The world today is undergoing revolutionary changes in science, technology, and industry. These changes have optimized the surgical procedure for lung cancer treatment into a more minimally invasive, precise, comprehensive, industrialized, and patient-centered manner. The definition of minimally invasive treatment for lung cancer has been expanded from simply reducing the size of the skin incision to reserve the lung function. The principle of precision surgery is emphasized throughout the whole process of patient management including diagnosis and treatment. Multimodality therapy helps narrow the gaps between different disciplines and thus provides more personalized treatment for lung cancer patients. Integration of industrial techniques such as visualization, surgical robot, and artificial intelligence into medical practice will potentially lead to a revolution in thoracic surgical procedure. Today, thoracic surgeons are responsible for establishing a self-reliant surgical practice for Chinese patients with lung cancer. It is necessary to attach great importance to patient-centered care, move forward to review minimally invasive surgical procedure, and foster better practice for lung cancer management by keeping up with cutting-edge research on science and technology in the context of changes and challenges.

The world today is undergoing revolutionary changes in science, technology, and industry. These changes have optimized the surgical procedure for lung cancer treatment into a more minimally invasive, precise, comprehensive, industrialized, and patient-centered manner. The definition of minimally invasive treatment for lung cancer has been expanded from simply reducing the size of the skin incision to reserve the lung function. The principle of precision surgery is emphasized throughout the whole process of patient management including diagnosis and treatment. Multimodality therapy helps narrow the gaps between different disciplines and thus provides more personalized treatment for lung cancer patients. Integration of industrial techniques such as visualization, surgical robot, and artificial intelligence into medical practice will potentially lead to a revolution in thoracic surgical procedure. Today, thoracic surgeons are responsible for establishing a self-reliant surgical practice for Chinese patients with lung cancer. It is necessary to attach great importance to patient-centered care, move forward to review minimally invasive surgical procedure, and foster better practice for lung cancer management by keeping up with cutting-edge research on science and technology in the context of changes and challenges.

Objective To determine the long-term impacts of major pulmonary complications ( MPCs) and identify the in-dependent risk factors in those non-small cell lung cancer(NSCLC)patients who underwent VATS lobectomy.Methods A ret-rospective study was developed to analyze the pulmonary complications of 574 non-small cell lung cancer patients who under-went VATS lobectomy in Peking University Hospital , the complications were graded according to TMM classification criteria . The effects of PCs on the long-term prognosis were analyzed by using the Kaplan-Meier method.Multivariate logistic regression analysis was used to determine the risk factors of MPCs.Results Of 574 patients, 106 had PCs, including 50(8.7％) MPCs, Postoperative pulmonary complications were associated with significantly longer drainage time (P<0.001) and hospital stays(P<0.001).Perioperative mortality was significantly increased in patients with PCs (4.0％ vs 0.6％; P =0.021). Those who develop a MPC had a reduced 3-year DFS and 5-year DFS(61.3％ vs.77.4％、42.2％ vs.69.3％;P=0.003), as well as the reduced 3-year OS and 5-year OS(78.5％vs.88.2％、62.4％ vs.79.2％;P=0.047).MPCs were independ-ent prognostic factors of patients with lung cancer .Multivariate logistic regression analysis showed that the independent risk fac-tors for MPCs were age, male, ASA grade.Conclusion Major pulmonary complications after VATS lobectomy are associated with a poorer long-time outcome.The independent risk factors for MPCs are age, male, and ASA grade.

Objective To develop an easy-to-use nomogram to assist clinicians in predicting major postoperative morbidity in those non-small-cell lung canccr patients who underwent VATS lobectomy.Methods A perspective multi-center study was developed to analyze the major postoperative complications of 612 non-small-cell lung cancer patients who underwent VATS lobectomy.Muhivariable logistic regression was used to model postoperative morbidity and built the nomogram to accurately predict the major complications.Results There were 606 (99％) survivors and 6 (1％) mortality.A total of 32 patients suffered from major complications.Using logistic regression to predict major complications,preoperative model for ASA score,age ≥70 years and operation time ＞ 150 nin were found to be the significant predictors(P ＜ 0.05) of morbidity and were included in our model.Conclusion We propose a nomogram to enable clinicians to better estimate morbidity in patients with VATS lobectomy.

Objective The aim of this study is to evaluate the efficacy and safety of preoperative Computed Tomography (CT)-guided microcoil localization for pulmonary ground-glass opacity.Methods We performed CT-guided Microcoil localization in 30 patients with 32 pure ground glass opacities between December 2012 and September 2013.All 30 patients underwent CT-guided micmcoil localization under local anesthesia with a 21G needle percutaneous lung biopsy.All patients accepted video-assisted thoracic surgery after the localization the same day or the next day.Results We located 32 pure ground glass opacitiesin 30 patients.The mean lesion diameter was 0.94 cm,the average depth from the visceral pleura was 0.71 cm,all leisons were successfully located by microcoil,asymptomatic pneumothorax was observed in seven patients,pulmonary hematoma was observed in two patients,pain was observed in one patient,dislodgement was found in one patient during the operation.None of these cases needed surgical treatment.Pathologic diagnoses of the target leisions were as follows:adenocarcinoma in situ (n =17),adenocarcinoma(n =9),atypical hyperplasia(n =4),inflammation (n =2).After the placement of preoperative CT-guided microcoil localization for pulmonary ground-glass opacity,all the 32 pulmonary pure ground-glass opacities resection success rate was 100％.Conclusion Preoperative CT-guided microcoil localization for pulmonary pure ground-glass opacity is a safe and effective way to improve the accuracy of surgical resection.

ObjectiveTo review the experience of video-assisted thoracoscopic resection for posterior mediastinal neurogenic tumors,to investigate the technical features and difficulties of thoracoscopic approach.MethodsFrom May 2001 to June 2011,58 patients underwent thoracoscopic resection of posterior mediastinal tumors in our institution,including 36 males and 22 females.The average age of the patients was 38.7 years.The average tumor size was 4.9 cm.16 patients had neurogenic or pulmonary symptoms at the time of diagnosis,while the other 42 were asymptomic.24 lesions were located in the left side,33 lesions in the right side,1 lesion in bilateral sides.All procedures generally required 3 ports,and intracapsular enucleation was preferred,supplying vessels were ligated by hemoclips or Hem-o-lock clips; the nerves of origin were cut off at both edges of the tumor.For bulky tumor,dense adhesion,and massive bleeding,open conversions were performed by extending the incision anteriorly to 6-10 cm.ResultsAll procedures were successfully performed without death event occurring.The average operating time was 127.2 min.The average intraoperative blood loss was 206.4 ml.3 cases requied blood transfusion.The average chest tube duration was 2.72 days.The average postoperative stay was 5.19 days.53 procedures were performed entirely under thoracoscopy to achieve gross-total resection.Conversions to an open procedure were necessitated in 5 patients (8.6％).7 patients experienced post-operative complications,with 4 Horner syndromes.There were 25 neurilemomas,23 neurofibromas,8 ganglioneuromas,1 paraganglioma,and 1 malignant paraganglioma.No local recurrence was seen after an average follow-up of 44.9 months.ConclusionVideo-assisted thoracoscopic removes of the posterior mediastinal tumors are safe,reliable and minimally invasive for selected patients with mastered throcoscopic skills.intracapsular enucleation is a safe procedure with reduced risk,while tumors larger than 6cm and located in the apex are with increased risk.

ObjectiveSummarize 500 cases of non-small cell lung cancer (NSCLC) that has accepted complete videoassisted thoracoscopic (VATs) lobectomy procedure in People's Hospital of Peking University,to report the mid-term follow-up results,and to evaluate the safety and effectiveness of VATs lobectomy.MethodsBetween September 2006 and September 2011,500 cases of non-small cell lung cancer that has accepted complete thoracoscopic lobectomy in the People's Hospital of Peking University were reviewed (267 male,233 female).Median patient age was 62.3 years.The average maximal diameter of solid tumors was 2.65cm.There are 496 cases of initial treat patients and 4 cases of operation after radiation and chemotherapy.This group consisted of lobectomies of left upper lobe ( n =129),left lower lobe ( n =73 ),right upper lobe ( n =163 ),right middle lobe x( n =47 ),right lower lobe( n =89 ).The operation procedure was complete VATs lobectomy combined with systematic lymph node resection ( at least 3 groups of lymph nodes in the mediastinum area),including 480 cases of purely lobectomy,13 cases of compound lobectomy (pulmonary lobe + pulmonary lobe,or pulmonary lobe + pulmonary segment),3 cases of segmentomy,2 cases of pneumonectomy,1 case of sleeve lobectomy and 1 case of bilateral lobectomy.ResultsAll procedures were carried out smoothly without serious complication,except 1 case of death of an advanced age patient due to multi-organ failure after the operation period.The average surgical duration was 198.1 min,and average blood loss was 214.6ml.There are 5 cases of postoperative hemorrhage,identified as pulmonary artery residual ooze blood,in which 4 cases of bleeding were stopped through re-operation,and 1 case was improved through conservative treatment.The median lymph nodes dissection was 5.7 group and median number of resected lymph nodes was 16.9.The median postoperative chest tube drainage duration was 7.8 day,and median postoperative hospital stay was 10.2 day.There were 45 cases (9.0％) of conversion to open thoracotomy and 87 cases ( 17.4％ ) of slight complications,including 32 cases of cardiac abnormalities,such as continuous arrhythmia,28 cases of air leakage beyond seven days,9 cases of pulmonary infections or atelectasis,6 cases of chylothorax,and 16 cases of other complications.The results of pathology show 363 cases of adenocarcinoma,85 cases of squamous carcinoma,12 cases of adenosquamous carcinoma,28 broncho-alveolar cell carcinoma,6 cases of large cell lung cancer and 6 cases of other lung cancer.The 1-year disease free survival (DFS) was 90.2％ and 1-year overall survival (OS) was 94.3％.The 3-year DFS was 76.4％ and 3-year OS was 81.3％.ConclusionCompletely video-assisted Thoracoscopic lobectomy procedure was a safe and effctive procedure for patients with non-small cell lung cancer.

Objective To evaluate the long term effect of video-assisted thoracoscopic thymectomy for myasth,enia gravis and the influence of concomitant thymoma.Methods 47 cases of myasthenia gravis were retrospectively reviewed who had received video-assisted thoracoscopic thymectomy from Apr.2001 through Oct.2009.The patients were separated to two groups with or without thymoma.Influence of oncologic factors was carefully studied.Results There were 20 males and 27 females with a mean age of 36.6 yrs.According to the typing system of the Myasthenia Gravis Foundation of America ( MGFA),the patients belonged to type Ⅰ 18 cases,type Ⅱ a 14 cases,type Ⅱ b 14 cases,and Ⅲa 1 case.22 patients were in the group with thymoma,and the other 25 in the group without thymoma.Until the deadline of follow-up time of Jun.2011,only two cases in non-thymomatous group were lost.Follow-up time was 20 to 122 months,mean 57 months.The complete stable remission rate(CSR),pharmacologic remission(PR),minimal manifestations(MM),worse(W),exacerbation(E) and died of myasthenia gravis(D) in non-thymomatous group were 78.3％,13.0％,4.3％,0,0 and 4.3％.In thymomatous group the values were 50.0％,22.7％,13.6％,4.5％,9.1％ and 0.Conclusion Video-assisted thoarcoscopic thymectomy has a satisfactory long term effect for myasthenia gravis.Thymomatous group has no different in overall effectiveness with that of non-thymomatous group although a probably lower complete stable remission rate is prompted.

Objective To evaluated the role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of mediastinal lesions around the trachea.MethodsThe study was retrospective, between September 2009 to July 2010, 34 consecutive patients with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin underwent EBUS-TBNA.Patients in whom EBUS-TBNA was nondiagnostic subsequently underwent surgical biopsy or a minimum of 6 months clinical and radiologic follow-up.ResultsOf the 34 patients, EBUS-TBNA achieved definitive diagnosis in 28 patients (82.4％), 10 were diagnosed as malignancies, 18 were diagnosed as benign.The sensitivity, specificity,and accuracy of EBUS-TBNA in distinguishing benign from malignant mediastinal lesions were 90.9％, 100％, and 97.1％,respectively.EBUS was well tolerated by all of the patients with no complications.ConclusionEBUS-TBNA of mediastinal lesions around the trachea is a minimally invasive safe diagnostic technique with high yield.

Objective To review the experience d EBUS-TBNA for staging of lung cancer and the value in diagnosing thoracic diseases in our single center.Methods The data of 343 patients who underwent EBUS-TBNA from September 2009 to August 2011 in our institution were retrospectively reviewed.There were 219 males and 124 females with an average age of (59.4 ± 13.6 ) years.Based on their primary indication,patyients were divided into three categories:group A:with known or strongly suspected lung cancer and enlarged mediastinal lymph nodes on chest radiographic examination ( short axis ≥ 1.0cm) ; group B:with enlarged mediastinal lymph nodes or mediastinal masses of unknown origin; and group C:with pulmonary parenchymal mass located close to the central airways.Results The average short axis diameter of the thoracic lesions was ( 1.94 ± 1.01 ) cm ( range from 0.5 to 8.0cm),and 2.66 punctures were performed per lesion.In group A ( n =208 ),151 patients were confirmed to have mediestinal lymph nodes metastasis while 51 showed negative results.Four patients were diagnosed as tuberculosis and two were confirmed to be stage Ⅱ sarcoidosis.37 in the 51 patients with negative EBUS-TBNA underwent thoracoscopic or thoracotomy for pulmonary resection and mediastinal lymph node dissection.Postoperative pathology confirmed that 32 patients did not have lymph nodes metastases.The diagnostic sensitivity,specificity,accuracy,positive predictive and negative predictive of EBUS-TBNA for the mediastiral staging of lung cancer were 96.8％ (151/156),100.0％ (32/32),97.3％ ( 183/188 ),100％ ( 151/151 ) and 86.5％ (32/37),respectively.In group B ( n =94),22 patients had malignancy and 72 had benign diseases.Thirteen patients received operative validation in the 23 cases which were diagnosed as proliferative lymph nodes by EBUS-TBNA,and by further operation two and three patients were confirmed as malignancy and other benign diseases respectively.The sensitivity,negative predictive value ( NPV ) and accuracy of EBUS-TBNA in distinguishing malignant mediastinal diseases was 88.0％ (22/25)、100％ (73/73) 、95.9％ (70/73)and 97.9％ (92/94),respectively.In group C( n =41 ),malignant diagnosis was achieved in 33 patients,while 4 patients confirmed as malignancy by further operations in the other 8 negative cases.The diagnostic sensitivity and accuracy of EBUS-TBNA for the diagnosis of unknown pulmonary parenchymal mass were 89.2％ (33/37) and 90.2％ (37/41),respectively.All the procedures were uneventful and no complication occurred.Conclusion EBUS-TBNA is a highly effective and safe procedure in the diagnosis of thoracic diseases and staging.of lung cancer.