Radical Surgery For Lung Cancer Research Articles

Improved tolerance of radical lung surgery after contralateral diaphragmatic elevation correction in lung cancer patients: a stepwise approach

We report on a 69 years old man with an incidental finding of a suspicious mass in the left upper lobe, detected during treatment of a severe pneumonia. This patient had a known right sided idiopathic diaphragm paralysis and suffered from severe breathlessness. He was treated for endogenous depression and psychosis. Diaphragm plication was successfully performed 4 weeks before contralateral upper sleeve lobectomy in a difficult patient with comorbidities. This case illustrates a stepwise approach in restoration of adequate lung function before radical lung cancer surgery of the nonaffected side.

Effects of different doses of cisatracurium besilate on hemodynamics and postoperative cognitive function in patients undergoing radical resection of lung cancer.

The effects of different doses of cisatracurium besilate on perioperative hemodynamics and early postoperative cognitive function in patients undergoing radical resection of lung cancer were investigated. One hundred and thirty-six patients who underwent radical resection of lung cancer from June 2013 to June 2016 in Dongying People's Hospital were retrospectively analyzed. Patients who were not given atracurium were selected as the control group (n=35). According to the different anesthetic doses, patients in the experimental group were separated into low dose (0.15 mg/kg cisatracurium besilate) group (LD group, n=34), medium dose (0.2 mg/kg cisatracurium besilate) group (MD group, n=36) and high dose (0.3 mg/kg cisatracurium besilate) group (HD group, n=31). The mean arterial pressure and heart rate (HR) were recorded before induction of anesthesia (T0), at the time of entering pleural cavity (T1), at the end of surgery (T2), and 1 day after surgery (T3). The Mini-Mental State Examination (MMSE) was used to evaluate the postoperative cognitive function scores of the 4 groups 1 day before operation and on the 1st, 3rd and 7th day after surgery. The agitation of patients at 6 and 12 h after operation was evaluated by Ramsay sedation score. There was no significant difference in arterial pressure among the four groups at T2 and T3 (P>0.05). There was no significant difference in terms of MMSE among the four groups 1 day before operation, 3 days after operation and 7 days after operation, but the MMSE score of the control group was significantly lower than that of the LD, MD and HD groups 1 day after surgery (P<0.05). Therefore, cisatracurium besilate can stabilize hemodynamics during radical operation of lung cancer and reduce the incidence of postoperative cognitive dysfunction, and it has no close association with the dose.

Acute exacerbation of interstitial lung disease after radical surgery for lung cancer: a case report

A 69-year-old male patient underwent a left upper lobectomy for lung cancer, showing slight interstitial changes in the lung before surgery. He suffered fever with cough and expectoration postoperatively, and high-resolution computed tomography (HRCT) of the thorax indicated that the interstitial lesion in the lung was aggravated. The course of the disease progressed rapidly, and treatment that included anti-infection and steroid pulse therapy was ineffective. We conducted a retrospective analysis of the clinical data and the process of diagnosis and treatment of this patient with acute exacerbation of interstitial lung disease (AE-ILD) after radical surgery for lung cancer. Patients with ILD should be given very careful consideration when selecting a therapeutic approach because interventions may aggravate AE-ILD, leading to a poor prognosis.

Surgical outcome of pulmonary artery reconstruction using the expanded polytetrafluoroethylene patch in patients with lung cancer.

Pulmonary artery reconstruction is sometimes utilized as an alternative to pneumonectomy in lung cancer surgery. We herein report our experience of pulmonary artery reconstruction using an expanded polytetrafluoroethylene (ePTFE) patch based on the surgical results and long-term outcome. Clinical records of lung cancer patients who underwent patch plasty were reviewed retrospectively. Between 2003 and 2017, pulmonary artery patch plasty were performed in 21 patients [18 males, 3 females; mean age 65 (range 47-79) years]. Induction chemoradiotherapy was performed in three patients. Bronchoplasty was performed in five patients. The pathologic stages were stage I in 3 patients, stage II in 6 and stage III in 12. Pneumonectomy, lobectomy and segmentectomy were performed in 2, 18 and 1 patient, respectively. The left upper lobe was the most frequent origin of lung cancer (15 patients). There was no reconstruction-related morbidity or mortality. The overall survival rate at 5years was 64.1% with a mean follow-up of 39.5months, and the survival rates for N0-1 and N2-3 were 80.8% and 28.6%, respectively. Patch angioplasty using the ePTFE sheet is a reliable procedure in radical surgery for lung cancer.

Competing Risk Analysis in Lung Cancer Patients Over 80Years Old Undergoing Surgery.

This study aimed to analyze cause-specific mortality in lung cancer patients over 80years old undergoing surgery. This retrospective, multi-institutional analysis included patients aged ≥ 80years who underwent radical surgery for primary lung cancer from January 1998 to December 2015. Preoperative clinical data, surgical results, survival, and cause of death were evaluated. Competing risk analysis for cause-specific mortality was performed. Of the 337 patients (median age 82years) enrolled and analyzed, 68.1% were male. There were 52 and 44 cancer-specific and non-cancer-specific deaths, respectively. On competing risk regression analysis, non-cancer-specific deaths were significantly associated with male sex (hazard ratio [HR]: 3.06, 95% confidence interval [CI]: 1.02-9.12, p = 0.046), coronary artery disease (HR: 2.49, 95% CI: 2.49 [1.14-5.47], p = 0.02), interstitial pneumonia (HR: 3.58, 95% CI: 1.73-7.40, p < 0.001), and pathological stage III (HR: 3.83, 95% CI: 1.44-10.13, p = 0.007). In contrast, cancer-specific deaths were significantly associated with limited resection (HR: 1.99, 95% CI: 1.02-3.89, p = 0.04) and pathological stage III (HR: 3.13, 95% CI: 1.44-6.80, p = 0.004). The 5-year cumulative incidences of lung cancer-specific and non-cancer-specific deaths were 18.0% and 15.9%, respectively. Prognostic factors for non-cancer-specific death were different from those of cancer-specific death, except for pathological stage. Each prognostic factor should be considered when deciding surgical indication and procedure and monitoring for pulmonary events during outpatient follow-up.

Effects of OPRM1 and ABCB1 gene polymorphisms on the analgesic effect and dose of sufentanil after thoracoscopic-assisted radical resection of lung cancer.

Objective: To study the effects of single-nucleotide polymorphisms of the OPRM1 and ABCB1 genes on the analgesic effect and consumption of sufentanil after thoracoscopic-assisted radical resection of lung cancer.Methods: A total of 225 Chinese Han nationality patients undergoing thoracoscopic-assisted radical resection of lung cancer were enrolled in the present study. Among them, 132 were males (58.67%) and 93 (41.33%) were females having American Society of Anesthesiologists statuses classified as grades I or II. The rs1799971, rs563649 and rs1323040 genotypes of the OPRM1 gene and rs2032582, rs1045642 and rs1128503 genotypes of the ABCB1 gene were detected by Sanger sequencing. The state anxiety index and pressure pain threshold were assessed preoperatively. Sufentanil was administered intravenously to maintain anesthesia. The doses and side effects of sufentanil consumed 6 h (T1), 24 h (T2) and 48 h (T3) after surgery were recorded.Results: The sufentanil doses at T1, T2 and T3 were significantly higher in radical-operation lung cancer patients with mutant homozygous rs1799971 and rs1323040 loci in the OPRM1 gene and rs2032582 and rs1128503 loci in the ABCB1 gene. The doses of sufentanil consumed by mutant heterozygous lung cancer patients at T1, T2 and T3 were significantly higher than those consumed by patients without mutations, and the differences were statistically significant (P<0.05). There was no significant difference in sufentanil doses consumed by lung cancer patients with mutant homozygous, mutant heterozygous and wild-type rs563649 locus of the OPRM1 gene and rs1045642 locus of the ABCB1 gene at T1, T2 and T3 (P>0.05). There was no significant difference in the visual analog scale scores at T1, T2 and T3 for different genotypes of OPRM1 and ABCB1 genes in lung cancer patients (P>0.05). No significant difference was found between the adverse reactions of OPRM1 and ABCB1 genotypes in patients undergoing radical resection of lung cancer (P>0.05).Conclusion: The rs1799971 and rs1323040 polymorphisms of the OPRM1 gene and rs2032582 and rs1128503 polymorphisms of the ABCB1 gene are related to the analgesic effect and consumed dose of sufentanil in Chinese Han patients undergoing radical operation of lung cancer.

Sevoflurane Effect on Cognitive Function and the Expression of Oxidative Stress Response Proteins in Elderly Patients undergoing Radical Surgery for Lung Cancer

To investigate the effects of sustained inhalation of sevoflurane on cognitive function and the expression of oxidative stress response proteins such as NADPH oxidase subunits NOX2 and NOX4 in elderly patients undergoing radical surgery for lung cancer. An experimental study. Department of Anesthesiology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, China, from February 2016 to October 2017. Elderly patients who underwent radical surgery for lung cancer were divided into the sevoflurane group and the propofol group, with 52 cases in each group. Sustained inhalation of sevoflurane and propofol was administered to maintain anesthesia in the respective groups. Cognitive function and lung function parameters were compared between the two groups. Serum S100 &beta; levels and expression of NOX2 and NOX4 proteins in peripheral blood mononuclear cells of the two groups were determined. At 24 hours after surgery, the lung function indices of the sevoflurane group such as FEV1, FVC and VC were higher than those of the propofol group (p<0.001, p=0.008 and p=0.002, respectively). At the end of the surgery and at 24 hours after surgery, the MMSE scores of the sevoflurane group were higher than the propofol group (all p<0.001). S100 levels were lower than the propofol group (p=0.003 and p<0.001, respectively). Levels of NADPH oxidase subunits NOX2 and NOX4 proteins in peripheral blood mononuclear cells of the sevoflurane group were lower than the propofol group (p=0.033, p<0.001, p<0.001and p<0.001, respectively). Compared with intravenous anesthesia with propofol, general anesthesia with sevoflurane inhalation has little effect on the short-term cognitive function in elderly patients undergoing radical surgery for lung cancer, and can effectively improve lung function. The mechanism may be related to the reduction of the expression of NOX2 and NOX4 proteins.

Effect of preoperative smoking cessation on postoperative pain outcomes in elderly patients with high nicotine dependence.

Objective:To investigate the effect of smoking cessation before surgery on postoperative pain and analgesic consumption after thoracoscopic radical resection of lung cancer in elderly patients with high nicotine dependence.Methods:A total of 107 male patients, ages 60 to 70 years, undergoing elective thoracoscopic radical lung cancer surgery from July 2017 to July 2018 were enrolled into 3 groups: group A (highly nicotine-dependent and discontinued smoking <3 weeks before surgery, n = 36), group B (highly nicotine-dependent and discontinued smoking >3 weeks before surgery, n = 38), and group C (nonsmokers, n = 33). Postoperative sufentanil consumption, visual analog scale (VAS) pain scores at rest and during cough, rescue analgesia, opioid-related adverse events, and patient satisfaction were assessed from 0 to 48 h postoperatively.Results:Patient characteristics were comparable among the 3 groups. Sufentanil consumption and VAS pain scores from postoperative 0 to 48 h were significantly higher in groups A and B than in group C. In addition, group B had lower sufentanil consumption and pain scores than group A. No differences in the need for rescue analgesia, patient satisfaction, or occurrence of postoperative adverse events, including nausea, vomiting, respiratory depression, and oversedation, were observed among the 3 groups.Conclusion:Compared with nonsmokers, highly nicotine-dependent male patients who were deprived of cigarettes experienced more severe pain and required treatment with more sufentanil after thoracoscopic radical lung cancer surgery. Moreover, preoperative smoking cessation at least 3 weeks before surgery led to better postoperative pain outcomes than smoking cessation within 3 weeks of surgery.

Effect of ulinastatin on postoperative outcomes in elderly patients undergoing thoracoscopic radical operation for lung cancer

Objective To evaluate the effect of ulinastatin on postoperative outcomes in elderly patients undergoing thoracoscopic radical operation for lung cancer. Methods Sixty patients of both sexes, aged 65-80 yr, weighing 40-85 kg, of American Society Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for thoracoscopic radical operation for lung cancer, were divided into 2 groups(n=30 each)using a random number table method: ulinastatin group(group UTI)and normal saline group(group NS). Ulinastatin 0.5×104 U/kg was intravenously infused within 1 h before skin incision in group UTI, while the equal volume of normal saline was given instead in group NS.Central venous blood samples were collected at 30 min before skin incision(T0), 30 min after start of surgery(T1), and 1 h and 1, 3 and 5 days after surgery(T2-5)for determination of the expression of CD42a+ , HLADR+ and CD14+ in monocytes(using the flow cytometry), plasma concentrations of interleukin-6(IL-6), IL-8 and tumor necrosis factor-alpha(TNF-α)(by enzyme-linked immunosorbent assay), and the plasma C-reactive protein(CRP)concentration(by immunoturbidimetry). The ratios of monocyte-platelet adhesion(CD42a+ /CD14+ )and monocyte activation function(HLADR+ /CD14+ )were calculated.Cognitive function was assessed and scored on day 1 before operation and day 7 after operation, and the incidence of postoperative cognitive dysfunction(POCD)was calculated using Z score. Results Compared with group NS, the CD42a+ /CD14+ ratio was significantly decreased at T1-3, the HLADR+ /CD14+ ratio was increased at T3, 4, the concentrations of plasma IL-6, IL-8, TNF-α and CRP were decreased at T1-5, and the incidence of POCD was decreased in group UTI(P<0.05). Compared with the baseline value at T0, the HLADR+ /CD14+ ratio was significantly decreased at T2-4 in group UTI, the HLADR+ /CD14+ ratio was decreased at T2-5, and the CD42a+ /CD14+ ratio was increased at T1, 2 and T4, 5 in group NS, and the concentrations of plasma IL-6, IL-8, TNF-α and CRP were increased at T1-5 in the two groups(P<0.05). Conclusion Ulinastatin can promote postoperative outcomes in the elderly patients undergoing thoracoscopic radical operation for lung cancer. Key words: Trypsin inhibitors; Thoracoscopy; Aged; Prognosis

Multiple Organ Lesions in a Case of Contamination With Multiple Radionuclides After 38 Years.

The patient was contaminated with multiple radionuclides 38 years ago due to an accident. To investigate the effects of radionuclide contamination on humans, he has been followed up by examinations for many years. Long-term effects gradually emerge in these years. Lung cancer was diagnosed by medical examinations. Besides, chronic gastritis with intestinal metaplasia was indicated by gastroscopic biopsies, while colorectal polyps found by colonoscopy. All 13 colorectal polyps were removed, and radical surgery for lung cancer was performed. Fortunately, pathological examinations indicated that it was early lung cancer. The ground glass nodule (GGN) in left lung identified during the follow-up will be resected when needed. It is speculated that multiple manifestations of the patient may be related to radiation, and different lesions in the organs may be related to systemic adaptive response. However, longer follow-up is needed due to a lack of effective and direct evidence. This work is expected to provide experiences for similar patients’ treatment and follow-up.

Observation of the effect and safety assessment of lobaplatin for pleural lavage in the radical operation of NSCLC

Objective To evaluate the clinical efficacy and safety of lobaplatin for pleural lavage in the radical operation of non-small cell lung cancer (NSCLC). Methods A total of 100 patients with NSCLC from June 2015 to December 2015 in Affiliated Hospital of Guilin Medical University were collected, and were divided into experimental group and control group according to the patients′ or family′s wishes for treatment, with 50 cases in each group. The lobectomy and mediastinal lymph node dissection were performed for patients in the two groups. During the operation of the experimental group, we flushed the chest with 42 ℃ distilled water 2 000 ml first, then we washed and steeped the pleura with 500 ml of 5% glucose injection containing 50 mg lobaplatin for 10 min, in the end sucked out the washing fluid. During the operation, patients of the control group only received a treatment of same amount of distilled water. Then, the short- and long-term effects and adverse reaction were tracked and compared. Results The thoracic drainage of the first 3 days after operation in experimental group was (1 150±150) ml, and the control group was (790±110) ml, with a significant difference (t=3.352, P=0.029). The numbers of white blood cell [(12.5±1.2)×109/L vs. (12.8±1.0)×109/L; t=0.333, P=0.756], the platelets [(235.2±52.5)×109/L vs. (236.5±34.5)]×109/L; t=0.036, P=0.973], the creatinine [(74.2±9.1) μmol/L vs. (75.2±8.7) μmol/L; t=0.138, P=0.897], urea nitrogen [(4.8±2.1) mmol/L vs. (5.5±2.4) mmol/L; t=0.391, P=0.716], glutamic-oxalacetic transaminase [(9.6±3.8) U/L vs. (8.2±2.5) U/L; t=0.533, P=0.622] and glutamic-pyruvic transaminase [(22.4±9.2) U/L vs. (21.8±6.4) U/L; t=0.093, P=0.931] showed no significant differences between experimental group and control group. The positive rate of drainage exfoliative cells (4.0% vs. 16.0%) and ipsilateral recurrence rate (0 vs. 30.0%) of experimental group were lower than those of control group, with significant differences (χ2=4.000, P=0.046; χ2=17.647, P<0.001). There was no death in experimental group during the follow-up period, and 2 patients in control group died. The rates of adverse reactions such as incisional pain (16.0% vs. 12.0%), nausea (10.0% vs. 14.0%), vomiting (4.0% vs. 0) and diarrhea (4.0% vs. 0) showed no significant differences between experimental group and control group (χ2=0.332, P=0.564; χ2=0.379, P=0.538; χ2=0.510, P=0.475; χ2=0.510, P=0.475). Conclusion The application of lobaplatin for pleural lavage in the radical operation of lung cancer is safe and effective, which can significantly reduce the rate of ipsilateral recurrence. Key words: Carcinoma, non-small-cell lung; Irrigation; Treatment outcome; Lobaplatin

Effect of epidural block on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia

Objective To evaluate the effect of epidural block on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia. Methods A total of 348 patients with primary non-small cell lung cancer of both sexes, aged 18-80 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, with body mass index of 18-30 kg/m2, with International Association for the Study of Lung Cancer staging criteria stage 1-2, scheduled for elective radical operation for lung cancer under general anesthesia, were divided into 2 groups (n=174 each) using a random number table method: general anesthesia plus patient-controlled intravenous analgesia (PCIA) group (group G) and general anesthesia plus epidural anesthesia plus patient-controlled epidural analgesia group (group GE). Anesthesia was induced by target-controlled infusion of propofol and fentanyl and intravenous injection of rocuronium.The patients were tracheally intubated and mechanically ventilated to maintain the end-tidal pressure of carbon dioxide at 30-40 mmHg.Anesthesia was maintained by target-controlled infusion of propofol and intravenous injection of remifentanil.An increment of fentanyl was given immediately after chest opening and closing, and cisatracurium besylate was injected intravenously.In group GE, 0.375% ropivacaine was epidurally injected in a initial dose of 5-8 ml followed by continuous epidural infusion at 5 ml/h, and infusion was stopped before closing the chest.Bispectral index value was maintained at 40-60 during operation.PCIA was performed at the end of operation with fentanyl, flurbiprofen, ramosetron or palonosetron hydrochloride, and the PCA pump was set up with a 0.5 ml bolus dose, a 15-min lockout interval and background infusion at a rate of 2 ml/h in group G. Patient-controlled epidural analgesia was performed with 0.15%-0.18% ropivacaine 250 ml, and the PCA pump was set up to deliver 2-3 ml bolus dose with a 20-min lockout interval and background infusion at 4-5 ml/h in group GE.Postoperative analgesia was performed until 48 h after operation in both groups.Patients were followed up by telephone at half a year and 1 and 2 yr after operation.The 12-item short-form scale was used to evaluate the quality of life.Physical component summary (PCS-12) and mental component summary (MCS-12) scores were calculated. Results PCS-12 and MCS-12 scores were significantly lower at 2 yr after operation than at half a year in both groups (P<0.05). Compared with group G, PCS-12 and MCS-12 scores were significantly increased at 2 yr after operation in group GE (P<0.05). Conclusion Compared with general anesthesia alone, epidural block provides better effect on postoperative long-term quality of life in patients undergoing radical operation for lung cancer under general anesthesia. Key words: Anesthesia, general; Anesthesia, epidural; Analgesia, patient-controlled; Quality of life

Hoarseness after radical surgery with systematic lymph node dissection for primary lung cancer.

Radical surgery with systematic upper mediastinal node dissection for primary lung cancer can cause recurrent laryngeal nerve (RLN) paralysis, but this is poorly reported. We retrospectively reviewed the clinical data for consecutive patients who underwent radical surgery for primary lung cancer with an observation period of at least 12 months. During follow-up, hoarseness and vocal fold movement were assessed clinically and laryngoscopically, respectively. Of the 365 patients included in this study, 22 (6.0%) experienced hoarseness as a complication. All 22 patients who experienced hoarseness had undergone upper mediastinal node dissection. Although 1 of the 22 patients refused to undergo laryngoscopy, we assessed the vocal fold movement in the remaining patients (95.5%). Among these, 5 patients (23.8%) had right RLN paralysis, and 15 (71.4%) had left RLN paralysis and showed no sign of RLN paralysis. Over 1-24 months, vocal cord movement improved in 61.1% (11/18); and over 1-28 months, hoarseness improved in 72.7% (16/22). All patients with right RLN paralysis improved without further treatment. We conclude that extensive follow-up is necessary to discern whether hoarseness is a temporary or permanent complication of radical surgery in patients with primary lung cancer who have undergone systematic lymph node dissection.

EGFR mutations in early-stage and advanced-stage lung adenocarcinoma: Analysis based on large-scale data from China.

BackgroundEGFR‐tyrosine kinase inhibitors play an important role in the treatment of advanced non‐small cell lung cancer (NSCLC). EGFR mutations in advanced NSCLC occur in approximately 35% of Asian patients and 60% of patients with adenocarcinoma. However, the frequency and type of EGFR mutations in early‐stage lung adenocarcinoma remain unclear.MethodsWe retrospectively collected data on patients diagnosed with lung adenocarcinoma tested for EGFR mutation. Early stage was defined as pathological stage IA–IIIA after radical lung cancer surgery, and advanced stage was defined as clinical stage IIIB without the opportunity for curative treatment or stage IV according to the American Joint Committee on Cancer Staging Manual, 7th edition.ResultsA total of 1699 patients were enrolled in this study from May 2014 to May 2016; 750 were assigned to the early‐stage and 949 to the advanced‐stage group. Baseline characteristics of the two groups were balanced, except that there were more smokers in the advanced‐stage group (P < 0.001). The total EGFR mutation rate in the early‐stage group was similar to that in the advanced‐stage group (53.6% vs. 51.4%, respectively; P = 0.379). There was no significant difference in EGFR mutation type between the two groups. In subgroup analysis of smoking history, there was no difference in EGFR mutation frequency or type between the early‐stage and advanced‐stage groups.ConclusionEarly‐stage and advanced‐stage groups exhibited the same EGFR mutation frequencies and types.

Effect of anesthesia factor on lung injury in patients undergoing thoracoscopic radical lung cancer surgery: combination of thoracic paravertebral block with dexmedetomidine mixed with ropivacaine and general anesthesia

Objective To investigate the effect of anesthesia factor on lung injury in patients undergoing thoracoscopic radical lung cancer surgery and to evaluate efficacy of combination of thoracic paravertebral block(TPVB) with dexmedetomidine mixed with ropivacaine and general anesthesia. Methods One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical statusⅡor Ⅲ, scheduled for elective thoracoscopic radical lung cancer surgery, were divided into 5 groups(n=20 each) using a random number table: general anesthesia group(group G), TPVB with ropivacaine combined with general anesthesia group(group R), intravenously infused dexmedetomidine combined with general anesthesia group(group Div), intravenously infused dexmedetomidine plus TPVB with ropivacaine combined with general anesthesia group(group Div+ R), and TPVB with dexmedetomidine mixed with ropivacaine combined with general anesthesia group(group Dtp+ R). In group R, TPVB was performed under ultrasound guidance, two-point method was selected according to the position of intercostal space at surgical incision, and 0.5% ropivacaine 10 ml was injected into each puncture site.Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 min in group Div.Dexmedetomidine was intravenously infused for TPVB in group Div+ R.TPVB solution contained dexmedetomidine 0.5 μg/kg and ropivacaine in group Dtp+ R.Anesthesia was then induced and maintained by IV infusion of propofol and remifentanil.The intraoperative consumption of propofol and remifentanil and development of adverse reactions such as hypoxemia, hypotension and bradycardia were recorded.Normal lung tissues around the tumor margin were obtained immediately after tumor resection for determination of the expression of hypoxia-inducible factor 1 alpha(HIF-1α), BCL2/adenovirus E1B 19kDa interacting protein 3(BNIP3) and microtubule-associated protein 1 light chain 3 Ⅱ(LC3 Ⅱ)(by Western blot), contents of tumor necrosis factor-alpha(TNF-α) and interleukin-6(IL-6) in lung tissues(by enzyme-linked immunosorbent assay) and cell apoptosis(by TUNEL) and for examination of the pathological changes(with a light microscope) which were scored.Apoptosis index was calculated. Results The amount of propofol consumed was significantly lower in Div+ R and Dtp+ R groups than in the other three groups, and the amount of remifentanil consumed was significantly higher in G and Div groups than in the other three groups(P<0.05). The incidence of hypertension and tachycardia was significantly lower in R and Div groups than in group G(P<0.05). The incidence of hypotension was significantly lower in R, Div and Dtp+ R groups than in group Div+ R(P<0.05). The incidence of bradycardia was significantly higher in Div and Div+ R groups than in group R(P<0.05). Compared with G and R groups, apoptosis index, contents of TNF-α and IL-6 and lung injury scores were significantly decreased, and the expression of HIF-1α, BNIP3 and LC3Ⅱ was up-regulated in Div, Div+ R and Dtp+ R groups(P<0.05). Compared with group Div, the TNF-α content and lung injury scores were significantly decreased, and the expression of HIF-1α and LC3Ⅱ was up-regulated in Div+ R and Dtp+ R groups, and the IL-6 content was significantly decreased in group Dtp+ R(P<0.05). Conclusion Combination of TPVB with dexmedetomidine mixed with ropivacaine and general anesthesia produces better efficacy in reducing lung injury in patients undergoing thoracoscopic radical lung cancer surgery. Key words: Dexmedetomidine; Amides; Nerve block; Anesthesia, general; Lung neoplasms

The application of preoperative neoadjuvant chemotherapy in patients with stage IIIA non-small cell lung cancer

Objective To analyze the clinical efficacy of neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer (NSCLC). Methods From March 2008 to October 2015, there were 92 cases of stage ⅢA NSCLC patients received 2 cycles of neoadjuvant chemotherapy and underwent radical surgery for lung cancer 3-4 weeks late (observation group), and another group of 65 cases of stage ⅢA NSCLC patients (control group) underwent surgery for lung cancer without preoperative chemotherapy. The clinical data as well as early and meddle term surgical outcome of both groups were analyzed retrospectively. Results The neoadjuvant chemotherapy effective rate was 73.9% in the observation group. All surgeries for lung cancer patients were undertaken either with video-assisted thoracotomy or traditional thoracotomy. No operative mortality and the postoperative pathology findings were in accordance with NSCLC. The bleeding amount and operation time of two groups were similar; the resection rate of the observation group was greater than that of the control group. All patients were followed up at least 3 years, and the 2 years and 3 years survival rate of the observation group was slightly higher than that of the control group. Conclusions Preoperative neoadjuvant chemotherapy in patients with NSCLC can improve the resection rate and prolong the survival time, which is worthy of clinical application. Key words: Chemotherapy, adjuvant; Carcinoma, non-small-cell lung/TH

Tumor-stroma ratio (TSR) in non-small cell lung cancer (NSCLC) patients after lung resection is a prognostic factor for survival.

In recent years, the tumor-stroma ratio (TSR) has been considered to a new and independent predictive variable for the prognosis of some kinds of neoplasms. The objective of this study was to assess the prognostic significance of the TSR in non-small cell lung cancer (NSCLC). A cohort of 261 NSCLC patients who underwent radical surgery of lung cancer were included in the present study. Two independent observers visually estimated the TSR on hematoxylin-eosin (H&E) stained tissue pathological slices. According to the proportion of stroma ≥50% or <50%, We separate the patients into two groups: those with stroma-poor and those with stroma-rich tumors. Both univariate and multivariate analyses disclosed that the TSR was associated with overall survival (OS) [hazard ratio (HR), 1.741; 95% confidence intervals (CI), 1.040-2.913 and HR, 1.904; 95% CI, 1.132-3.202, respectively]. The HR values for disease-free survival (DFS) were 1.795 (95% CI, 1.073-3.005) and 2.034 (95% CI, 1.210-3.420). The OS and DFS of patients with stroma-poor tumors were better than those with stroma-rich tumors. These results demonstrated that the TSR is a new prognostic factor for NSCLC. Stroma-poor tumors were associated with longer disease-free period and better prognosis than were stroma-rich tumors in NSCLC patients. The TSR may contribute to the development of individualized treatment for NSCLC in the future.

Effect of sevoflurane preconditioning on autophagy in operated lung tissues of patients undergoing one-lung ventilation

Objective To evaluate the effect of sevoflurane preconditioning on autophagy in the operated lung tissues of the patients undergoing one-lung ventilation. Methods Forty patients of both sexes, with American Society of Anesthesiologists physical status Ⅰ-Ⅲ, aged 30-80 yr, weighing 45-84 kg, scheduled for elective radical operation for lung cancer performed via video-assisted thoracoscope under general anesthesia, were divided into control group(C group)and sevoflurane preconditioning group(SP group), with 20 patients in each group.In SP group, sevoflurane was inhaled for 30 min with the final concentration of 2.0%, followed by washout.The normal lung tissues(the distance from the edge of the lump>2 cm)around the lump were obtained for detection of the expression of microtubule-associated protein 1 light chain 3 Ⅱ by Western blot. Results Compared with C group, the expression of microtubule-associated protein 1 light chain 3 Ⅱ in lung tissues was significantly up-regulated in SP group(P<0.05). Conclusion Sevoflurane preconditioning can enhance autophagy in the operated lung tissues of the patients undergoing one-lung ventilation, which may be related to the lung protective effect. Key words: Anesthetics, inhalation; Ischemic preconditioning; Autophagy; Respiration, artificial; Respiratory distress syndrome, adult

P3.04-047 The Incidence and Outcome of Hoarseness after Systematic Upper Mediastinal Nodal Dissection by Radical Surgery for Primary Lung Cancer: Topic: Miscellaneous II

Recurrent laryngeal nerve (RLN) paralysis can occur following systematic upper mediastinal nodal dissection by radical surgery for primary lung cancer. However, there have been very few reports. We retrospectively reviewed the clinical data of 365 consecutive patients who underwent radical surgery for primary lung cancer with an over 6-month observation period in our institution from July 2010 to August 2015. There were 22 cases that experienced hoarseness after lung cancer surgery (6.0%). We could identify the movement of the vocal folds with a laryngoscope in 21 out of 22 cases (95.5%), because one patient refused to have the examination. Categorical variables were analyzed with Fisher’s exact test and continuous variables with the student’s-t test. P < 0.05 was considered statistically significant for all tests. Hoarseness subsequent to radical surgery for primary lung cancer arose in 16 out of 308 (5.2%) cases of video-assisted thoracic surgery (VATS) including robotic VATS, in contrast with six out of 88 cases (6.8%) of open thoracotomy. All patients who experienced hoarseness had received upper mediastinal nodal dissection. Patients who had received right upper nodal dissection experienced hoarseness in eight out of 150 cases (5.3%), in contrast to 14 out of 84 cases (16.3%, P = 0.020) for left upper lymph node dissection. Laryngoscopic examination revealed that five patients (23.8%) were diagnosed with right RLN paralysis and 15 (71.4%) as left. One patient who underwent VATS right upper lobectomy with upper mediastinal and subcarinal nodal dissection had left RLN paralysis. There was a patient (4.8%) who did not suffer from RLN paralysis, and one patient refused to undergo the examination. Eleven out of 18 patients (61.1%) were identified to improve the diagnosis of disorders of the vocal cords with the laryngoscope. It took one to 24 months (average 6.5 months) to improve the movement of the vocal cords observed with the laryngoscope. In addition, fourteen out of 19 cases (73.7%) were recognized for the improvement of their hoarseness. It took one to 28 months (average 10.4 months) to improve the voice disorder after surgery. In our cohort, 8.4% of patients who underwent systematic upper mediastinal lymph node dissection had hoarseness as a subjective symptom. However, 73.7% of patients who suffered from hoarseness and 62.5% of patients who were identified as having disorders of the vocal cords improved in more than two years.

Preoperative platelet to lymphocyte and neutrophil to lymphocyte ratios are independent prognostic factors for patients undergoing lung cancer radical surgery: A single institutional cohort study.

BackgroundThe aim of this study was to assess the prognostic value for NSCLC patients who were scheduled to receive lung cancer radical resection.MethodsIn this cohort study (Dec.2014-Feb.2016), patients with non-small cell lung cancer (NSCLC) who underwent radical lung cancer thoracotomy were enrolled and accessed at postoperative complications, one-year overall survival (OS) and relapse-free survival (RFS). The preoperative PLR and NLR of all patients were calculated based on preoperative complete blood counts. Univariate and multivariate Cox regression analyses were performed to determine the associations of PLR and NLR with OS and RFS.ResultsA total of 174 NSCLC patients were studied. The results indicated that both high PLR (>148.6) and NLR (>2.9) were related to a high rate of postoperative pulmonary complications significantly (49.3%vs.29.1%, P = 0.007; 50.7% vs. 28.6%, P = 0.003). Moreover, NSCLC patients with a high PLR level (> 148.6) was significantly associated with a lower one-year OS (90.3% vs. 77.5%, P = 0.034).ConclusionsPreoperative PLR and NLR were good prognostic factors for postoperative pulmonary complications and OS in NSCLC patients undergoing radical lung cancer surgery. Thus, blood PLR and NLR would be helpful as a prognostic tool before radical lung cancer surgery.