Primary lung cancer in children and adolescents.

PURPOSE: Primary lung cancer is extremely rare in children and adolescents. The aim of this study is to clarify clinical features and outcomes of primary lung cancer in children and adolescents. METHODS: Young patients (aged ≤ 20 years) diagnosed as primary lung cancer between 2012 and 2023 were retrospective reviewed. According to radiological appearance of the nodules, they were divided into solid nodule (SN) group and ground glass opacity (GGO) group. RESULTS: A total of 74 patients were identified, with a median age at diagnosis of 18 years old (range: 11-20), including 7 patients in SN group and 67 patients in GGO group. In the GGO group, none of the nodules enlarged or changed during an average surveillance period of 10.8 months before surgery, except one. Wedge resection was the most common procedure (82.1%), followed by segmentectomy (16.4%) and lobectomy (1.5%). Histopathological analysis revealed that 64.2% of GGO nodules were adenocarcinoma in situ and minimally invasive adenocarcinomas, while the remaining 35.8% were invasive adenocarcinomas. Mutational analysis was performed in nine patients, with mutations identified in all cases. After a mean follow-up period of 1.73 ± 1.62 years, two patients in the SN group died due to multiple distant metastases, while all patients in the GGO group survived without recurrence. The overall survival (100%) of the GGO group was significantly higher than SN group (66.7%). CONCLUSIONS: Primary lung cancer in children and adolescents are rare and histopathological heterogeneous. Persistent GGO nodules may indicate early-stage lung adenocarcinoma in children and adolescents.

Efficacy of neoadjuvant immunochemotherapy and survival surrogate analysis of neoadjuvant treatment in IB-IIIB lung squamous cell carcinoma.

Until now, there are still few comparisons between neoadjuvant immunochemotherapy and chemotherapy as first-line treatment for patients with stage IB-IIIB lung squamous cell carcinoma (LUSC). In addition, the ability of pathologic response to predict long-term survival has still not been established. In this retrospective, controlled clinical trial, we ultimately enrolled 231 patients with stage IB to IIIB LUSC who received 2-4 cycles perioperative immunochemotherapy or chemotherapy alone, followed by resection. The primary endpoint of this study was pathological response. Secondary endpoints were disease-free survival (DFS), overall survival (OS), objective response rate (ORR), surgical resection rate and adverse events (AEs). The rates of major pathologic response (MPR) and pathologic complete response (pCR) in the immunochemotherapy group were 66.7% and 41.9%, respectively, which were both higher than that in the other group (MPR: 25.0%, pCR: 20.8%) (P < 0.001). The median DFS in the chemotherapy group was 33.1 months (95% CI 8.4 to 57.8) and not reached in the immunochemotherapy group (hazard ratio [HR] for disease progression, disease recurrence, or death, 0.543; 95% CI 0.303 to 0.974; P = 0.038). The median OS of the immunochemotherapy group was not achieved (HR for death, 0.747; 95% CI 0.373 to 1.495; P = 0.41), with the chemotherapy group 64.8 months (95% CI not reached to not reached). The objective response rate (ORR) of immunochemotherapy regimen was higher than that of the chemotherapy regimen (immunochemotherapy: 74.5%, chemotherapy: 42.3%, P < 0.001). About 60.8% in the immunochemotherapy group and 61.5% in the chemotherapy group eventually underwent surgery. The incidence of grade3 and 4 adverse events was 18.3% in the immunochemotherapy group and 2.6% in the chemotherapy group. MPR was significantly associated with DFS and OS (HR, 0.325; 95% CI 0.127 to 0.833; P = 0.019; and HR, 0. 906; 95% CI 0.092 to 1.008; P = 0.051, respectively). The C-index of MPR (0.730 for DFS, 0.722 for OS) was higher than the C-index of cPR (0.672 for DFS, 0.659 for OS) and clinical response (0.426 for DFS, 0.542 for OS). Therapeutic regimen (P < 0.001; OR = 7.406; 95% CI 3.054 to 17.960) was significantly correlated with MPR. In patients with stage IB to IIIB LUSC, neoadjuvant treatment with immunochemotherapy can produce a higher percentage of patients with a MPR and longer survival than chemotherapy alone. MPR may serve as a surrogate endpoint of survival to evaluate neoadjuvant therapy.

Prevalence of ground glass nodules in preschool children: a cross-sectional study.

Background: Following increased screening efforts and the use of thin-slice computed tomography (CT), there has been a considerable increase in the incidence of ground-glass nodules (GGNs) in adults. As a result, we have more and more treatments for ground-glass nodules in adults, but few in children. Most think development pattern of pulmonary GGNs is lung inflammation, tumor, or tuberculosis that are more related to acquired or environmental factors. By studying the incidence of pulmonary GGNs in preschool children, we sought to determine whether we had ground glass nodules in the lung before we were teenagers, but we didn't pay attention to them until later. If the hypothesis holds, we may change the cognition and treatment strategies of ground glass nodules. Even not, there are few epidemiological studies with big data that can fill this gap. Methods: We retrospectively collected the data of all preschool children who had undergone CT at the Children's Hospital of Zhejiang University School of Medicine from 2013 to 2020. These data were filtered according to the following exclusion criteria: severe artifacts, data with identical names to the original data; and patients without follow-up records (≥3 months). Inclusion criteria: must have undergone thin-slice CT (≤1.25 mm) at the first and last follow-up. Two thoracic radiologists with 5 years of experience and another senior one assessed the images. Results: There were a total of 13,361 cases after relevant exclusions, 311 patients were finally enrolled. Clinical features: age at diagnosis (year): 3.56±1.84, female: 147, male: 164, follow-up interval (month): 6.90±4.74, leukemia: 99, pneumonia: 21, lung cyst: 8, space-occupying lesions outside the lungs: 69, foreign body in respiratory tract: 6. After manual screening and reading, only 1 patient meets all requirements. The results showed that between 2013 and 2020, the incidence of GGNs that could be basically determined in the Children's Hospital of Zhejiang University School of Medicine was 0.32%. Conclusions: There have been few previous studies of GGNs in children, and based on our study, we found that there is still some associated morbidity for preschool children, it is rarely found when they are young.

The microbiome of lower respiratory tract and tumor tissue in lung cancer manifested as radiological ground-glass opacity.

Recent studies have confirmed the existence of microbiota in the lungs. The relationship between lung ground-glass opacity (GGO) and microbiota in the lung microenvironment is not clear. In this study, we investigated the microbial composition and diversity in bronchoalveolar lavage fluid (BALF) of diseased lung segments and paired contralateral healthy lung segments from 11 GGO patients. Furthermore, lung GGO and paired normal tissues of 26 GGO patients were explored whether there are microbial characteristics related to GGO. Compared with the control group, the community richness of GGO tissue and BALF of GGO lung segment (α-diversity) and overall microbiome difference (ß-diversity) had no significant difference. The microbiome composition of BALF of GGO segments is distinct from that of paired healthy lung segments [genus (Rothia), order (Lachnospiraceae), family (Lachnospiraceae), genus (Lachnospiraceae_NK4A136_group, Faecalibacterium), and species (Faecalibacterium prausnitzii, Bacteroides uniforms)]. GGO tissue and adjacent lung tissue had more significant differences at the levels of class, order, family, genus, and species level, and most of them are enriched in normal lung tissue. The area under the curve (AUC) using 10 genera-based biomarkers to predict GGO was 91.05% (95% CI: 81.93-100%). In conclusion, this study demonstrates there are significant differences in the lower respiratory tract and lung microbiome between GGO and the non-malignant control group through the BALF and lung tissues. Furthermore, some potential bacterial biomarkers showed good performance to predict GGO.

Does a thoracoscopic approach provide better outcomes for pulmonary metastases?

Traditional open thoracotomy (OT) is the gold standard treatment for patients with pulmonary metastases. However, it remains controversial whether video-assisted thoracic surgery (VATS) can provide comparable outcomes to OT. We conducted this review to compare the outcomes of VATS with OT in pulmonary metastasectomy (PM). Relevant studies published up to November 2019 were identified from PubMed data base and screened. Studies were then selected by the researchers based on our selection criteria. Data including the type of study, patient groups, outcomes and key results were extracted from the included studies and summarized. Screening of 2,788 papers identified 9 that were relevant to our research question. The authors, dates of publication, journal details, type of study, patient groups, outcomes and key results from these papers were summarized. All 9 studies documented the survival rate (1-, 3- and 5-year survival). Metastases from colorectal cancer were investigated in three studies, and metastases from sarcoma were investigated in one study. The overall survival rate of VATS was not inferior to that of OT in patients with pulmonary metastases. VATS was also associated with better perioperative results compared with OT. In conclusion, VATS is suitable as an alternative surgical technique for PM.

A nomogram for predicting the risk of lymph node metastasis in T1-2 non-small-cell lung cancer based on PET/CT and clinical characteristics.

BACKGROUND: Accurately predicting the risk level for a lymph node metastasis is critical in the treatment of non-small cell lung cancer (NSCLC). This study aimed to construct a novel nomogram to identify patients with a risk of lymph node metastasis in T1-2 NSCLC based on positron emission tomography/computed tomography (PET/CT) and clinical characteristics. METHODS: From January 2011 to November 2017, the records of 318 consecutive patients who had undergone PET/CT examination within 30 days before surgical resection for clinical T1-2 NSCLC were retrospectively reviewed. A nomogram to predict the risk of lymph node metastasis was constructed. The model was confirmed using bootstrap resampling, and an independent validation cohort contained 156 patients from June 2017 to February 2020 at another institution. RESULTS: Six factors [age, tumor location, histology, the lymph node maximum standardized uptake value (SUVmax), the tumor SUVmax and the carcinoembryonic antigen (CEA) value] were identified and entered into the nomogram. The nomogram developed based on the analysis showed robust discrimination, with an area under the receiver operating characteristic curve of 0.858 in the primary cohort and 0.749 in the validation cohort. The calibration curve for the probability of lymph node metastasis showed excellent concordance between the predicted and actual results. Decision curve analysis suggested that the nomogram was clinically useful. CONCLUSIONS: We set up and validated a novel and effective nomogram that can predict the risk of lymph node metastasis for individual patients with T1-2 NSCLC. This model may help clinicians to make treatment recommendations for individuals.

Heat shock factor 5 correlated with immune infiltration serves as a prognostic biomarker in lung adenocarcinoma.

Lung adenocarcinoma (LUAD) is the predominant subtype of lung cancer with a relatively poor prognosis. The dramatic improvements of new immunotherapy strategies have shown promising results in lung cancer patients. This study aimed to elucidate the functions of immune-associated genes in LUAD prognosis and pathogenesis by analyzing public databases. We obtained expression profiles of LUAD patients from The Cancer Genome Atlas (TCGA) database and applied the ESTIMATE algorithm to calculate immune scores and stromal scores. A series of microenvironment-related genes with prognostic value was then identified. Of note, heat shock factor 5 (HSF5) was found to be decreased in LUAD patients and positively correlated with overall survival, which was further confirmed in the Gene Expression Omnibus (GEO) database. Moreover, Gene Ontology (GO) analysis based on the correlated genes of HSF5 demonstrated that HSF5 expression was significantly associated with the immune response and inflammatory activities. Based on the Tumor IMmune Estimation Resource (TIMER) and Gene Expression Profiling Interactive Analysis (GEPIA) datasets, HSF5 expression showed strong correlations with various immune cell infiltration and diverse immune marker sets. These findings suggest that HSF5 can be used as a promising biomarker for determining prognosis and immune infiltration in LUAD patients.

H3K27ac-activated LINC00519 promotes lung squamous cell carcinoma progression by targeting miR-450b-5p/miR-515-5p/YAP1 axis.

OBJECTIVES: Long non-coding RNAs (lncRNAs) are extensively reported as participants in the biological process of diverse malignancies, including lung squamous cell carcinoma (LUSC). Long intergenic non-protein coding RNA 519 (LINC00519) is identified as a novel lncRNA which has not yet been studied in cancers. MATERIALS AND METHODS: LINC00519 expression was detected by qRT-PCR. The effect of LINC00519 on LUSC cellular activities was determined by in vitro and in vivo assays. Subcellular fractionation and FISH assays were conducted to identify the localization of LINC00519. The interaction between miR-450b-5p/miR-515-5p and LINC00519/YAP1 was verified by RIP, RNA pull-down and luciferase reporter assays. RESULTS: Elevated level of LINC00519 was identified in LUSC tissues and cell lines. High LINC00519 level predicted unsatisfactory prognosis. Then, loss-of-function assays suggested the inhibitive role of silenced LINC00519 in cell proliferation, migration, invasion and tumour growth and promoting effect on cell apoptosis in LUSC. Mechanically, LINC00519 was activated by H3K27 acetylation (H3K27ac). Moreover, LINC00519 sponged miR-450b-5p and miR-515-5p to up-regulate Yes1 associated transcriptional regulator (YAP1). Additionally, miR-450b-5p and miR-515-5p elicited anti-carcinogenic effects in LUSC. Finally, rescue assays validated the effect of LINC00519-miR-450b-5p-miR-515-5p-YAP1 axis in LUSC. CONCLUSIONS: H3K27ac-activated LINC00519 acts as a competing endogenous RNA (ceRNA) to promote LUSC progression by targeting miR-450b-5p/miR-515-5p/YAP1 axis.

Survival rates after lobectomy versus sublobar resection for early-stage right middle lobe non-small cell lung cancer.

BACKGROUND: Lung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early-stage non-small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early-stage right middle lobe NSCLC. METHODS: Patients who underwent lobectomy or sublobar resection for stage IA right middle lobe NSCLC tumors ≤ 2 cm between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results database of 18 registries. Cox regression model analysis was used to evaluate the prognostic factors. The lung cancer-specific survival (LCSS) and overall survival (OS) rates between the two groups were compared. RESULTS: A total of 861 patients met our criteria, including 662 (76.9%) patients who underwent lobectomy and 199 (23.1%) patients who underwent sublobar resection. No statistical differences in LCSS and OS rates were identified between the groups of patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1-2 cm, lobectomy was associated with more favorable LCSS and OS rates compared to sublobar resection. CONCLUSION: Lobectomy and sublobar resection deliver a comparable prognosis for patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1-2 cm, lobectomy showed better survival rates than sublobar resection.

Combination therapy of apatinib with icotinib for primary acquired icotinib resistance in patients with advanced pulmonary adenocarcinoma with EGFR mutation.

Multi-targeted agents represent the next generation of targeted therapies for solid tumors, and patients with acquired resistance to EGFR-tyrosine kinase inhibitors (TKIs) may also benefit from their combination with TKI therapy. Third-generation targeted drugs, such as osimertinib, are very expensive, thus a more economical solution is required. The aim of this study was to explore the use of apatinib combined with icotinib therapy for primary acquired resistance to icotinib in three patients with advanced pulmonary adenocarcinoma with EGFR mutations. We achieved favorable oncologic outcomes in all three patients, with progression-free survival of four to six months. Unfortunately, the patients ultimately had to cease combination therapy because of intolerable adverse effects of hand and foot syndrome and oral ulcers. Combination therapy of apatinib with icotinib for primary acquired resistance to icotinib may be an option for patients with advanced pulmonary adenocarcinoma with EGFR mutations, but physicians must also be aware of the side effects caused by such therapy.

Is thymomectomy sufficient for non-myasthenic early stage thymoma patients? A retrospective, single center experience.

BACKGROUND: Thymic complete resection is considered the standard treatment for all thymic tumors; however, the ideal resection for non-myasthenic early stage thymic tumors has not yet been determined. We conducted a retrospective study to examine this unique scenario. METHODS: We retrospectively analyzed the data of 118 early stage thymoma patients who underwent thymectomy (TM) or thymomectomy (TMM) with curative intent between January 2003 and December 2013 at our institution. Patients with myasthenia, thymic carcinomas, tumors with undetermined histology, and more advanced stage thymoma patients were excluded. We compared overall survival (OS) and disease-free survival (DFS) according to the extent of thymic resection, tumor staging, and size. RESULTS: One hundred and eighteen patients were staged as early thymoma. TM was performed in 43 (35.6%) patients and TMM in 75 (64.4%). Forty-nine (65.3%) patients with a tumor ≤ 3 cm underwent TMM, and 9 (20.9%) TM. Twenty-six (34.7%) patients with a tumor > 3 cm underwent TMM, and 34 (79.1%) TM. Seventy-four patients were categorized as stage I: 57 (76%) underwent TMM and 17 (39.5%) TM. Forty-four patients were categorized as stage II: 18 (24%) underwent TMM and 26 (60.5%) TM. There was no statistically significant difference in recurrence between the groups (P = 0.250). CONCLUSION: No difference in the rate of recurrence was observed in early stage non-myasthenic patients following thymic resection and Masaoka-Koga staging. However, TM is considered a better option for early stage thymoma patients with tumors > 3 cm.

Distribution and prognosis of mediastinal lymph node metastases of nonsmall cell lung cancer.

BACKGROUND AND OBJECTIVE: With the popularity of minimally invasive techniques, preoperatively determining whether mediastinal lymph node dissection (MLD) is necessary for patients with cN1/2 nonsmall cell lung cancer (NSCLC) has sparked controversy once again. This study aims to analyze whether different primary sites are associated with the distribution of mediastinal lymph node metastases and to investigate the necessity of lymph node dissection and the factors influencing prognosis. MATERIALS AND METHODS: One hundred and thirteen patients with pathologically confirmed NSCLC with N2 lymph node metastases were included in the study and were grouped according to the lung lobes, in which primary lesions were located for statistically analyzing the metastatic rates of different mediastinal lymph node stations. Through a 3-year follow-up survey, risk factors influencing the 3-year postoperative survival were analyzed. RESULTS: N2 stations with the highest metastasis rate for different pulmonary lobes were Station 2/4 of the right upper lobe (100%), Station 7 of the right middle/lower lobes (80.0%/88.9%), Station 5 of the left upper lobe (84.4%), and Station 7 of the left lower lobe (78.6%). Three-year survival rate of the cross-regional N2 group was lower than the total N2 group (47.8% vs. 75.3%), P = 0.009 (<0.01). Three-year survival rates for preoperative stages T1 and T2 were superior to stages T3 and T4, showing significant differences (P < 0.05). CONCLUSION: Station 7 is likely the most frequently metastases sites in all mediastinal lymph node stations. Cross-regional metastasis of N2 and staging of T3 and T4 were the risk factors for 3-year survival rate, whereas poor differentiation was not the risk factor. Due to the presence of micrometastases and skip metastases, MLD was first recommended for patients with preoperative stage cN1/2.

Down-Regulation of MiR-1294 is Related to Dismal Prognosis of Patients with Esophageal Squamous Cell Carcinoma through Elevating C-MYC Expression.

AIMS: Changes in the expression of microRNAs (miRNAs) have been found in many cancers. This study aimed to investigate the expression of miR-1294 in patients with esophageal squamous cell carcinoma (ESCC) and its effect on prognosis. The underlying mechanism was explored as well. METHODS: We examined the expression of miRNA in human ESCC cancer tissues and adjacent non-tumor controls using quantitative reverse transcription polymerase chain reaction (qRT-PCR). And the relationship between expressions of miR-1294 and ESCC prognosis was analyzed in this study. Over-expression and knock-down methods were used to investigate the biological functions of miRNA-1294. The effect of miRNA-1294 on cell proliferation was evaluated by MTT. Besides, the function of miR-1294 on cell migration and invasion were evaluated by transwell assays. RESULTS: MiR-1294 was significantly down-regulated in human ESCC tissues compared with the non-tumor controls tissues (P=0.014). And patients with low miR-1294 expression had a significantly poorer prognosis than those with a high miR-1294 expression (P=0.040). Negative association was defined between the expression of miR-1294 and the c-MYC expression in ESCC patients (Pearson correlation, r=-0.299, P=0.0079). Additionally, it was found that miR-1294 suppress esophageal cancer cells proliferation, migration and invasion capacity through targeting c-MYC in vitro. CONCLUSIONS: Down-regulation of miR-1294 correlates with poor prognosis of ESCC. It's partially due to the reduced function of c-MYC. This study may give insight into the understanding of pathogenesis of esophageal cancer and provide evidence for diagnosis and treatment of esophageal cancer.

Rapid and ultrasensitive electrochemical detection of multidrug-resistant bacteria based on nanostructured gold coated ITO electrode.

Rapid and ultrasensitive detection of pathogenic bacteria and their relevant multidrug resistance is particularly important in clinical diagnosis, disease control, and environmental monitoring. In this contribution, we have explored the possibility to rapidly detect some important disease related bacteria based on a nanostructured Au modified indium tin oxide electrode through the antibiotic agents such as doxorubicin. The rapid and real-time electrochemical detection of multidrug resistant bacteria like Escherichia coli and Staphylococcus aureus could be readily realized through the nanostructured Au based biosensor with high sensitivity. The observations of surface-enhanced Raman spectroscopy and laser confocal fluorescence microscopy also demonstrate the effectiveness of the relevant new strategy for the rapid and ultrasensitive electrochemical detection of some disease related bacteria.

Segmentectomy or lobectomy for early stage lung cancer: a meta-analysis.

Early stage lung cancer is routinely treated by lobectomy whenever clinically feasible, whereas the role of segmentectomy is controversial. The purpose of this study was to investigate the benefits of segmentectomy vs lobectomy for early stage lung cancer through a meta-analysis of published data. Eligible studies were identified from MEDLINE through February 2013. The manual selection of relevant studies was based on the summary analysis. We used published hazard ratios (HRs) if available or estimates from the published survival data. Lobectomy was chosen as the reference in all HR calculations. We compared the effect of segmentectomy and lobectomy for Stage I, Stage IA, Stage IA with tumours larger than 2 cm but smaller than 3 cm in size and Stage IA with tumours of 2 cm or smaller in 22 observational studies. The HRs of overall and cancer-specific survival indicated significant benefits of lobectomy for Stage I, Stage IA and Stage IA with tumours larger than 2 cm but smaller than 3 cm at 1.20 (95% confidence interval [CI] 1.04-1.38; P = 0.011), 1.24 (95% CI 1.08-1.42; P = 0.002) and 1.41 (95% CI 1.14-1.71; P = 0.001), respectively. For tumours 2 cm or smaller, segmentectomy provided an effect equivalent to that of lobectomy (HR 1.05; 95% CI 0.89-1.24; P = 0.550). No significant publication bias was detected in any part of the analysis. These findings should be interpreted in the context of the inherent limitations of meta-analyses of retrospective studies, including the heterogeneity of patient characteristics.

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer.

BACKGROUND: Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients. METHODS: We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis. RESULTS: Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis. CONCLUSIONS: Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs.

[Applications of video-assisted thoracic surgery for the diagnosis and treatment of patients with small pulmonary nodules].

BACKGROUND AND OBJECTIVE: Chest computed tomography (CT), particularly thin-slice high resolution CT, has low sensitivity and specificity for detecting pulmonary nodules <10 mm in size. This limitation leads to challenges in clinical diagnosis and treatment of small pulmonary nodules. This study introduces the use of video-assisted thoracoscopic surgery (VATS) for the diagnosis and treatment of small pulmonary nodules. METHODS: From November 2009 to May 2012, 64 patients with small pulmonary nodules without prior preoperative pathologic diagnosis were treated by pulmonary wedge resection through VATS. The diagnosis of small pulmonary nodules was established from rapid frozen section. The type of operation depends on the pathology and the condition of the patients. Twenty patients with primary lung cancer were subjected to lobectomy and radical resection of the lymph nodes by complete thoracospic lobectomy or video-assisted thoracoscopic invasive lobectomy. Pulmonary wedge resection was performed in 44 patients, among whom 21 have benign nodule, 18 have precancerous lesion, 3 have metastatic nodule, and 2 have primary lung cancer for which lobectomy was not fit. RESULTS: Confirmative diagnosis is difficult to obtain among patients with small pulmonary nodules. VATS is effective in the diagnosis and treatment of small pulmonary nodules. With VATS, patients with benign small pulmonary nodules can be cured, and patients with primary lung cancer can receive definite diagnosis and effective treatment in time. CONCLUSIONS: CT-guided hook-wire fixation is useful in precise lesion localization for surgical resection.

Are we really doing better with Hem-o-lok in VATS?

BACKGROUND: Due to advances in clip design, new types of surgical ligation clips are available that may reduce clip failure and improve function, but in the field of minimally invasive thoracic surgery, experience of using Hem-o-lok for pulmonary artery ligation is limited. METHODS: To assess risk factors and predictors of failure of the Hem-o-lok vascular clip, using vessels harvested from a porcine model. RESULTS: The Hem-o-lok clip had the worst holding strength compared to other clips. Its hemostatic ability for pulmonary vessels was far less stable compared with renal and hepatic vessels. The Hem-o-lok clip either leaked or burst when the vessel to which it was applied was cut flush. The clip became even more likely to fail if the vessel sleeve was mobilized too "clean." CONCLUSION: Our experiment proved that the use of Hem-o-lok clips in video-assisted thoracoscopic surgery (VATS) has some potential risk. We recommend that all possible care be taken when it is applied to pulmonary vessels during VATS. Leaving some tissues around vessels may increase the thickness of the vessel, which, in turn, may increase the holding strength.