Nomogram to Predict Overall Survival for Thoracic Esophageal Squamous Cell Carcinoma Patients After Radical Esophagectomy.

BACKGROUND: Effective tools evaluating the prognosis for patients with esophageal cancer undergoing surgery is lacking. The current study aimed to develop a nomogram to predict overall survival (OS) and provide evidence for adjuvant therapy for patients with esophageal carcinoma after esophagectomy. METHODS: The study retrospectively reviewed patients with pathologic T1N +/T2-4aN0-3, M0 thoracic esophageal squamous cell carcinoma after radical esophagectomy, with or without adjuvant therapy, in one institution as the training cohort (n = 2281). A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS, which were validated in an independent validation cohort (n = 1437). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate prognostic efficacy. RESULTS: In the training cohort, the median OS was 50.46 months, and the 5-year OS rate was 47.08%. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, removed lymph nodes, and T and N categories were identified as predictive factors for OS. The nomogram showed favorable prognostic efficacy in the training and validation cohorts (5-year OS AUC: 0.685 and 0.744, respectively), which was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system. The nomogram distinguished OS rates among six risk groups, whereas AJCC could not separate the OS of 2A and 1B, 3C and 3B, or 3A and 2B. Patients with a nomogram score of 72 to 227 were predicted to achieve a 5-year OS increase of 10% or more from adjuvant therapy. CONCLUSION: The nomogram could effectively predict OS and aided decision making in adjuvant therapy for patients with thoracic esophageal squamous cell carcinoma after esophagectomy.

The all-optical modulator in dielectric-loaded waveguide with graphene-silicon heterojunction structure.

All-optical modulators based on graphene show great promise for on-chip optical interconnects. However, the modulation performance of all-optical modulators is usually based on the interaction between graphene and the fiber, limiting their potential in high integration. Based on this point, an all-optical modulator in a dielectric-loaded waveguide (DLW) with a graphene-silicon heterojunction structure (GSH) is proposed. The DLW raises the waveguide mode, which provides a strong light-graphene interaction. Sufficient tuning of the graphene Fermi energy beyond the Pauli blocking effect is obtained with the presented GSH structure. Under the modulation light with a wavelength of 532 nm and a power of 60 mW, a modulation efficiency of 0.0275 dB µm-1 is achieved for light with a communication wavelength of 1.55 µm in the experiment. This modulator has the advantage of having a compact footprint, which may make it a candidate for achieving a highly integrated all-optical modulator.

[Comparison of the lymph node dissection and complications between video-assisted thoracoscopic (VATS) esophagectomy and conventional esophagectomy via right thoracotomic].

OBJECTIVE: Video-assisted thoracoscopic (VATS) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node (LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not. METHODS: The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1, 2009 to July 30, 2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy. RESULTS: One hundred and twenty-nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another part 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P > 0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 (P < 0.001). The average dissected LN stations was 3.2 vs. 3.6 (P = 0.038). The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 (P = 0.012). The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P = 0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41.1% in the VATS group versus 42.6% in the conventional group (P = 0.801). The cardiopulmonary complication rate was 25.6% vs. 27.1% (P = 0.777). The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P = 0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P = 0.049) but longer operating time (161.3 min vs. 127.8 min, P < 0.01). CONCLUSIONS: In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to un-skillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.

[Role of conventional pulmonary function tests and stair climbing test in the prediction of postoperative cardiopulmonary complications in non-small cell lung cancer patients after surgery].

OBJECTIVE: To evaluate and compare the value of stair climbing tests and conventional pulmonary function tests in the prediction of postoperative cardiopulmonary complications in non-small cell lung cancer patients underwent surgery. METHODS: From April 1, 2010 to Jan. 30, 2012, a total of 162 patients with thoracic carcinoma underwent stair climbing test (SCT) and conventional pulmonary function tests (PFT) preoperatively. The correlation of postoperative cardiopulmonary complications with the SCT and PFT parameters were analyzed retrospectively using chi-square test, independent sample t test and binary logistic regression analysis. RESULTS: Of the 162 patients, 19 without operation were excluded, due to an advanced stage (9 cases), poor cardiopulmonary function (5 cases), rejecting operation (4 cases) and exploration alone (1 case). 143 cases were eligible and evaluated eventually. Forty-one of the 143 patients (28.7%) had postoperative cardiopulmonary complications, but no death occurred. The patients were stratified into groups based on the time of stair climbing 5 stories (18.36 m, t, <92 s, ≥ 92 s). Exercise oxygen desaturation (EOD) during the stair climbing test (<5%, ≥ 5%) and the difference between the pulse at resting state and the pulse at end of stair climbing test (ΔP, <55 beats/min, ≥ 55 beats/min), respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with t ≥ 92 s, EOD ≥ 5% and ΔP < 55 beats/min (38.5%, 42.0% and 35.1%, respectively) than that in the group with t<92 s, EOD<5% and ΔP ≥ 55 beats/min (16.9%, 21.5% and 18.2%, respectively). Binary logistic regression analysis showed that postoperative cardiopulmonary complications were independently correlated with EOD and lung function which did not meet the requirement of the lung resection operation mode. CONCLUSIONS: A symptom-limited stair climbing test is a safe, simple and low-cost method to evaluate the cardiopulmonary function preoperatively. It can predict the occurrence of postoperative cardiopulmonary complications in non-small cell lung cancer patients. Conventional pulmonary function tests and stair-climbing test can be recommended to be routinely performed in all patients with non-small cell lung cancer before thoracic surgery.

[Exploration of lymph node metastasis and appropriate lymph node dissection modes in patients with clinical stage I non-small cell lung cancer].

OBJECTIVE: To explore the pattern of lymph node metastasis and evaluate the modes and extent of mediastinal lymph node dissection in patients with ≤ 3 cm, clinical stage I primary non-small cell lung cancer (NSCLC). METHODS: Data of 270 eligible patients who underwent pulmonary resection with systematic lymph node dissection in our hospital between March 2012 and August 2013 were retrospectively analyzed in order to investigate the relationship between the clinicopathological features and lymph node metastatic patterns. Patients with multiple primary carcinomas or non-primary pulmonary malignancies and those who received any chemotherapy or radiotherapy or did not undergo systematic nodal dissection were excluded. The criteria of systematic nodal dissection included the removal of at least six lymph nodes from at least three mediastinal stations, one of which must be subcarinal. The data were analyzed and compared using Chi-square test. RESULTS: The postoperative morbidity rate was 14.8% and no death occurred in this series. The imaging findings showed 34 cases of pure ground glass opacity lesions, 47 partial solid nodules, and 189 solid nodules. Apart from 34 p-GGO lesions, among the other 236 cases, ≤ 1 cm lesions were in 22 cases, 1 cm- ≤ 2 cm lesions in 138 cases, and >2 cm- ≤ 3 cm lesions in 76 cases based on radiologic findings. The pathological types included adenocarcinoma (n = 245), squamous cell carcinoma (n = 18) and other rare types (n = 7). The overall lymph node metastasis rate was 18.9% (51/270), and the incidence of lymph node involvement was 0(0/34) in cancers with p-GGO, 2.1% (1/47) in mixed solid nodules, 26.5% (50/189) in solid nodules, 18.2% (4/22) in nodules ≤ 1 cm, 14.5% (20/138) in 1 cm < nodules ≤ 2 cm, and 35.5% (27/76) in 2 cm < nodules ≤ 3 cm. The metastasis rates of non-specific tumor-draining region lymph nodes detected in the patients with positive and negative lobe-specific lymph node involvement were 20.0%-50.0% vs. 0-2.9% (P < 0.001). CONCLUSIONS: Usually NSCLC with p-GGO nodules has no lymph node metastasis, therefore, systematic nodal dissection may be not necessary. The larger the tumor size is, the higher the lymph node metastatic rate is for mixed or solid nodules. Intraoperative frozen-section examination of the lobe-specific lymph nodes should be performed routinely in patients with ≤ 2 cm stage I NSCLC, and systematic nodal dissection should be done if positive, but it may be not necessary if negative. However, the effectiveness of the systematic selective lymph node dissection still needs to be further confirmed.

[Surgical treatment and prognostic analyses of bronchopulmonary carcinoid tumors].

OBJECTIVE: To explore the surgical treatment and prognostic factors of bronchopulmonary carcinoid tumors (BPC). METHODS: The clinical data of 65 patients undergoing surgery for BPC from May 1999 to December 2007 were reviewed retrospectively. The predictors of univariate and multivariate analyses included gender, age, smoking history, pathological type and tumor stage. RESULTS: The procedures included segmentectomy (n = 1), lobectomy (n = 36), bilobectomy (n = 6), sleeve resection (n = 4), pneumonectomy (n = 11), carinal resection (n = 2), bronchoplastic resection (n = 4) and exploratory thoracotomy (n = 1). The 1- , 3- and 5-year overall survival rates were 86.2%, 73.8% and 64.6% respectively. Univariate analysis showed that gender (P = 0.029), age (P = 0.003), smoking history (P = 0.039), pathological type (P < 0.01), tumor stage (P < 0.01), postoperative radiochemotherapy (P < 0.01), lymph node metastasis (P < 0.01) and surgical type (P = 0.042) were prognostic factors. And multivariate analysis revealed that pathological type (P = 0.019) and lymph node metastasis (P < 0.01) were independent prognostic factors. CONCLUSION: Surgery remains a first-choice for BPC. The major resection procedure is anatomical lobectomy or pneumonectomy. Both pathological type and lymph node metastasis are independent prognostic factors.

[Preliminary experience of clinical applications of the 7th UICC-AJCC TNM staging system of esophageal carcinoma].

OBJECTIVE: To compare the instructive value of the 6th and 7th editions of the UICC-AJCC staging system in prognosis of esophageal cancer (EC) patients. METHODS: The staging and prognosis of 1397 esophageal carcinoma patients undergoing curative resection from Jan. 2003 to Dec. 2006 in our hospital were retrospectively reviewed and analyzed according to the 6th AJCC staging system and the 7th UICC-AJCC staging system. RESULTS: The 5-year overall survival (OS) of EC patients with curative resection was 38.5% (481/1250 cases), with a follow-up rate of 89.5% (1250/1397 case). In overall terms, both the editions were statistically significant discriminators of OS (P < 0.05). The 5-year OS of stages I, II and III patients were 64.9%, 43.5%, 25.2% according to the 6th edition, and 63.5%, 44.5%, 23.5% according to the 7th edition, respectively. Distinct differences in survival were present among patients categorized as stage Ia and Ib according to the 7th edition (P < 0.05), with a 5-year OS of 80.0% and 58.3%, respectively. Similarly, according to the 7th edition, the 5-year overall survivals (OS) of the stages IIIa, IIIb and IIIc patients were 28.2%, 18.4% and 16.7%, respectively, showing that the prognoses were significantly different (P < 0.05). In addition, according to the 7th edition, the prognoses of patients in stages N0, N1, N2 and N3 were also significantly different (P < 0.01), and the 5-year OS were 50.0%, 31.5%, 18.7% and 16.7%, respectively. CONCLUSIONS: Both the 6th and 7th editions of UICC-AJCC staging system are significant discriminators for survival of esophageal cancer patients. The 7th edition is proved to be more accurate in prognosis. The number of lymph node metastases is an important predictor of prognosis.

[Role of conventional pulmonary function tests and cardiopulmonary exercise test in the prediction of postoperative cardiopulmonary complications in high risk thoracic cancer patients].

OBJECTIVE: To evaluate and compare the value of cardiopulmonary exercise test and conventional pulmonary function tests in the prediction of postoperative cardiopulmonary complications in high risk patients with chest malignant tumors. METHODS: From January 2006 to January 2009, 216 consecutive patients with thoracic malignant tumors underwent conventional pulmonary function tests (PFT, spirometry + DLCOsb for diffusion capacity) and cardiopulmonary exercise test (CPET) preoperatively. The correlation of postoperative cardiopulmonary complications with the parameters of PFT and CPET were retrospectively analyzed using Chi-square test, independent sample t-test and logistic regression analysis. The P value < 0.05 was considered as statistically significant. RESULTS: Of the 216 patients, 57 did not receive operation due to advanced stage diseases or poor cardiopulmonary function in most of them. The remaining 159 underwent different modes of operations. Thirty-six patients (22.6%) in this operated group had postoperative cardiopulmonary complications and 10 patients (6.3%) developed operation-related complications. Three patients (1.9%) died of the complications within 30 days postoperatively. The patients were stratified into groups based on V(O(2)) max/pred (≥ 65.0%, < 65.0%); V(O(2)) max×kg(-1)×min(-1) (≥ 20 ml, 15 - 19.9 ml, < 15 ml) and FEV1 (≥ 2.0 L, 1.2 - 1.99 L, < 1.2 L) according to the criteria in reported papers. There was statistically significant difference among these groups in the parameters (P < 0.05), the rates of postoperative cardiopulmonary complications were much higher in the groups with poor cardiopulmonary function (V(O(2)) max/pred < 65.0%; V(O(2)) max×kg(-1)×min(-1) < 15 ml or FEV1 < 1.2 L). It was shown by logistic regression analysis that postoperative cardiopulmonary complications were significantly correlated with age, associated diseases, poor results of PFT or CPET, operation modes and operation-related complications. CONCLUSIONS: FEV1 in spirometry, V(O(2)) max×kg(-1)×min(-1) and V(O(2)) max/pred in cardiopulmonary exercise test can be used to stratify the patients' cardiopulmonary function status and is correlated well with FEV1. V(O(2)) max×kg(-1)×min(-1) is the best parameter among these three parameters to predict the risk of postoperative cardiopulmonary complications in patients with chest malignant tumors and borderline cardiopulmonary function.

[Comparison of the results of lymph node dissection via left versus right thoracotomy].

OBJECTIVE: Up to now surgical treatment has been still the most effective treatment for esophageal cancer. However, postoperative lymph node recurrence is still a frequent event and affects long term survival considerably. The aim of this study is to compare the results of lymph node dissection via left vs. right thoracotomies and to verify whether there is any essential difference in lymphadenectomy between these two approaches. METHODS: Five hundred and fifty-nine cases with thoracic esophageal cancer were randomly selected from the database of esophageal cancer patients who underwent surgical treatment in our hospital between May 2005 and January 2011, including 282 cases through left thoracotomy and 277 cases through right thoracotomy. This series consisted of 449 males and 110 females with a mean age of 58.8 years (age range: 36 - 78 years). The pathological types were mainly squamous cell carcinoma (548 cases) and other rare types (11 cases). The data were analyzed and compared using Chi-square test. The P-value < 0.05 was considered as statistically significant. The actual 5-year survival rate was calculated based on the recent follow-up data of the patients who underwent surgery at least 5 years ago. RESULTS: The average number of dissected lymph nodes was 23.4 via left versus 24.6 via right thoracotomies. The overall lymph node metastasis rate was 48.9% via left thoracotomy and 53.8% via right thoracotomy, and 34.8% vs. 50.5% in the chest (P < 0.001), 29.1% vs. 17.7% in the abdomen (P = 0.001). The pathologically confirmed lymph node metastasis rate was 45.9%, 44.0% and 34.9% in the upper, middle and lower segments of thoracic esophagus, respectively. The lymph node metastasis rates detected via left and right thoracotomy in the stage T1 cases were 14.7% (5/34) vs. 42.9% (12/28) (P < 0.001), and in the stage T2 cases were 35.4% (17/48) vs. 52.8% (28/53) (P = 0.007); in the station of para-thoracic esophagus were 9.6% vs. 13.4%, in the left upper mediastinum were 2.1% vs. 7.6%, and in the right upper mediastinum were 1.4% vs. 26.0%, respectively. The preliminary actual 5-year survival rate was 38.2% in the cases via left thoracotomy vs. 42.1% in those via right thoracotomy. CONCLUSIONS: The results of this study demonstrate that lymph node dissection is more complete via right thoracotomy than via left thoracotomy, especially for the tracheoesophageal groove and para-recurrent laryngeal nerve nodes, which may eventually improve the survival of patients with esophageal cancer. Therefore, surgical treatment via right thoracotomy by Ivor-Lewis (two incisions) mode or Levis-Tanner (three incisions) mode with two-field or three-field complete lymph node dissection may become prevalent in the future.

[Surgical treatment of sternal tumors: resection of the tumors and reconstruction of the chest wall defects].

OBJECTIVE: To investigate the efficacy of surgical treatment of sternal tumors and repairing methods of the chest wall defects. METHODS: Fifteen patients with sternal tumors were diagnosed and underwent resection of the sternal tumors according to the en-bolck principle and repair of the chest wall defects using various materials from January 1968 to December 2010 in our hospital. RESULTS: Of 6 patients with sternal manubrim tumors, one patient had reconstruction only with steel wire, other 5 patients healed completely after repair with soft materials. Of 7 patients with sternal body tumors, one patient recovered quickly without reconstruction because he had only partial resection; four patients had chest wall repair with soft materials, but they breathed hardly; and two patients had chest wall reconstruction with rigid materials. One patient had ventilatory support, another patient recovered quickly. Ventilatory support was needed in two patients treated by subtotal sternectomy because they had chest wall repair with soft materials. CONCLUSIONS: In surgical treatment of sternal tumors by manubrim sternetomy, the chest wall defects can be constructed with soft materials. After resection of sternal body tumors and subtotal sternectomy, the thoracic wall defects need to be reconstructed with rigid materials.

[Comparison of the short-term outcomes of surgical treatment for non-small cell lung cancer via video assisted thoracoscopic surgery and open thoracotomy].

OBJECTIVE: To compare the short-term outcomes of surgical treatment for non-small cell lung cancer (NSCLC) by video-assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). METHODS: Data of 737 consecutive NSCLC patients who underwent surgical treatment for non-small cell lung cancer by video-assisted thoracoscopic surgery and 630 patients who underwent pulmonary resection via open thoracotomy (as controls) in Cancer Institute & Hospital, Chinese Academy of Medical Sciences between January 2009 and August 2011 were retrospectively reviewed. The risk factors after lobectomy were also analyzed. RESULTS: In the 506 NSCLC patients who received VATS lobectomy, postoperative complications occurred in 13 patients (2.6%) and one patient died of acute respiratory distress syndrome (0.2%). In the 521 patients who received open thoracotomy (OT) lobectomy, postoperative complications occurred in 21 patients (4.0%) and one patient died of pulmonary infection (0.2%). There was no significant difference in the morbidity rate (P > 0.05) and mortality rate (P > 0.05) between the VATS group and OT group. In the 190 patients who received VATS wedge resections, postoperative complications occurred in 3 patients (1.6%). One hundred and nine patients received OT wedge resections. Postoperative complications occurred in 4 patients (3.7%). There were no significant differences for morbidity rate (P = 0.262) between these two groups, and there was no perioperative death in these two groups. Univariate and multivariate analyses demonstrated that age (OR = 1.047, 95%CI: 1.004 - 1.091), history of smoking (OR = 6.374, 95%CI: 2.588 - 15.695) and operation time (OR = 1.418, 95%CI: 1.075 - 1.871) were independent risk factors of postoperative complications. CONCLUSIONS: To compare with the NSCLC patients who should undergo lobectomy or wedge resection via open thoracotomy, a similar short-term outcome can be achieved via VATS approach.

[Clinical analysis and surgical treatment of 14 cases of esophageal gastrointestinal stromal tumors].

OBJECTIVE: To explore the clinical features and surgical management of esophageal gastrointestinal stromal tumors (GIST). METHODS: The clinical data of patients with esophageal GISTs undergoing surgery at our hospital between January 1999 and April 2012 were retrospectively reviewed. RESULTS: Of 14 patients, the male: female ratio was 8:6; the median age of the patients was 42 years (range 33 - 63 years). Dysphagia was the most common symptom, and all cases were diagnosed postoperatively. The tumors were resected by enucleation or esophagectomy or endoscopic submucosal resection. The median follow-up was 43.5 months, ranging from 2 to 142 months, with all patients have no recurrence and metastasis. CONCLUSION: Esophageal GIST is rather rare. At present, surgical resection and postoperative diagnosis remain the mainstay for treatment of patients with esophageal GISTs in China.

[Diagnosis and surgical treatment of pulmonary sclerosing hemangioma].

OBJECTIVE: As a rare benign lung tumor, pulmonary sclerosing hemangioma (PSH) occurs predominantly in Asian women in their fifth and sixth decades of life. PSH is considered to be evolved from primitive undifferentiated respiratory epithelium. In this study, we summarized our experience in 89 cases of PSH. METHOD: There were a total of 89 patients who received surgical resection and were histopathologically diagnosed as PSH during the period January 2001 to December 2010 in department of thoracic surgery, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences. The clinical data of these patients including symptoms, disease courses, image characteristics and surgical procedures were collected and reviewed retrospectively. RESULTS: The PSHs were most frequently (50.6%) found in the patients aged 41 to 60 years with a median age of 51 years (range: 24 - 71), and the sex ratio (male/female) was approximately 1:7 in this series. In the 89 patients, 53 (59.6%) were asymptomatic while the other 36 (40.4%) had some non-special symptoms such as cough (30.3%), hemoptysis (24.7%). There were only 3 cases (3.4%) with multiple PSHs, 4 cases (4.5%) combined with synchronous primary lung cancer, and 13 cases (14.6%) with lesions located in the hilar region. The median diameter of the 92 lesions was 2.3 cm (range: 0.3 - 6.0 cm), of which 38% located in the right lower lobe and 26.1% in the right middle lobe, and only about 1/3 were assumed as PSHs preoperatively based on CT imaging. One of the five patients who underwent PET-CT scan had been misdiagnosed as malignant. Of the 92 lesions, 47 were resected by enucleation, 29 by wedge resection, 14 by lobectomy, and 2 by pneumonectomy. CONCLUSION: PSH frequently occurs in the middle-aged women. Most individuals with PSH are asymptomatic or have some non-specific symptoms. Their lesions are usually found accidentally by chest imaging. Although PSH often shows typical imaging characteristics of benign neoplasm of the lung, it is difficult to establish a defined pathological diagnosis preoperatively. The significant error or deferred rate of intraoperative frozen-section evaluation for PSH may result in some unnecessarily extensive surgical procedures. The complete surgical resection is considered the only effective treatment for PSH, and the normal pulmonary tissue should be reserved as possible.

Clinical analysis of 19 cases of adult primary mediastinal liposarcoma.

OBJECTIVE: To explore the pathoclinical features of adult primary mediastinal liposarcoma and their correlation with the prognosis. METHODS: The clinical data of 19 patients with adult primary mediastinal liposarcoma who were treated in our hospital between 1970 and 2011 were retrospectively analyzed. Eighteen patients underwent open thoracic tumor excisions for at least one time, and the remaining one patient only received biopsy surgery. Histopathological results after surgery revealed that 6 well-differentiated type tumors, 6 myxoid type tumors, 3 pleomorphic type tumors, 2 mixed type tumors, and 2 un-classified tumors. RESULTS: Among 6 patients with well-differentiated type tumors, 1 died after having been survived for 10 years; 5 were still alive, with a mean duration of 126.2 months,the 5-year survival rate was 100%. Among 6 patients with myxoid type tumors, 5 patients had follow-up data, with a mean survival of 26.2 months. Among 3 patients with pleomorphic type tumors, only one patient had follow-up data: the patient finally died, with a survival of 34 months. Of 2 patients with mixed type tumors, only one patient had follow-up data: the patient survived 8 months and died. Of 2 patients with un-classified type tumors, one had follow-up data: the patient lived for 24 months and died. CONCLUSIONS: Mediastinal liposarcoma is a rare disease. Surgery is the primary therapeutic modality. Different pathological subtypes have different epidemiological features, biological behaviors, and malignant potentials. Pathological subtype is an important prognosis factor. Patients with well-differentiated tumors have much better prognosis than those with other subtypes.

[Surgical treatment of bilateral thoracotomy in patients with lesions of left main bronchus invading carina].

OBJECTIVE: To investigate the outcome for surgical treatment of bilateral thoracotomy in patients with lesions of left main bronchus invading carina by bilateral thoracotomy. METHODS: The clinical data of 4 patients with lesions of left main bronchus invading carina undergoing bilateral thoracotomy were retrospectively reviewed. RESULTS: There were two male and two female patients with a median age of 37.5 (range: 27 - 55) years old. Four patients were all accessed by bilateral thoracotomy, and received carinal reconstruction. Of these 4 patients, three patients received left pneumonectomy and one patient received carinal resection without concomitant pulmonary resection. Pathological results showed that one patient had tuberculosis. And other three patients were of 1 squamous cell carcinoma and 2 adenoid cystic carcinomas. Three patients received mechanical ventilation for a period of 3 - 21 days. one patient died of anastomotic dehiscence at 5 days postoperatively. CONCLUSION: Bilateral thoracotomy is an alternative approach for relatively young patients with decent cardiopulmonary functions with lesions of left main bronchus invading carina. Operation type should be based on histopathological type and length of involved left main bronchus.

[Value of endobronchial ultrasound-guided transbronchial needle aspiration in hilar and mediastinal lesions].

OBJECTIVE: To evaluate the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in cases of undiagnosed intrapulmonary lesions. METHODS: A total of 89 patients with intrathoracic lesions underwent EBUS-TBNA, including 56 pulmonary lesions, 7 lymph node staging in lung cancer patients, 21 unknown hilar and/or mediastinal lymphadenopathies and 5 mediastinal tumors. All samples were evaluated for cytological and pathological examinations. RESULTS: No complication of EBUS-TBNA was observed. Among 89 cases, 76 had positive results, 5 negative and 5 cases excluded as unsatisfied samples. In 56 patients with pulmonary lesions, EBUS-TBNA demonstrated 45 malignant tumors, 5 benign diseases, 3 suspicious cancers, 1 negative and 2 unsatisfied samples. In 7 lung cancer patients staged by EBUS-TBNA, 5 showed metastasis and 2 showed no metastasis. In 21 cases with mediastinal and/or hilar lymphadenopathy, EBUS-TBNA demonstrated 3 malignant tumors, 13 benign diseases, 2 negative and 3 unsatisfied samples. All 5 mediastinal lesions were malignant. Three suspicious cancers were confirmed, 1 by CT-guided percutaneous transthoracic needle biopsy and 2 by clinical follow-ups. In 2 lung cancer patients EBUS-TBNA showed negative, 1 surgical sample showed metastasis and another no metastasis by PET-CT. Three negative cases were diagnosed as benign by clinical follow-ups. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were 95%, 100%, 100% and 20% respectively. CONCLUSION: EBUS-TBNA is both effective and safe in making a diagnosis of intrathoracic lesions.

[Application of video assisted thoracic surgery for chest tumors: experience of 144 cases in a single institution].

OBJECTIVE: To evaluate the indication and safety of video assisted thoracic surgery (VATS) for chest tumors. METHODS: Data of 144 consecutive patients receiving VATS between January and November 2009 in Cancer hospital Chinese Academy of Medical Sciences were retrospectively reviewed. RESULTS: There was no conversion to open thoracotomy. Overall morbidity rate was 2.08% (3/144) and mortality rate was 0.69% (1/144). There were no significant differences for operative time, number of nodal dissection, morbidity rate, mortality rate, overall hospitalization and postoperative length of stay between VATS lobectomy group and open thoracotomy (OT) lobectomy group. Chest tube duration was shorter in the VATS lobectomy group than OT lobectomy group and more early-stage lung cancer patients were found in VATS group. There were no significant differences for number of nodal dissection, chest tube duration, morbidity rate, mortality rate, and postoperative length of stay between VATS lung wedge resection group and OT lung wedge resection group. Operative time and overall hospitalization were shorter in the VATS wedge resection group than OT wedge resection group. CONCLUSION: Morbidity and mortality rate of VATS were acceptable. VATS lobectomy can be used as an alternative surgical technique for early-stage lung cancer. For lung wedge resection, VATS was superior than OT.

[Diagnostic value of transbronchial needle aspiration combined with transesophageal endoscopic ultrasound-guided fine needle aspiration in mediastinal and pulmonary hilar lesions].

OBJECTIVE: To evaluate the value of transbronchial needle aspiration (TBNA) combined with transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis of mediastinal and pulmonary hilar lesions as well as in the lymph node staging (N staging) of lung cancer. METHODS: 129 patients with mediastinal and pulmonary hilar lesions underwent either TBNA or EUS-FNA with cytological needle aspiration. The samples obtained from TBNA or EUS-FNA were examined by both cytologiy and histopathology. RESULTS: Of the 129 patients, 59 underwent TBNA and 70 EUS-FNA. The diagnostic rate were 84.7% (50/59) by TBNA and 94.3% (66/70) by EUS-FNA, resepectively. The diagnosis of 116 (89.9%) patients were confirmed by either TBNA or EUS-FNA. The pathological and cytological diagnostic rates were 92.2% (107/116) and 88.0% (102/116), resepectively. The diagnostic rate was elevated by 8.4% (9/107) through pathological examination. The histological classification rates by cytological and pathological examination were 73.8% (76/116) and 89.3% (92/103), respectively. The diagnostic rate of histological classification was elevated by 35.5% (27/76) through pathological examination. CONCLUSION: The combination of TBNA and EUS-FNA can improve the diagnostic rate for wider mediastinal and pulmlonary hilar lesions. Pathological examination of the samples obtained from the TBNA and EUS-FNA can elevate not only the rate of diagnosis but also the rate of histological classification.

Adjuvant radiotherapy for stage pN1M0 esophageal squamous cell carcinoma: Results from a Chinese two-center study.

BACKGROUND: Whether postoperative radiotherapy is beneficial in the treatment of esophageal squamous cell carcinoma with one or two regional lymph node (LN) metastases (pN1) after esophagectomy is uncertain. This study aimed to explore the effect of postoperative radiotherapy (PORT) on survival. METHODS: Propensity score-matching (PSM) analysis was conducted to balance the two arms (surgery only [S] or surgery plus postoperative radiotherapy [PORT]). The survival rate was calculated by the Kaplan-Meier method and analyzed using the log-rank test. RESULTS: A total of 992 cases confirmed positive for one or two regional LN metastases were eligible. After PSM, 622 patients were reviewed. Each group consisted of 311 cases. The median follow-up was 80.7 months. For the overall cohort, the one-, three- and five-year overall survival (OS) were 90.6%, 51.9% and 38.2%, respectively. Disease-free survival (DFS) was 76.0%, 41.4% and 32.1%, respectively. The five-year OS and DFS were 45.0% and 39.8% for PORT, which was significantly higher than the S group (31.3% and 24.2%, both P < 0.001). On subgroup analysis, PORT was associated with improved OS and DFS for patients with pathological stage pT3-4N1M0, compared with S group (five-year OS 41.3% vs. 23.5%, P < 0.001; five-year DFS 35.8% vs. 18.8%, P < 0.001). However, for pT1-2N1M0 patients, PORT did not benefit OS and DFS compared with S (P = 0.063). CONCLUSIONS: In summary, the addition of PORT after esophagectomy was associated with a statistically significant improvement in OS and DFS for patients with pathological one or two lymph-node positive pathology, in particular for stage pT3-4N1M0 patients.

[Primary soft tissue sarcomas of mediastinum: experience in 22 cases from a single institution].

OBJECTIVE: To assess the presentation, imaging features, and prognostic factors of primary soft tissue sarcoma of mediastinum. METHODS: The clinical data of 22 patients with primary soft tissue sarcoma of mediastinum, 12 males and 10 females, aged 46 (28-69), hospitalized over 27 years were retrospectively reviewed, focusing on the clinical presentations, preoperative diagnosis, imaging features, immunohistochemical studies, treatment, and survival. RESULTS: Chest pain, dyspnea, cough, and shoulder pain were the most common complaints. Imaging findings showed large lobulated mass. The overall 5-year survival rate was 62. 8%. The 5-year survival rate of the patients with tumors larger than 10 cm was 65.6%, significantly higher than that of the patients with tumors smaller than 10 cm (38.8% , P = 0. 019). The long-term survival rate of the patients who received complete resection was 84 months , longer, though not significantly, than that of the patients who received incomplete resection (8 months, P = 0.059). The 5-year survival rate of the patients with lesions at high grade and stage III were 38.2% and 38.2% respectively, both lower, though not significantly, than those of lesions at low grade and stage I (60% and 60% respectively, both P =0.317). The 5-year survival rate of the patients who received surgery only was 8 months, shorter, though not significantly, than that of the patients who received surgery plus adjuvant therapy (12 months, P = 0.204). CONCLUSION: Tumor size and character of resection are important prognostic factors for primary soft tissue sarcoma of mediastinum.