thyroidectomy demonstrates favorable safety, cosmetic outcomes, and feasibility. Appropriate selection of surgical techniques and meticulous protection of critical structures during the procedure can further reduce the risk of complications and optimize therapeutic outcomes.
Humans ; Thyroidectomy/methods* ; Retrospective Studies ; Female ; Robotic Surgical Procedures/methods* ; Male ; Adult ; Middle Aged ; Axilla/surgery* ; Operative Time ; Postoperative Complications ; Thyroid Neoplasms/surgery* ; Thyroid Gland/surgery* ; Lymph Node Excision

Objective:To investigate the clinical efficacy of robotic surgery via the bilateral axillo-breast approach（BABA） in lateral lymph node dissection for papillary thyroid carcinoma（PTC）. Methods:Clinicopathological records of 324 PTC patients receiving unilateral neck dissection in Tianjin Medical University Cancer Institute and Hospital from December 2020 to November 2024 were retrospectively analyzed. Of these patients, 108 underwent robotic surgery via BABA（robotic group）, while the remaining patients underwent conventional open surgery（open group）. The extent of lateral neck lymph node dissection included level Ⅱ, Ⅲ and Ⅳ. The differences in surgical indexes, postoperative complication rates and cosmetic outcomes of incisions were compared between two groups. Results:All study subjects completed the operation successfully, and there was no conversion in the robotic group. The average age of patients in the robotic group was lower than that in the open group, and the proportion of female patients was higher in the robotic group compared to the open group（P<0.05）. Patients in the robotic group had a greater number of dissected lymph nodes in level ⅡB and higher cosmetic scores（P<0.05）. There were no statistically significant differences between the two groups in the average dissection time of lateral cervical lymph nodes, the number of dissected lymph nodes and metastatic lymph nodes in level ⅡA, Ⅲ, and Ⅳ, average postoperative drainage volume, average postoperative hospital stay, and postoperative complication rates（P>0.05）. Conclusion:The application of robotic surgical system via BABA in lateral neck lymph node dissection for PTC is safe and feasible, with superior advantages in level ⅡB dissection and better postoperative cosmetic outcomes.
Humans ; Thyroid Neoplasms/surgery* ; Robotic Surgical Procedures/methods* ; Female ; Retrospective Studies ; Neck Dissection/methods* ; Lymph Node Excision/methods* ; Male ; Thyroid Cancer, Papillary ; Axilla/surgery* ; Thyroidectomy/methods* ; Breast/surgery* ; Middle Aged ; Adult ; Lymph Nodes/surgery* ; Treatment Outcome

OBJECTIVE: To explore the clinical significance of extended pelvic lymph node dissection (EPLND) under the robot-assisted laparoscope in the treatment of high-risk PCa. METHODS: This study included 29 cases of high-risk PCa treated by robot-assisted laparoscopic radical prostatectomy and EPLND from April 2020 to January 2023. We collected the general data on the patients, recorded the status of dissection of the lymph nodes and postoperative complications, and analyzed the significance of EPLND. RESULTS: The patients were aged (69.3±6.6) years old, with the preoperative PSA level of 8.43－434 μg/L, Gleason score (GS) 6 in 1, GS 7 in 9, and GS ≥8 in 19 cases. The operation time averaged (97.2±15.7) min, with the mean blood loss of (30.5±11.2) ml, and 3－42 (median = 13) lymph nodes dissected, less than 10 in 10 cases, 11－19 in 12, and more than 20 in 7. Positive pelvic lymph nodes (median = 4) were found in 13 cases, with a positive rate of 44.8%. Positive incisal margin was observed in 11 cases (37.9%), lymphovascular invasion (LVI) in 4 (13.8%), and perineural invasion (PNI) in another 4 (13.8%). Lymph node metastasis was significantly correlated with positive incisal margin (P<0.05), but not with LVI, PNI or age (P>0.05). No significant vascular or nerve injuries occurred during the operation. GS 6 was detected in 1, GS 7 in 7, and GS ≥8 in 21 cases postoperatively. CONCLUSION Robot-assisted laparoscopic EPLND is an important strategy for the treatment of high-risk PCa, which contributes to accurate pathological staging of the malignancy. However, evidence is lacking for its benefit to the survival of high-risk PCa patients, and more follow-up studies are needed to confirm its treatment effect.
Humans ; Male ; Lymph Node Excision/methods* ; Prostatic Neoplasms/pathology* ; Laparoscopy/methods* ; Robotic Surgical Procedures ; Aged ; Prostatectomy/methods* ; Pelvis ; Lymphatic Metastasis ; Lymph Nodes/surgery* ; Middle Aged

Objectives: To evaluate the positive rate of left posterior lymph nodes of the superior mesenteric artery (14cd-LN) in patients undergoing pancreaticoduodenectomy for pancreatic head carcinoma,to analyze the impact of 14cd-LN dissection on lymph node staging and tumor TNM staging. Methods: The clinical and pathological data of 103 consecutive patients with pancreatic cancer who underwent pancreaticoduodenectomy at Pancreatic Center,the First Affiliated Hospital of Nanjing Medical University from January to December 2022 were analyzed,retrospectively. There were 69 males and 34 females,with an age(M (IQR))of 63.0 (14.0) years (range:48.0 to 86.0 years). The χ² test and Fisher's exact probability method was used for comparison of the count data between the groups,respectively. The rank sum test was used for comparison of the measurement data between groups. Univariate and multivariate Logistic regression analyzes were used for the analysis of risk factors. Results: All 103 patients underwent pancreaticoduodenectomy successfully using the left-sided uncinate process and the artery first approach. Pathological examination showed pancreatic ductal adenocarcinoma in all cases. The location of the tumors was the pancreatic head in 40 cases,pancreatic head-uncinate in 45 cases,and pancreatic head-neck in 18 cases. Of the 103 patients,38 cases had moderately differentiated tumor and 65 cases had poorly differentiated tumor. The diameter of the lesions was 3.2 (0.8) cm (range:1.7 to 6.5 cm),the number of lymph nodes harvested was 25 (10) (range:11 to 53),and the number of positive lymph nodes was 1 (3) (range:0 to 40). The lymph node stage was stage N0 in 35 cases (34.0%),stage N1 in 43 cases (41.7%),and stage N2 in 25 cases (24.3%). TNM staging was stage ⅠA in 5 cases (4.9%),stage ⅠB in 19 cases (18.4%),stage ⅡA in 2 cases (1.9%),stage ⅡB in 38 cases (36.9%),stage Ⅲ in 38 cases (36.9%),and stage Ⅳ in 1 case (1.0%). In 103 patients with pancreatic head cancer,the overall positivity rate for 14cd-LN was 31.1% (32/103),and the positive rates for 14c-LN and 14d-LN were 21.4% (22/103) and 18.4% (19/103),respectively. 14cd-LN dissection increased the number of lymph nodes (P<0.01) and positive lymph nodes (P<0.01). As a result of the 14cd-LN dissection,the lymph node stage was changed in 6 patients,including 5 patients changed from N0 to N1 and 1 patient changed from N1 to N2. Similarly,the TNM stage was changed in 5 patients,including 2 patients changed from stage ⅠB to ⅡB,2 patients changed from stage ⅡA to ⅡB,and 1 patient changed from stage ⅡB to Ⅲ. Tumors located in the pancreatic head-uncinate (OR=3.43,95%CI:1.08 to 10.93,P=0.037) and the positivity of 7,8,9,12 LN (OR=5.45,95%CI:1.45 to 20.44,P=0.012) were independent risk factors for 14c-LN metastasis; while tumors with diameter >3 cm (OR=3.93,95%CI:1.08 to 14.33,P=0.038) and the positivity of 7,8,9,12 LN (OR=11.09,95%CI:2.69 to 45.80,P=0.001) were independent risk factors for 14d-LN metastasis. Conclusion: Due to its high positive rate in pancreatic head cancer,dissection of 14cd-LN during pancreaticoduodenectomy should be recommended,which can increase the number of lymph nodes harvested,provide a more accurate lymph node staging and TNM staging.
Male ; Female ; Humans ; Pancreaticoduodenectomy/methods* ; Retrospective Studies ; Prognosis ; Lymph Node Excision/methods* ; Lymph Nodes/pathology* ; Pancreatic Neoplasms/pathology* ; Neoplasm Staging

Due to the anatomical specificity of esophagus, esophagectomy can be carried out using different approaches, such as left transthoracic, right transthoracic and transhiatal approaches. Each surgical approach is associated with a different prognosis due to the complex anatomy. The left transthoracic approach is no longer the primary choice due to its limitations in providing adequate exposure, lymph node dissection, and resection. The right transthoracic approach is capable of achieving a larger number of dissected lymph nodes and is currently considered the preferred procedure for radical resection. Although the transhiatal approach is less invasive, it could be challenging to perform in a limited operating space and has not been widely adopted in clinical practice. Minimally invasive esophagectomy offers a wider range of surgical options for treating esophageal cancer. This paper reviews different approaches to esophagectomy.
Humans ; Prognosis ; Lymph Node Excision/methods* ; Lymph Nodes/pathology* ; Esophageal Neoplasms/pathology* ; Esophagectomy/methods*

Objective: We aimed to explore the feasibility of a single-port thoracoscopy- assisted five-step laparoscopic procedure via transabdominal diaphragmatic(TD) approach(abbreviated as five-step maneuver) for No.111 lymphadenectomy in patients with Siewert type II esophageal gastric junction adenocarcinoma (AEG). Methods: This was a descriptive case series study. The inclusion criteria were as follows: (1) age 18-80 years; (2) diagnosis of Siewert type II AEG; (3) clinical tumor stage cT2-4aNanyM0; (4) meeting indications of the transthoracic single-port assisted laparoscopic five-step procedure incorporating lower mediastinal lymph node dissection via a TD approach; (5) Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1; and (6) American Society of Anesthesiologists classification I, II, or III. The exclusion criteria included previous esophageal or gastric surgery, other cancers within the previous 5 years, pregnancy or lactation, and serious medical conditions. We retrospectively collected and analyzed the clinical data of 17 patients (age [mean ± SD], [63.6±11.9] years; and 12 men) who met the inclusion criteria in the Guangdong Provincial Hospital of Chinese Medicine from January 2022 to September 2022. No.111 lymphadenectomy was performed using five-step maneuver as follows: superior to the diaphragm, starting caudad to the pericardium, along the direction of the cardio-phrenic angle and ending at the upper part of the cardio-phrenic angle, right to the right pleura and left to the fibrous pericardium , completely exposing the cardio-phrenic angle. The primary outcome includes the numbers of harvested and of positive No.111 lymph nodes. Results: Seventeen patients (3 proximal gastrectomy and 14 total gastrectomy) had undergone the five-step maneuver including lower mediastinal lymphadenectomy without conversion to laparotomy or thoracotomy and all had achieved R0 resection with no perioperative deaths. The total operative time was (268.2±32.9) minutes, and the lower mediastinal lymph node dissection time was (34.0±6.0) minutes. The median estimated blood loss was 50 (20-350) ml. A median of 7 (2-17) mediastinal lymph nodes and 2(0-6) No. 111 lymph nodes were harvested. No. 111 lymph node metastasis was identified in 1 patient. The time to first flatus occurred 3 (2-4) days postoperatively and thoracic drainage was used for 7 (4-15) days. The median postoperative hospital stay was 9 (6-16) days. One patient had a chylous fistula that resolved with conservative treatment. No serious complications occurred in any patient. Conclusion: The single-port thoracoscopy-assisted five-step laparoscopic procedure via a TD approach can facilitate No. 111 lymphadenectomy with few complications.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Diaphragm/surgery* ; Retrospective Studies ; Feasibility Studies ; Esophagogastric Junction/surgery* ; Lymph Node Excision/methods* ; Stomach Neoplasms/pathology* ; Laparoscopy/methods* ; Gastrectomy/methods* ; Esophageal Neoplasms/pathology* ; Adenocarcinoma/pathology* ; Thoracoscopy

The successful report of total mesorectal excision (TME)/complete mesocolic excision (CME) has encouraged people to apply this concept beyond colorectal surgery. However, the negative results of the JCOG1001 trial denied the effect of complete resection of the "mesogastrium" including the greater omentum on the oncological survival of gastric cancer patients. People even believe that the mesentery is unique in the intestine, because they have a vague understanding of the structure of the mesentery. The discovery of proximal segment of the dorsal mesogastrium (PSDM) proved that the greater omentum is not the mesogastrium, and further revised the structure (definition) of the mesentery and revealed its container characteristics, i.e. the mesentery is an envelope-like structure, which is formed by the primary fascia (and serosa) that enclose the tissue/organ/system and its feeding structures, leading to and suspended on the posterior wall of the body. Breakdown of this structure leads to the simultaneous reduction of surgical and oncological effects of surgery. People quickly realized the universality of this structure and causality which cannot be matched by the existing theories of organ anatomy and vascular anatomy, so a new theory and surgical map- membrane anatomy began to form, which led to radical surgery upgraded from histological en bloc resection to anatomic en bloc resection.
Humans ; Fascia/anatomy & histology* ; Laparoscopy ; Lymph Node Excision/methods* ; Mesentery/surgery* ; Mesocolon/surgery* ; Omentum ; Serous Membrane ; Clinical Trials as Topic

Radical resection of gastrointestinal tumors based on the membrane anatomy theory has significantly reduced the postoperative recurrence rate and improved the surgical efficacy. However, the theory of membrane anatomy has not been widely adopted in radical surgery for esophageal cancer. Our study found that the esophagus also has a membranous anatomical structure. As a foregut organ, the esophagus also has a mesenteric structure, and there is also a fifth metastasis pathway within the esophageal mesentery for esophageal cancers. The leak and metastasis of cancer caused by destruction of the mesenteric integrity may be the fundamental reason for the high postoperative recurrence rate. Using the nano carbon and indocyanine green fluorescence tracing technique, we demonstrated the lymphatic drainage of the upper esophageal segment to the left gastric artery mesenteric lymph nodes. Therefore, in the radical resection of esophageal cancer, we used the membrane anatomy theory for guidance to completely remove the esophageal cancer, esophageal mesentery, left gastric artery and its mesentery, as well as all structures within the mesentery, preventing the spread of cancer cells through the blood vessels, lymphatic system, and mesentery, and improving the efficacy and prognosis. This article elaborates on the theoretical basis of the anatomical structure of the esophageal membrane, embryonic development, imaging, autopsy, and endoscopic observation of the structure, as well as the application effect of the esophageal membrane anatomical theory in esophageal cancer radical surgery. It elucidates the anatomical structure of the esophageal membrane and the lymphatic drainage characteristics of esophageal cancer, reveals the law of lymphatic metastasis in esophageal cancer, optimizes lymphatic dissection strategies, and improves the efficacy of esophageal cancer radical surgery.
Humans ; Lymph Node Excision/methods* ; Esophageal Neoplasms/surgery* ; Lymph Nodes ; Endoscopy ; Dissection

Although it has become a consensus in the field of colorectal surgery to perform radical tumor treatment and functional protection under the minimally invasive concept, there exist many controversies during clinical practice, including the concept of embryonic development of abdominal organs and membrane anatomy, the principle of membrane anatomy related to right hemicolectomy, D3 resection, and identification of the inner boundary. In this paper, we analyzed recently reported literature with high-level evidence and clinical data from the author's hospital to recognize and review the membrane anatomy-based laparoscopic assisted right hemicolectomy for right colon cancer, emphasizing the importance of priority of surgical dissection planes, vascular orientation, and full understanding of the fascial space, and proposing that the surgical planes should be dissected in the parietal-prerenal fascial space, and the incision should be 1 cm from the descending and horizontal part of the duodenum. The surgery should be performed according to a standard procedure with strict quality control. To identify the resection range of D3 dissection, it is necessary to establish a clinical, imaging, and pathological evaluation model for multiple factors or to apply indocyanine green and nano-carbon lymphatic tracer intraoperatively to guide precise lymph node dissection. We expect more high-level evidence of evidence-based medicine to prove the inner boundary of laparoscopic assisted radical right colectomy and a more rigorous consensus to be established.
Humans ; Laparoscopy/methods* ; Colonic Neoplasms/pathology* ; Lymph Node Excision/methods* ; Colectomy/methods* ; Dissection