Shanghai Chest Hospital Research Articles

Multivariate analysis of medical adhesive-related skin injury in peripherally inserted central catheter implanted patients with lung cancer

Objective To analyze prevalence and determinants of medical adhesive-related skin injury (MARSI) in peripherally inserted central catheter implanted patients with lung cancer, to create evidence for improved clinical care. Methods A cross-sectional observational study design was adopted. Skin pictures and electronic medical records of 200 lung cancer patients who visited Shanghai Chest Hospital for PICC between June 2017 and September 2017 were analyzed to calculate prevalence of MARSI and identify related factors. Results The prevalence of MARSI was 31.5% (63/200), and mechanical trauma accounted for 50.8% of all cases (32/63). Age, diabetes and anaphylaxis were significantly related to MARSI. Conclusion Analysis of MARSI in PICC implanted patients with lung cancer provided evidence for improved clinical care of such patients. Key words: Peripherally inserted central catheter; Medical adhesive-related; Skin injury

Development and Validation of Web-Based Nomograms to Precisely Predict Conditional Risk of Site-Specific Recurrence for Patients With Completely Resected Non-small Cell Lung Cancer: A Multiinstitutional Study

There is currently no consensus regarding the optimal postoperative follow-up strategy for patients with completely resected non-small cell lung cancer (NSCLC). We aimed to develop web-based nomograms to precisely predict site-specific postoperative recurrence in patients with NSCLC and to guide individual surveillance strategies including when to follow up and what diagnostic tests to perform. We investigated the pattern of recurrence in a series of 2,017 patients with NSCLC (squamous cell carcinoma and nonlepidic invasive adenocarcinoma) who underwent complete surgical resection at Fudan University Shanghai Cancer Center (development cohort), and developed web-based clinicopathologic prediction models for conditional risk of site-specific recurrence based on Cox regression. The variables used in the analysis included sex, age, smoking history, tumor size, tumor histology, lymphovascular invasion, visceral pleural invasion, and pathologic TNM stage. A separate cohort of 3,308 patients with NSCLC from Shanghai Chest Hospital was used for external validation. In the development cohort and the external validation cohort for the established nomograms to predict overall recurrence, thorax recurrence, abdomen recurrence, neck recurrence, brain recurrence, and bone recurrence, the C-statistics of Harrell etal were 0.743 and 0.748, 0.728 and 0.703, 0.760 and 0.749, 0.779 and 0.757, 0.787 and 0.784, and 0.777 and 0.739, respectively. The calibration plots showed optimal agreement between nomogram-predicted 3-year recurrence-free survival and actual 3-year recurrence-free survival. These user-friendly nomograms can precisely predict site-specific recurrence in patients with completely resected NSCLC, based on clinicopathologic features. They may help physicians to make individual postoperative follow-up plans.

Continuous 389 cases of Da Vinci robot-assisted thoracoscopic lobectomy in treatment of non-small cell lung cancer: experience in Shanghai Chest Hospital.

To analyze the perioperative indexes of 389 patients with non-small cell lung cancer in single center after robot-assisted thoracoscopic (RATS) lobectomy, and to summarize the surgical key points in robotic lobectomy. The clinical data of 389 stage I non-small cell lung cancer patients who underwent RATS lobectomy from May 2013 to December 2016 were retrospectively analyzed. Among them, there were 261 females (67.1%) and 128 males (32.9%); aged from 20-76 years old, with a mean age of 55.01 years; with ASA I in 106 cases, ASA II in 267 cases and ASA III in 16 cases; with BMI from 16.87-34.05, averaged at 23.09±2.79. The largest tumor in preoperative chest CT measurement was 0.3-3.0 cm, ranging from 1.29±0.59 cm; with stage Ia in 153 cases, stage Ib in 148 cases, stage Ic in 32 cases, stage IIb in 26 cases and stage IIIa in 30 cases; including 380 adenocarcinomas and 9 squamous carcinomas. The operating time was 46-300 min, averaged at 91.51±30.80 min; with a blood loss of 0-100 mL in 371 cases (95.80%), 101-400 mL in 12 cases (3.60%) and >400 mL in 2 cases (0.60%); there were 4 (1.2%) conversions to thoracotomy, in which 2 patients had massive hemorrhage and 2 patients had extensive dense adhesion; there was no mortality during operation and perioperatively. The drainage on the first day after operation was 0-960 mL, averaged at 231.39±141.87 mL; the postoperative chest tube was placed for 2-12 d, averaged at 3.96±1.52 d; the postoperative hospital stay was 2-12 d, averaged at 4.96±1.51 d, with postoperative hospital stay >7 d in 12 cases (3.60%). The postoperative air leakage was the main reason (35 cases, 9%) for prolonged hospital stay, and there was no re-admitted case within 30 days. All the patients underwent systemic lymph node dissection. The total cost of hospitalization was 60,389.66-134,401.65 CNY, averaged at 93,809.23±13,371.26 CNY. The application of Da Vinci robot surgery system in resectable non-small cell lung cancer is safe and effective, and could make up for the deficiencies of traditional thoracoscopic surgery. The number and level of robot surgery in our center have reached international advanced level, but the relatively expensive cost has become a major limitation in limiting its widespread use. With continuous improvements in robotic technology, its scope of application will be wider, which will inevitably bring new insights in lung surgical technology.

Robot assisted esophagectomy for esophageal squamous cell carcinoma.

This study aims to report our experience with robot assisted esophagectomy (RAE) for the treatment of resectable esophageal squamous cell carcinoma (ESCC). A series of 249 consecutive patients diagnosed with ESCC who underwent RAE from November 2015 to December 2017 at Shanghai Chest Hospital were evaluated, and their clinical data were reviewed retrospectively. One hundred patients were equally divided into four groups according to the surgery order, and the short-term outcomes in each group were analyzed. Overall, 249 patients (201 males and 48 females) with a mean age of 63.4±7.3 years who underwent RAE were analyzed. The thoracic procedure was successfully performed with the assistance of a robot. The mean total duration was 250.6±58.4 mins, and the estimated blood loss was 215.5±87.6 mL. R0 resection was performed in 232 (93.2%) patients with a mean total number of dissected lymph nodes of 18.5±9.1 and mean yield of lymph nodes along the recurrent laryngeal nerve (RLN) of 4.4±3.2. The median postoperative hospital stay was 11 days, and no 90-day mortality was observed. Forty-five (18.1%) patients experienced pulmonary complications, and the recurrent laryngeal nerve injury were observed in 38 (15.3%) patients. A significant reduction in thoracic duration was observed after the initial 25 cases (P<0.001). After 50 cases, the dissection of total lymph nodes, mediastinum lymph nodes and lymph nodes along the RLN were significantly improved (P<0.001, P<0.001, P=0.001, respectively) with a shorter postoperative hospital stay (P=0.005). RAE is a safe and feasible alternative surgical approach for resectable esophageal carcinoma and is associated with a large yield of lymph nodes, especially along the RLN. The surgeon will reach a plateau of operative duration after 25 cases and a plateau of lymphadenectomy after 50 cases.

Minimally invasive esophagectomy for esophageal squamous cell carcinoma-Shanghai Chest Hospital experience.

Esophageal cancer is a common gastrointestinal cancer and ranks sixth in tumor-related death. Esophageal adenocarcinoma is prevalence in European countries and the United States, while esophageal squamous cell carcinoma is frequently observed in Asian countries (1). Radical surgical resection combined with systematic lymph node dissection has always been used as a significant approach for treating esophageal cancer.

Erratum to annual report of Department of Thoracic Surgery at Shanghai Chest Hospital

Erratum to annual report of Department of Thoracic Surgery at Shanghai Chest Hospital

Health state utilities in patients with advanced non-small-cell lung cancer in China.

Non-small-cell lung cancer (NSCLC) is a leading global health threat that impairs patient health outcomes. Health state utilities are fundamental values in economic evaluation and significantly vary across countries. Given the scarce data on the Chinese population, the current study measured utility values in the Chinese patients with NSCLC. This study was conducted as a cross-sectional survey of patients with advanced NSCLC at the Shanghai Chest Hospital. Utility values were assessed using the EuroQol five-dimension (EQ-5D) instrument and scored based on the Chinese-specific value algorithm. Predictors of utility values were examined using a subgroup analysis and a multiple regression model. The mean EQ-5D utility value of recruited patients was 0.814. The regression analysis revealed that tumor stage, treatment regimen and line of therapy were the potential predictors of utility values. This study provides the Chinese-specific health utility data for advanced NSCLC using the EQ-5D.

Experiences of esophageal replacement with ileocolon graft: a series of 34 cases

Objective: To evaluate the safety and effectiveness of esophageal replacement with ileocolon graft. Methods: Totally 34 cases of esophageal replacement with ileocolon graft from July 2015 to November 2017 at Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University were analyzed retrospectively, including 24 male and 10 female, aging from 7 to 72 years old. Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route except one subcutaneous route. The primary esophageal disease, postoperative complication rate and quality of life were analyzed. Results: The overall postoperative complication rate was 23.5% (8/34), cervical anastomotic leakage rate of 5.9% (2/34), necrosis of colon graft of 5.9% (2/34). There were 3 patients experienced re-operation including 2 patients with colon graft necrosis and 1 patient with intestinal obstruction after ERC. One patient with colon graft necrosis died of septic shock after reoperation. Six cases of cervical esophago-jejunal anastomosis stenosis and 1 case of diarrhea occurred in the later time. All patients were followed up for a median time of 9 months (range: 1 to 28 months), 32 cases survived but 1 patient died until last follow-up by the end of December 2017. Conclusion: Esophageal replacement with ileocolon graft by right and/or middle colic artery as a blood supply using retrosternal route was safe and effective.

Predictors of recurrence and survival of pathological T1N0M0 invasive adenocarcinoma following lobectomy.

This retrospective research was designed to investigate the relationship between pT1N0M0 invasive adenocarcinoma (IADC) harboring solid (SOL) and/or micropapillary (MIP) components and its prognosis following lobectomy. Clinical data of pT1N0M0 IADC patients were retrospectively collected from Shanghai Chest Hospital. Survival curves were plotted by Kaplan-Meier methods. Multivariable cox regressions were conducted to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS), through which nomograms were performed to visualize the risk of recurrences and outcomes in personalized information. Totally, 1965 patients were enrolled, including 248 harboring SOL/MIP and 1717 not. IADC demonstrated worse 5-year RFS (81.9 vs. 92.2%, p < 0.001) and OS (85.7 vs. 94.4%, p < 0.001) when harboring SOL and/or MIP components. And this status became an independent factor associated with poorer RFS (HR 2.445, 95% CI 1.565-3.821, p < 0.001) and OS (HR 2.139, 95% CI 1.180-3.878, p = 0.012) instead of novel classification of IADC predominant patterns. No difference existed between SOL/MIP predominant and minor patterns. In addition, age > 60, smoking, post-chemotherapy and T1b were all indicating poorer RFS and smoking was also related with worse OS. The c-indexes of nomograms were 0.723 for RFS (95% CI, 0.662-0.784) and 0.703 for OS (95% CI, 0.629-0.777) respectively. Once the pT1N0M0 IADC harboring SOL/MIP, it strongly indicated the worse clinical recurrence and survival outcome, no matter whether the SOL and/or MIP was predominant. Smoking was correlated with worse prognosis for those patients. Age > 60 and stage T1b also indicated poorer RFS. Whether post-chemotherapy was harmful to pT1N0M0 IADC patients needed further research.

Annual report of Department of Thoracic Surgery at Shanghai Chest Hospital

This is the first annual report of the Department of Thoracic Surgery at Shanghai Chest Hospital. The Department of Thoracic Surgery at Shanghai Chest Hospital is one of the earliest departments to utilize standardized surgery treatment for thoracic cancer and is considered a key national clinical discipline in China. The Department of Thoracic Surgery at Shanghai Chest Hospital has been naturally evolving into several thoracic sub-specialties of expertise, including lung, esophagus, mediastinum, trachea, and transplantation. The volume of thoracic surgery cases has exceeded 10,000 operations and procedures since 2016. We will provide details of each sub-specialty area within this manuscript.

Shanghai Chest Hospital—looking forward

It is a distinct honor for me to provide a commentary on this 2017 Annual report from the Shanghai Chest Hospital (SCH) (1). I have had a close relationship with this institution and many of its outstanding surgeons for several decades. This 2017 Report is a remarkable document. The tripartite mission of every excellent academic medical center is patient care, education and research scholarship. The SCH is fulfilling this mission in every respect. I would like to make a number of observations about current activity, focus and opportunities for future progress.

Commentary on the 2017 annual report of Shanghai Chest Hospital

I have had the privilege of reviewing the annual report of thoracic surgery at the Shanghai Chest Hospital (1). The surgeons and hospital are to be commended on an outstanding report and impressive accomplishment in the area of thoracic surgery.

Survival analysis for lung adenosquamous carcinoma patients with brain metastasis.

Purpose: We retrospectively collected consecutive survival data of lung adenosquamous cell carcinoma (ASC) patients with brain metastasis (BM) in our institute and discussed the factors related to prognosis of these patients.Patients and Methods: A total of 42 patients diagnosed as lung ASC with BM between July 1, 2008 and December 31, 2010 at the Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University were retrospectively reviewed. Time to BM (TTB) and overall survival (OS) data were analyzed. OS1 was calculated from the time ASC was diagnosed until the death of a patient. OS2 was defined as the duration from BM was first identified to the death of a patient. 1-year, 2-year and 3-year survival rates were also computed. Univariate and multivariate survival analysis was performed using Kaplan-Meier methods and Cox regression.Results: The median TTB for all patients was 5.7 months [95% confidence interval (CI): 0.8 - 10.6 months]. The median OS1 was 13.8 months (95%CI: 11.2 - 16.4 months). TTB longer than 12 months [adjusted HR: 0.15 (95%CI: 0.05 -0.48 vs. TTB≤ 6 months, P=0.001); 0.22 (95%CI: 0.07- 0.71, vs. TTB 6-12 months, P=0.010) and resection for BM lesions [adjusted hazard ratio (HR): 0.47 (95%CI: 0.24 - 0.94 vs. not resected, P=0.032)] were independent predictors for a longer OS1. The median OS2 was 7.9 months (95%CI: 4.5 - 11.3 months). Treatment cycles more than 3 [adjusted HR: 0.41 (95%CI: 0.20 - 0.83 vs. treatment cycles <3, P=0.013)] was an independent predictor for a longer OS2.Conclusions: This study shows that resection of BM if possible, and standard chemo-radiotherapy in patients with multiple BM lesions is associated with longer overall survival.

Dr. Ahmad S. Ashrafi: minimally invasive esophagectomy (MIE) in Surrey Memorial Hospital (SMH) and North America

Shanghai Chest Hospital 2 nd International Summit of Esophageal Surgery took place on 23–24 March, 2018 in Shanghai. With the theme “The survival of patient comes first”, the summit covered a series of lectures and reports on the long-term survival of modern treatment of esophageal cancer, including a variety of surgical approaches and treatment strategies used in various regions to manage the cancer in order to lay the groundwork for the future development of esophageal cancer treatment in China.

The annual report of shanghai chest hospital—a view from abroad

This is the first annual report of the Shanghai Chest Hospital in which the authors describe the development over the past nine years not only in the different fields of surgery but also of the number of procedures performed.

Objective and subjective financial burden and its associations with health-related quality of life among lung cancer patients.

The purpose of this study is to examine the effect of financial burden, using objective and subjective indicators, on the health-related quality of life (HRQOL) in lung cancer patients. A total of 227 patients diagnosed with lung cancer (from the inpatient unit of the department of internal medicine-chest oncology, in Shanghai Chest Hospital, China) participated in the study. Financial information was measured by direct medical costs, direct nonmedical costs, healthcare-cost-to-income ratio, and perceived financial difficulty. HRQOL was measured using the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale. Catastrophic health spending, defined as a healthcare-cost-to-income ratio of more than 40%, was reported in 72.7% of the participants, whereas 37.0% reported that healthcare costs exceeded annual household income. Financial difficulty was perceived in 83.7% of the participants. Patients whose healthcare costs exceeded their annual household income and who perceived financial difficulty reported a clinically meaningful difference in overall HRQOL (>6 points on the FACT-L) compared with participants without catastrophic health spending or perceived financial difficulty. Healthcare costs did not show a significant effect on HRQOL. Healthcare costs exceeding total annual household income and perceived financial difficulty are associated with poorer HRQOL in lung cancer patients. Subjective indicator of financial burden has a stronger effect on quality of life than objective indicators. Health-cost-to-income ratio and perceived financial difficulty can be implied as objective and subjective indicators of financial burden to identify the patients who may need additional assistance. Communication on deciding on cost-effective treatments can be facilitated.

Risk factors of lymph node metastasis in patients with non-small cell lung cancer ≤ 2 cm in size: A monocentric population-based analysis.

AimThis study was designed to determine the risk factors of lymph node metastasis in non‐small cell lung cancer (NSCLC) patients with tumors ≤ 2 cm, using the Shanghai Chest Hospital Lung Cancer Database.MethodsFive hundred and eighteen patients with NSCLC ≤ 2 cm were included in this study, and were classified into lymph node‐positive and lymph node‐negative groups. Univariate and multivariate logistic regression analyses were performed to select the independent risk factors for lymph node metastasis in NSCLC patients.ResultsNo evidence of metastasis was found in tumors ≤ 1 cm, all positive results were in tumors sized 1–2 cm. Imaging characteristics, including solid and part‐solid nodules, were strongly associated with lymph node metastasis (odds ratio [OR] 24.959, 95% confidence interval [CI] 5.999–103.835, P < 0.001; OR 12.559, 95% CI 3.564–44.259, P < 0.001) and subgroup logistic analysis (OR 21.384, 95% CI 5.058–90.407, P < 0.001; OR 11.632, 95% CI 3.290–41.126, P < 0.001). Greater lymph node metastasis was observed in non‐adeno non‐squamous carcinoma. The presence of pleural invasion and carcinoembryonic antigen levels indicated lymph node dissection. Similar results were revealed in subgroup analysis in tumors ≤ 2 to > 1 cm.ConclusionSize had a great impact on lymph node metastasis, especially tumors of 1–2 cm. Preoperative imaging, non‐adeno non‐squamous carcinoma, pleural invasion, and carcinoembryonic antigen all indicated lymph node dissection. There was no discrepancy between N1 and N2 positive lymph nodes.

A multi-center retrospective study of single-port versus multi-port video-assisted thoracoscopic lobectomy and anatomic segmentectomy.

To assess the feasibility and perioperative outcomes of single-port (SP) and multi-port (MP) approaches for video-assisted thoracoscopic surgery (VATS) lobectomy and anatomical segmentectomy. Retrospective data from 458 patients who received VATS lobectomy or anatomical segmentectomy at Shanghai Chest Hospital, Korea University Guro Hospital, Affiliated Hospital of National Taiwan University, University of Hong Kong Queen Mary Hospital and Shenzhen Hospital were collected. Patients were divided into SP group and MP group according to the surgical approach. Perioperative factors such as operation time, blood loss during surgery, conversion rate, the number and stations of lymph nodes harvested, postoperative chest tube drainage time, postoperative hospitalization time, perioperative morbidity and mortality, and pain scores during the first 3 days after surgery were compared between the two groups. There were no differences in the number (P=0.278) and stations (P=0.564) of lymph nodes harvested, postoperative morbidity (P=0.414) or mortality(P=0.246), and pain score on the third day (P=0.630) after surgery between the two groups. The SP group had a longer operation time (P=0.042) and greater intraoperative blood loss (P<0.001), but the conversion rate was even higher in the MP group (P=0.018). Patients in the SP group had shorter chest tube removal time (P=0.012) and postoperative hospitalization time (P=0.005). Pain scores were lower on the first (P=0.014) and second (P=0.006) day after surgery in the SP group. SP VATS lobectomy and anatomical segmentectomy is technologically more demanding than MP VATS. It can be safe and feasible in the hands of experienced surgeons, with comparable preoperative outcomes to MP VATS, but less pain in the early postoperative period.

Associated factors of postoperative relapse and metastasis in pT1bN0M0-pT4aN0M0 thoracic esophageal squamous cell carcinoma

To investigate the associated high risk factors of postoperative relapse and metastasis for patients with confined tumors (grade pT1b-4a) without lymph-node metastases (pN0) in thoracic esophageal squamous cell carcinoma (ESCC). Clinicopathological and follow up data of ESCC patients undergoing radical surgical resection as primary treatment in the Department of Thoracic Surgery, Shanghai Chest Hospital between January 2004 and December 2012 from Hospital Database were retrospectively collected. The inclusion criteria were as follows: (1) the first development of ESCC confirmed by histopathology without lymphatic and distant metastasis; (2) pathological stage of pT1bN0M0 to pT4aN0M0 according to the Union for International Cancer Control (UICC) in 2009; (3) curative trans-thoracic esophagectomy with R0 (tumor-free surgical margin) resection, using the Ivor-Lewis or McKeown procedure; two-field lymphadenectomy or three-field lymph node dissection based on the positive results of preoperative cervical ultrasonography examination or CT scan; (4) without adjuvant chemotherapy and/or radiotherapy before and after operation; (5) complete follow-up data. Logistic regression analysis was employed to identify the clinicopathological factors affecting the postoperative relapse and metastasis. A total of 112 patients were eligible, including 94 male cases and 18 female cases; age of (58.6±7.7) years; squamous carcinoma of upper thorax in 25 cases, of middle thorax in 67 cases and of lower thorax segment in 20 cases; 12 cases of high-differentiated ESCC, 49 cases of moderate-differentiated ESCC, poorly-differentiated ESCC in 48 cases; 4 cases of I(a stage, 9 cases of I(b, 24 cases of II(a, 62 cases of II(b, 13 cases of III(a; the tumor length >4 cm in 43 cases, ≤4 cm in 69 cases. Forty-three (38.4%) patients presented relapse or metastasis during the follow-up, including 24 (21.4%) of loco-regional relapse, 13 (11.6%) of distant metastasis, and 6(5.4%) of both above. Multivariate regression analysis revealed that poorly-differentiated tumor (OR=1.899, 95%CI:1.233-2.925, P=0.004), upper-middle location (OR=2.351, 95%CI:1.188-4.653, P=0.014), and tumor length >4 cm (OR=2.381, 95%CI:1.009-5.618, P=0.048) were independent risk factors of overall postoperative relapse and metastasis for thoracic ESCC with stage pT1b N0M0-T4aN0M0. Further stratified analysis identified that only poorly-differentiated tumor (OR=1.730, 95%CI:1.121-2.671, P=0.013) was an independent risk factor of loco-regional relapse, whereas pathological stage II(b-III(a (OR=3.372, 95%CI:1.206-9.428, P=0.021) was an independent risk factor of distant metastasis. Poorly-differentiated tumor, tumor length >4 cm, and upper-middle location may be regarded as high risk factors for predicting overall relapse and metastasis of pN0 thoracic ESCC patients after esophagectomy. Moreover, poorly-differentiated tumor is the only independent risk factor of postoperative loco-regional relapse, meanwhile it should be noted that pathological stage II(b-III(a is closely related to postoperative distant metastasis.

Role of Postoperative Radiotherapy in the Treatment of Adenoid Cystic Carcinoma of the Trachea and Bronchus with Positive Surgical Margin: Rethinking about the Resection Range

Adenoid Cystic carcinoma (ACC) of the tracheobronchial tree is quite uncommon. The experience regarding their treatment and long-term outcome is limited. The aim of this study was to evaluate the role of postoperative radiotherapy in the treatment of ACC of the trachea and bronchus with positive surgical margin. Operated patients were enrolled in this study with pathologically confirmed trachea or bronchus ACC in Shanghai Chest Hospital. Clinical, pathologic and radiotherapeutic data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier and log-rank tests. Multivariate analysis was performed using the Cox regression model. Meanwhile, the chi-square test was applied to analyze the failure pattern among different groups (R0/0: negative margin resection without postoperative radiotherapy; R1/0: positive margin resection without postoperative radiotherapy and R1/1: positive margin resection with postoperative radiotherapy). From January 2001 to December 2014, 77 patients were eligible for the study. The median follow-up time was 67 months (range, 16-203). The 5-year and 10- year OS rates in R0/0, R1/1, R1/0 patients were 100.0%, 98.9%, 90.0% and 85.7%, 89.9%, 59.1%, respectively(P = 0.086). Pairwise comparisons showed OS of group R1/1 was similar to group R0/0 (P = 0.438), although much better than group R1/0 (P = 0.032). The 5-year and 10- year local PFS rates in R0/0, R1/1, R1/0 patients were 85.9%, 98.0%, 78.8% and 43.0%, 98.0%, 33.8%, respectively (P = 0.003). Pairwise comparisons showed a difference between group R1/1 and R0/0 (P = 0.023) and between group R1/1 and R1/0 (P = 0.001). Cox multivariate analysis of patients with positive surgical margin identified the radiologic appearance (P = 0.012) and postoperative radiotherapy (P = 0.006) as significantly favorable prognostic factors for local PFS, and only postoperative radiotherapy as the corresponding variable for OS. Thirty-two patients had experienced recurrence by the end of follow-up, including local recurrence (n = 3), local recurrence with metastases (n = 5), pure pulmonary metastases (n = 16), pure bone metastases (n = 1) and multiple metastases (n = 7). Chi-square test suggested patients without postoperative radiotherapy were more prone to local recurrence than those received postoperative radiotherapy (P = 0.001). Similar outcome was not demonstrated for distant metastases (P = 1.000). For patients with positive surgical margin, postoperative radiotherapy can significantly prolong local PFS and OS, thus achieving similar survival to those with complete resection. Patients without postoperative radiotherapy are more likely to relapse instead of metastasize. These results suggest that postoperative radiotherapy provide an effective complement to operation with positive surgical margin. Appropriate resection range of ACC of trachea and bronchus should be rethinking.