Radical Surgery For Lung Cancer Research Articles

Clinicopathological features, prognostic factor analysis, and survival nomogram of patients with double primary cancers involving lung cancer.

Although the incidence of double primary cancers (DPCs) involving lung cancer is rising, they have not been studied sufficiently. This study retrospectively analyzed the clinicopathological and prognostic characteristics of DPC patients with lung cancer and developed a survival nomogram to predict the individual OS rates. We included 103 DPC patients with lung cancer from Shengjing Hospital between 2016 and 2021. Based on the 6-month cancer occurrence interval, the cases were categorized as synchronous DPCs (sDPCs) or metachronous DPCs (mDPCs). Furthermore, the mDPCs were subdivided based on whether the lung cancer occurred first (LCF cohort) or the other cancer occurred first (OCF cohort). Among the patients, 35 (33.98%) and 68 (66.02%) had sDPCs and mDPCs, respectively. In the mDPCs cohort, 18 (26.47%) belonged to the LCF cohort and 50 (73.53%) to the OCF cohort. The most frequent primary cancer sites were the breast (27.18%), colorectum (22.33%), and urinary system (18.45%). Independent risk factors for progression-free survival were Stage IV lung cancer (p = 0.008) and failure to undergo radical lung cancer surgery (p = 0.028). The risk factors for OS included squamous carcinoma (p = 0.048), Stage IV lung cancer (p = 0.001), single cancer resection plus drug therapy (p < 0.001), drug therapy alone (p = 0.002), failure to undergo radical lung cancer surgery (p = 0.014), and chemotherapy (p = 0.042). The median OS was 37 months, with 3- and 5-year rates of 50.9% and 35.9%, respectively. DPCs involving lung cancer account for 1.11% of cases. The breast, colorectum, and urinary system were the most common extra-pulmonary sites, and mDPCs were more frequent than sDPCs. Radical lung cancer surgery significantly affects prognosis, and drug therapy alone may be preferable when only one tumor is operable. The developed nomogram can accurately predict individual 3-year and 5-year OS rates.

Comparison of Thoracoscopy-Guided Thoracic Paravertebral Block and Ultrasound-Guided Thoracic Paravertebral Block in Postoperative Analgesia of Thoracoscopic Lung Cancer Radical Surgery: A Randomized Controlled Trial.

Ultrasound-guided thoracic paravertebral block (UTPB) is widely used for postoperative analgesia in thoracic surgery. However, it has many disadvantages. Thoracoscopy-guided thoracic paravertebral block (TTPB) is a new technique for thoracic paravertebral block (TPB). In this study, we compared the use of TTPB and UTPB for pain management after thoracoscopic radical surgery for lung cancer. In total, 80 patients were randomly divided 1:1 into the UTPB group and the TTPB group. The surgical time of TPB, the success rate of the first puncture, block segment range, visual analog scale (VAS) scores at 2, 6, 12, 24, and 48h post operation, and the incidence of postoperative adverse reactions were compared between the two groups. The surgical time of TPB was significantly shorter in the TTPB group than in the UTPB group (2.2 ± 0.3 vs. 5.7 ± 1.7min, t = - 12.411, P < 0.001). The success rate of the first puncture and the sensory block segment were significantly higher in the TTPB group than in the UTPB group (100% vs. 76.9%, χ2 = 8.309, P < 0.001; 6.5 ± 1.2 vs. 5.1 ± 1.3 levels, t = - 5.306, P < 0.001, respectively). The VAS scores were significantly higher during rest and coughing at 48h post operation than at 2, 6, 12, and 24h post operation in the TTPB group. The VAS scores were significantly lower during rest and coughing at 12 and 24h post operation in the TTPB group than in the UTPB group (rest: 2.5 ± 0.4 vs. 3.4 ± 0.6, t = 7.325, P < 0.001; 2.5 ± 0.5 vs. 3.5 ± 0.6, t = 7.885, P < 0.001; coughing: 3.4 ± 0.6 vs. 4.2 ± 0.7, t = 5.057, P < 0.001; 3.4 ± 0.6 vs. 4.2 ± 0.8, t = 4.625, P < 0.001, respectively). No significant difference was observed in terms of postoperative adverse reactions between the two groups. Compared with UTPB, TTPB shows advantages, such as simpler and more convenient surgery, shorter surgical time, a higher success rate of the first puncture, wider block segments, and superior analgesic effect. TTPB can effectively reduce postoperative pain due to thoracoscopic lung cancer radical surgery. https://www.chictr.org.cn , identifier ChiCTR2300072005, prospectively registered on 31/05/2023.

Effect of dexmedetomidine on postoperative nausea and vomiting in female patients undergoing radical thoracoscopic lung cancer resection

Introduction: Postoperative nausea and vomiting (PONV) is a prevalent postsurgical complication. The objective of our study was to compare the effect of different doses of dexmedetomidine on PONV in female patients undergoing radical thoracoscopic lung cancer resection.Methods: A total of 164 female patients undergoing elective thoracoscopic radical lung cancer surgery were enrolled and assigned to one of four groups. Patients received 0.2 μg/kg/h, 0.4 μg/kg/h, 0.8 μg/kg/h dexmedetomidine and normal saline in the Dex1, Dex2, Dex3 and Control groups, respectively. The primary outcome was the incidence of PONV during 48 h postoperatively. The second outcomes included the incidence of PONV and postoperative vomiting (POV) at four time points postoperatively (T1: PACU retention period; T2: PACU discharge to postoperative 12 h; T3: postoperative 12 h-postoperative 24 h; T4: postoperative 24 h-postoperative 48 h), the area under the curve of PONV grade (PONVAUC), PONV grade, POV grade and other postoperative recovery indicators.Results: The incidence of PONV differed among the four groups. The Dex2 group (29.27%) was lower than that in the Dex1 group (61.90%) and Control group (72.50%). The incidence of PONV at T2 in the Dex1 group (11.90%) and Dex2 group (9.76%) was lower than that in the Control group (42.50%). The incidence of PONV at T3 in the Dex2 group (29.27%) was lower than that in the Dex1 group (61.90%) and Control group (62.50%). The PONVAUC was lower in the Dex2 group than in the Control group. The incidence of POV at T3 in the Dex2 and Dex3 groups was lower than that in the Control group. The consumption of remifentanil, norepinephrine, PACU dwell time, VAS scores, postoperative PCA press frequency, and the time for the first postoperative oral intake were different among the four groups. The regression model shows that the Dex2 group is a protective factor for PONV.Conclusion: Dexmedetomidine can reduce the incidence of PONV and accelerate postoperative recovery in female patients undergoing radical thoracoscopic lung cancer resection. Compared with the other two dosages, 0.4 μg/kg/h dexmedetomidine is preferable.Clinical Trial Registration:chictr.org.cn, identifier ChiCTR2300071831

Efficacy observation of acupuncture plus point application for pain after thoracoscopic radical lung cancer surgery

Efficacy observation of acupuncture plus point application for pain after thoracoscopic radical lung cancer surgery

Evaluation of the application value of seven tumor-associated autoantibodies in non-small cell lung cancer based on machine learning algorithms

Objective: Based on the diagnostic model established and validated by the machine learning algorithm, to investigate the value of seven tumor-associated autoantibodies (TAABs), namely anti-p53, PGP9.5, SOX2, GAGE7, GBU4-5, MAGEA1 and CAGE antibodies in the diagnosis of non-small cell lung cancer (NSCLC) and to differentiate between NSCLC and benign lung nodules. Methods: This was a retrospective study of clinical cases. Model building queue: a total of 227 primary patients who underwent radical lung cancer surgery in the Department of Thoracic Surgery, Shengjing Hospital of China Medical University, from November 2018 to June 2021 were collected as the NSCLC group, and 120 cases of benign lung nodules, 122 cases of pneumonia and 120 healthy individuals were selected as the control groups. External validation queue: a total of 100 primary patients who underwent radical lung cancer surgery in the Department of Thoracic Surgery, Shengjing Hospital of China Medical University, from May 2022 to December 2022 were collected as the NSCLC group, and 36 cases of benign lung nodules, 32 cases of pneumonia and 44 healthy individuals were selected as the control groups. In addition, NSCLC was divided into early (stage 0-ⅠB) and mid-to-late (stage ⅡA-ⅢB) subgroups. The levels of 7-TAABs were detected by enzyme immunoassay, and serum concentrations of CEA and CYFRA21-1 were detected by electrochemiluminescence. Four machine learning algorithms, XGBoost, Lasso logistic regression, Naïve Bayes, and Support Vector Machine are used to establish classification models. And the best performance model was chosen based on evaluation metrics and a multi-indicator combination model was established. In addition, an online risk evaluation tool was generated to assist clinical applications. Results: Except for p53, the levels of rest six TAABs, CEA and CYFRA21-1 were significantly higher in the NSCLC group (P<0.05). Serum levels of anti-SOX2 [1.50 (0.60, 10.85) U/ml vs. 0.8 (0.20, 2.10) U/ml, Z=2.630, P<0.05] and MAGEA1 antibodies [0.20 (0.10, 0.43) U/ml vs. 0.10 (0.10, 0.20) U/ml, Z=2.289, P<0.05], CEA [3.13 (2.12, 5.64) ng/ml vs. 2.11 (1.25, 3.09) ng/ml, Z=3.970, P<0.05] and CYFRA21-1 [4.31(2.37, 7.14) ng/ml vs. 2.53(1.92, 3.48) ng/ml, Z=3.959, P<0.05] were significantly higher in patients with mid-to late-stage NSCLC than in early stages. XGBoost model was used to establish a multi-indicator combined detection model (after removing p53). 6-TAABs combined with CYFRA21-1 was the best combination model for the diagnosis of NSCLC and early NSCLC. The optimal diagnostic thresholds were 0.410, 0.701 and 0.744, and the AUC was 0.828, 0.757 and 0.741, respectively (NSCLC vs. control, NSCLC vs. benign lung nodules, early NSCLC vs. benign lung nodules) in model building queue, and the AUC was 0.760, 0.710 and 0.660, respectively (NSCLC vs. control, NSCLC vs. benign lung nodules, early NSCLC vs. benign lung nodules) in external validation queue. Conclusion: In the diagnosis of NSCLC, 6-TAABs is superior to that of traditional tumor markers CEA and CYFRA21-1, and can compensate for the shortcomings of traditional tumor markers. For the differential diagnosis of NSCLC and benign lung nodule, "6-TAABs+CYFRA21-1" is the most cost-effective combination, and plays an important role in prevention and screening for early lung cancer.

Comparison of clinical efficacy of da Vinci robot-assisted lung cancer surgery with two-, three- and four-hole approaches.

Orifice reduction strategies for da Vinci robotic surgery have been a hot topic of research in recent years. We retrospectively analyzed the perioperative outcomes of robotic-assisted thoracoscopic surgery (RATS) with two, three, and four-hole approaches in radical lung cancer surgery. Our results revealed that the two-hole group has advantages in terms of operative time, postoperative 3-day drainage, postoperative drainage time, postoperative hospital stay and postoperative day 3 visual analogue scale (VAS) pain scores. There were no significant differences between the three groups in terms of intraoperative bleeding, number of lymph nodes dissected, VAS pain scores on postoperative days 1 and 2, and postoperative complications. In addition, the two-hole group was superior to the three-hole and four-hole groups in terms of C-reactive protein (CRP), procalcitonin (PCT) and interleukin 10 (IL-10). In summary, the RATS two-hole approach has advantages in operation time, rapid recovery after operation and some postoperative inflammatory indicators, and is worth promoting in hospitals that are skilled in three-hole and four-hole da Vinci robot surgery and have conditions.

Retracted: Application of Da Vinci Robot and Thoracoscopy in Radical Lung Cancer Surgery.

[This retracts the article DOI: 10.1155/2022/2011062.].

Furmonertinib as adjuvant therapy in postoperative EGFR-mutated stage IA2-IIIA non-small cell lung cancer (NSCLC) with high-risk pathological factors.

150 Background: NSCLC patients with high-risk pathological factors such as micropapillary (MP), solid (S), spread through air spaces (STAS), and visceral pleural invasion (VPI) have shown poor prognosis in previous studies. Furmonertinib (AST2818) is a novel, promising oral third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), which has demonstrated efficacy in tumours harbouring sensitive EGFR mutations and T790M resistance mutation. Here, we investigated the efficacy and safety of furmonertinib as adjuvant therapy in postoperative EGFR-mutated NSCLC patients with high-risk pathological factors. Methods: Patients who underwent radical lung cancer surgery with both EGFR mutations and MP/S/STAS/VPI were enrolled and received furmonertinib 80mg daily. The adjuvant therapy time (6-36months) depended on patients’ pathologic stage and physical conditions. The disease-free survival (DFS), safety and tolerability were evaluated. Results: This study retrospectively analyzed 69 patients who were pathologically confirmed adenocarcinoma, EGFR mutation positive (exon 19 deletion/L858R/exon 20ins), stage IA2-IIIA NSCLC. All of them had at least one high-risk pathological factor. There were 44 (63.8%) patients with MP, 14 (20.3%) with S, 10 (14.5%) with STAS and 33 (47.8%) with VPI. All patients were followed at least 13 months, and 24 (34.8%) of them have been followed up for over 21 months, median follow-up time was 18.5 months. By the cut-off date of March 1, 2023, all patients were alive and with no radiographic recurrence, including 3 (4.3%) with exon 20ins. During therapy, 26 (37.7%) patients had treatment-related adverse events (TRAEs) of any grade. The most common TRAEs were rash (12/69, 17.4%), mouth ulcer (6/69, 8.7%), diarrhea (5/69, 7.2%) and transaminase elevation (4/69, 5.8%). Only 2 (2.9%) patients had TRAEs of grade 3 or higher and 1(1.4%) of the two discontinued therapy. Conclusions: This is the first study to demonstrate that furmonertinib has good efficacy and a tolerable safety profile as adjuvant therapy in EGFR-mutated NSCLC patients with high-risk pathological factors who underwent radical lung cancer surgery.[Table: see text]

Efficacy of Using Maryland Forceps Versus Electrocoagulation Hooks in RATS Lung Cancer Surgery: A Propensity Score-Matched Study.

Here we compare the difference in recent outcomes between the use of Maryland forceps (MF) and electrocoagulation hooks (EH) in robotic-assisted thoracoscopic radical lung cancer resection. We retrospectively analyze the clinical data of 247 patients with lung cancer who underwent robotic-assisted thoracoscopic surgery from February 2018 to December 2022. On the basis of the intraoperative use of energy devices, we divided the clinical data into two groups, including 84 cases in the MF group and 163 cases in the EH group, respectively. The patients in the two groups were matched with propensity score matching analysis, and further, the perioperative clinical data of the two groups were compared. Compared with the EH group, patients in the MF group had shorter operative time, lesser intraoperative bleeding, shorter postoperative drainage time, and shorter postoperative hospital stay (P < 0.05). By comparing the intraoperative and postoperative complications in the two groups, it was found that the incidence of intraoperative lymph node fragmentation, the incidence of postoperative celiac disease, and the incidence of postoperative food choking were significantly lower in the MF group than that in the EH group. The increase of CRP, IL-6, IL-8, and TNF-α levels in the MF group was less than that in the EH group. The use of MF in robotic-assisted thoracoscopic radical lung cancer surgery is safe and effective, with advantages in lymph node dissection, reduced surgical trauma, and fewer postoperative complications.

Preoperative Frailty Assessment Predicts Postoperative Mortality, Delirium and Pneumonia in Elderly Lung Cancer Patients: A Retrospective Cohort Study.

The purpose of this study was to investigate the predictive value of the 5-factor modified frailty index (mFI-5) for postoperative mortality, delirium and pneumonia in patients over 65 years of age undergoing elective lung cancer surgery. Data were collected from a single-center retrospective cohort study conducted in a general tertiary hospital from January 2017 to August 2019. In total, the study included 1372 elderly patients aged over 65 who underwent elective lung cancer surgery. They were divided into frail group (mFI-5, 2-5), prefrail group (mFI-5, 1) and robust group (mFI-5, 0) on the basis of mFI-5 classification. The primary outcome was postoperative 1-year all-cause mortality. Secondary outcomes were postoperative pneumonia and postoperative delirium. Frailty group had the highest incidence of postoperative delirium (frailty 31.2% versus prefrailty 1.6% versus robust 1.5%, p < 0.001), postoperative pneumonia (frailty 23.5% versus prefrailty 7.2% versus robust 7.7%, p < 0.001), and postoperative 1-year mortality (frailty 7.0% versus prefrailty 2.2% versus robust 1.9%. p < 0.001). Frail patients have significantly longer length of hospitalization than those in the robust group and prefrail patients (p < 0.001). Multivariate analysis showed a clear link between frailty and increased risk of postoperative delirium (aOR 2.775, 95% CI 1.776-5.417, p < 0.001), postoperative pneumonia (aOR 3.291, 95% CI 2.169-4.993, p < 0.001) and postoperative 1-year mortality (aOR 3.364, 95% CI, 1.516-7.464, p = 0.003). mFI-5 has potential clinical utility in predicting postoperative death, delirium and pneumonia incidence in elderly patients undergoing radical lung cancer surgery. Frailty screening of patients (mFI-5) may provide benefits in risk stratification, targeted intervention efforts, and assist physicians in clinical decision-making.

Association between Mortality and Lung Low Attenuation Areas in NSCLC Treated by Surgery.

to test the association with overall survival (OS) of low attenuation areas (LAAs) quantified by staging computed tomography (CT) of patients who underwent radical surgery for nonsmall-cell lung cancer (NSCLC). patients who underwent radical surgery for NSCLC at our institution between 1 January 2017 and 30 November 2021 were retrospectively evaluated. Patients who performed staging or follow-up CTs in other institutions, who received lung radiotherapy or chemotherapy, and who underwent previous lung surgery were excluded. At staging and 12-months follow-up CT, LAAs defined as voxels <-950 Hounsfield units, were extracted by software. The percent of LAAs relative to whole-lung volume (%LAAs) and the ratio between LAAs in the lobe to resect and whole-lung LAAs (%LAAs lobe ratio) were calculated. Cox proportional hazards regression analysis was used to test the association between OS and LAAs. the final sample included 75 patients (median age 70 years, IQR 63-75 years; females 29/75, 39%). It identified a significant association with OS for pathological stage III (HR, 6.50; 95%CI, 1.11-37.92; p = 0.038), staging CT %LAAs ≥ 5% (HR, 7.27; 95%CI, 1.60-32.96; p = 0.010), and staging CT %LAA lobe ratio > 10% (HR, 0.24; 95%CI 0.05-0.94; p = 0.046). in patients with NSCLC who underwent radical surgery, a %LAAs ≥ 5% and a %LAA lobe ratio > 10% at staging CT are predictors, respectively, of shorter and longer OS. The LAA ratio to the whole lung at staging CT could be a critical factor to predict the overall survival of the NSCLC patients treated by surgery.

The value of lung ultrasound score in assessing pulmonary complications after radical lung cancer surgery and analysis of its risk factors.

The value of lung ultrasound score in assessing pulmonary complications after radical lung cancer surgery and analysis of its risk factors.

299P Furmonertinib as adjuvant therapy in EGFR-mutated non-small cell lung cancer following radical lung cancer surgery

Furmonertinib (AST2818) is a novel promising third-generation EGFR tyrosine kinase inhibitor (TKI) that targets both EGFR sensitive mutations and T790M mutation. Furmonertinib has shown encouraging efficacy and good tolerability in advanced Non–Small-Cell Lung Cancer (NSCLC) in previous clinical trials, especially in patients with CNS metastasis. Here, we investigated the efficacy and safety of furmonertinib as adjuvant therapy in postoperative EGFR-mutated NSCLC patients.

ANALYSIS OF POSTOPERATIVE COMPLICATIONS IN THE TREATMENT OF PATIENTS WITH LUNG CANCER

Summary. The aim of the study. Based on the analysis of the nature and course of postoperative complications in the treatment of patients with lung cancer, to improve the results of surgical treatment of this category of patients.&#x0D; Materials and methods. The results of the analysis of postoperative complications of 363 patients with lung cancer who were treated in the oncological department of the thoracic cavity of the clinic of the Communal Non-Commercial Enterprise «Regional Center of Oncology» in Kharkiv for the period from 2017 to 2021 are presented. There were 234 men (64.6 %) , women - 128 (35.4 %), the age of patients ranged from 43 to 84 years, the average age was (59.8±2.4 years). All patients underwent radical surgery for primary lung cancer. Lobectomies were performed most often. In this volume, 296 patients were operated on, which was 81.5 %. Pneumonectomy was performed on 51 patients, which was 14.1 %. Anatomical segmentectomy was performed in 16 patients (4.4 %). Postoperative complications and factors causing them were analyzed.&#x0D; Research results and their discussion. The main complications typical for the postoperative period of lung cancer patients are highlighted. Complications in the postoperative period occurred in 10.5 % of patients. Complications related to failure of bronchus stump sutures and tracheobronchial tree anastomoses occurred in 8 patients (2.2 %). In two patients, this led to the development of pleural empyema and death.Thanks to early diagnosis, 4 patients underwent rethoracotomy, bronchus stump suturing, resection or final pneumonectomy.&#x0D; Cardiovascular complications (acute myocardial infarction, acute cardiovascular failure, stroke, pulmonary embolism) were found in 5 patients (1.4 %). 3 patients died of stroke, acute myocardial infarction and acute cardiovascular failure. Two patients survived, and one of them was diagnosed with Pulmonary embolism (PE), COVID-19 and bilateral pneumonia.&#x0D; Postoperative mortality was 2.5 % (9 patients died). Two patients (0.6 %) died from failure of the bronchus stump sutures, which led to empyema of the pleura. Two patients (0.6 %) died from the consequences of intrapleural bleeding. Another 2 (0.6 %) patients died of acute myocardial infarction. One patient each (0.3 %) died of stroke, postoperative pneumonia, and pericux abscess, which led to empyema of the pleura.&#x0D; Conclusions. The surgical method of treating patients with lung cancer remains the main one despite the number of postoperative complications, the majority of which are «non-surgical». Analysis of the nature and course of postoperative complications in the treatment of patients with lung cancer, and the improvement of the method of determining functional operability, made it possible to reduce the frequency of complications and form a concept for improving the results of surgical treatment of this category of patients.

Evaluation of pulmonary artery bleeding during thoracoscopic pulmonary resection for lung cancer.

Bleeding from the pulmonary artery (PA) can be fatal in video-assisted thoracoscopic surgery (VATS) for lung cancer. We evaluated intraoperative PA injury and assessed precautions for thoracoscopic anatomic pulmonary resection. We retrospectively analyzed a total of 1098 patients who underwent radical surgery for lung cancer utilizing complete VATS from January 2010 to December 2021. A total of 16 patients (1.5%) had PA injury during VATS, while hemostasis was performed by conversion to thoracotomy in eight patients (50.0%). Although there was a significantly greater operation time and blood loss for patients in the PA injury group (318.4 vs. 264.9min, p= 0.001; 550.3 vs. 60.5g, p≤ 0.001, respectively), there was no significant different for the chest tube insertion duration and length of postoperative hospital stay (4.9 vs. 7.8 days, p= 0.157; 10.6 vs. 9.9 days, p= 0.136, respectively). There was a significant difference observed for the surgical procedure related to the left upper lobectomy in the PA injury group (43.8 vs. 18.8%, p= 0.012), with the primary causative PA determined to be the left anterior segmental PA (A3 ) (31.3%). VATS is both feasible and safe for lung cancer treatment provided the surgeon performs appropriate hemostasis, although fatal vascular injury could potentially occur during VATS. Surgeons need to be aware of the pitfalls regarding PA dissection management.

Effects of Thoracic Paravertebral Block on Postoperative Anxiety and Depression for Patients Undergoing Thoracoscopic Lung Cancer Radical Surgery.

This study is aimed at investigating the effect of thoracic paravertebral block (TPVB) on the occurrence of chronic postoperative pain, postoperative anxiety, and depression in patients undergoing thoracoscopic radical lung cancer surgery. A total of 120 patients who underwent thoracoscopic radical lung cancer surgery in our hospital from June 2019 to March 2021 were included. There were 62 males and 58 females, with an age of 18-75 years old and a body mass index of 20-28 kg/m2. Patients were divided into two groups using the random number table method, TPVB group (n = 60) and normal saline group (control group, n = 60). Two-point nerve block was performed at T5-6 and T6-7 levels. Patients in the TPVB group received nerve block with 15 mL of 0.375% ropivacaine hydrochloride, while those in the control group received 5 mL of 0.9% normal saline. The numeric rating scale (NRS) scores at rest and during movement at 24 and 48 hours after surgery and the number of times the button on the patient-controlled analgesia pressed at 24 h after surgery in two groups were recorded. All patients were followed up by outpatient visits or phone visits at 1 year after surgery and assessed using Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale and Hospital Anxiety and Depression Scale (HADS). According to the inclusion, exclusion, and drop-out criteria, 108 patients were finally included, with 52 patients in the TPVB group and 56 patients in the control group. There was no statistically significant difference between the two groups in terms of age, sex, height, body weight, body mass index, ASA classification, and operation time (P > 0.05). NRS pain scores at 24 h (P = 0.0108) and 48 h (P = 0.0000) after surgery, the number of times pressing patient-controlled analgesia at 24 h after surgery (P = 0.0000), the LANSS scores (P = 0.0000), HADS anxiety score (P = 0.0000), and depression scores (P = 0.0000) at 1 year after surgery in the TPVB group were both significantly lower than those in the control group. To sum up, ultrasound-guided TPVB can effectively relieve pain at 48 hours after thoracoscopic lung cancer radical surgery and chronic postoperative pain at 6 months after V thoracoscopic lung cancer radical surgery.

Reliability of dynamic perfusion digital radiography as an alternative to pulmonary perfusion scintigraphy in predicting postoperative lung function and complications.

BackgroundAccurate perioperative risk assessment can enhance the perioperative management of patients undergoing radical surgery for lung cancer. In this study, we compared the accuracy of predicting perioperative complications by lung function values, estimated by blood flow ratios (BFRs), to determine whether dynamic perfusion digital radiography (DPDR) could substitute for pulmonary perfusion scintigraphy (PPS).MethodsPatients scheduled for radical surgery for lung cancer who underwent simultaneous dynamic chest radiography (DCR) and lung perfusion scintigraphy were assessed. We confirmed the agreement between two methods in the assessment of the BFR and its predicted postoperative (ppo) value. Besides, the best spirometry thresholds for the risk of perioperative respiratory or cardiovascular complications were calculated from a receiver operating characteristic (ROC) analysis. The imaging methods were compared for sensitivity and specificity.ResultsAmong the 44 cases enrolled, DPDR and PPS showed high correlations in BFR (r=0.868, P<0.01) and its postoperative value (r=0.975, P<0.01) and between the predicted and measured spirometry values. In both imaging modalities, the estimated postoperative diffusing capacity test for carbon monoxide (DLco) had the best prediction [area under the curve (AUC) >0.7] for respiratory complications within 1 month (with different cut-offs for same target cases). For predicting, respiratory complications within 1–3 months after surgery, these values were similar between two modalities. Furthermore, the ppoDLco values from both imaging methods were excellent indicators of the induction of postoperative long term oxygen therapy, with the AUC greater than 0.8.ConclusionsThis study showed that simple and less invasive DPDR can be a good alternative to PPS for predicting postoperative pulmonary function values and the risk of postoperative respiratory complications. This new imaging modality will offer new insights and possible functional analyses of pulmonary circulation.

948TiP Efficacy and safety of almonertinib in the adjuvant treatment of resectable stage I non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR)-sensitizing mutations in solid and/or micropapillary components

Pathological subtypes are prognostic indicators independent of TNM stage, and patients with micropapillary and solid components have poorer prognosis. Previous studies have found that the presence of a micropapillary component was significantly associated with worse recurrence-free survival in patients with stage I lung adenocarcinoma, even the components are less than 5%, and postoperative adjuvant chemotherapy can still bring benefit to those patients even with stage IA. Third-generation EGFR-TKI have recently shown striking benefit for postoperative adjuvant therapy in patients with EGFR-mutated NSCLC. At present, there is no systematic study on the efficacy and safety of third-generation EGFR-TKI in stage I NSCLC patients with high-risk recurrence factors, such as solid and micropapillarycomponents. The third-generation EGFR-TKI, aumolertinib(HS-10296), showed promising efficacy in advanced NSCLC patients with sensitive EGFR mutation. This is the first study to explore the efficacy and safety of aumolertinib as adjuvant therapy in patients with EGFR mutant stage I NSCLC with solid and/or micropapillary component. Approximately 52 stage I EGFR-mutated NSCLC patients with solid and/or micropapillary components ≥10% will be enrolled in this multicenter single-arm study. After radical lung cancer surgery, they will receive oral almonertinib 110 mg/d as adjuvant therapy for 3 years. The primary endpoint is 2-year disease free survival (DFS) rates, and secondary endpoints included the 3-, 4-, and 5-year DFS rates, 5-year overall survival rates, safety and quality of life, Circulating tumor DNA will also be monitored during the study. Recruitment of this study is ongoing, and the first patient had been enrolled in January 2022. The author.

Short-Term Surgical Outcomes for Lobectomy Between Robot-Assisted Thoracic Surgery and Uniportal Video-Assisted Thoracoscopic Surgery.

ObjectivesTo evaluate the short-term outcomes of uniportal video–assisted thoracoscopic surgery (UVATS) and Da Vinci robot–assisted thoracoscopic surgery (RATS) in lobectomy and lymph node (LN) dissection.MethodsThe two groups of patients with primary non-small cell lung cancer (NSCLC; RATS group, UVATS group) were matched by the propensity score to compare LN dissection and recent clinical outcomes. The results were analyzed by univariate analysis. From November 2020 to November 2021, 412 NSCLC patients (54 RATS and 358 UVATS) from a single institution of the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. Age, sex, lung lobe, surgical resection scope, solid nodules, and core tumor ratios were matched according to different surgical methods.ResultsFrom November 2020 to November 2021, 412 patients with NSCLC (54 RATS, 358 UVATS) from the Provincial Hospital affiliated with Shandong First Medical University were included in the analysis. According to our matching results, LN dissection was more thorough in the RATS group.ConclusionRATS has potential advantages over UVATS in radical lung cancer surgery.

Application of Da Vinci Robot and Thoracoscopy in Radical Lung Cancer Surgery.

In this article, we have explored the feasibility and safety of Da Vinci's robotic surgery system in the radical resection of lung cancer. For this purpose, 73 cases of patients with lung cancer who underwent radical resection in the thoracic surgery of our hospital, particularly from July to September 2020, were collected, of which 22 cases operated with the Da Vinci robot were the Da Vinci robot group, including 11 men and 11 women. The 51 patients who underwent thoracoscopic surgery were in the thoracoscopic group, including 24 males and 27 females. All 22 patients in the Da Vinci robot group completed the operation under the Da Vinci robot operation system without conversion to thoracotomy. In the thoracoscopic group, 49 patients successfully completed the operation under thoracoscopy, and 2 patients were converted to thoracotomy. There was a significant difference between the two groups in the average operation time and the number of lymph nodes, but there was no significant difference in the amount of intraoperative bleeding and postoperative hospital stay. Compared with thoracoscopic radical lung cancer surgery, Da Vinci's robotic surgery system is equally safe and effective, and more lymph nodes are cleaned during surgery.