Genetic polymorphism and gene expression of microsomal epoxide hydrolase in non-small cell lung cancer.

Genetic polymorphisms of microsomal epoxide hydrolase (mEH) have been associated with increased risk of lung cancer. However, expression of mEH and its clinical significance in non-small cell lung cancer (NSCLC) have not been investigated. In this study we investigated the expression and genetic polymorphism of mEH in non-small cell lung cancer (NSCLC) patients. Genetic polymorphism was determined by restriction fragment length polymorphism of polymerase chain reaction (PCR) products. The allelic expression pattern as well as expression level of mEH were determined by reverse transcription-PCR (RT-PCR), cDNA sequencing, sequence alignment, immunoblotting and immunohistochemistry. Genotype distributions of mEH in Taiwan's NSCLC patients were 44.4% of 340TAC/340TAC, 48.6% of 340TAC/340CAC, and 7.0% of 340CAC/340CAC in exon 3, and 80.6% of 418CAT/418CAT, 19.4% of 418CAT/418CGT and 0% of 418CGT/418CGT in exon 4. Of the 72 NSCLC biopsies analyzed, mEH was expressed in 60 (83%) surgical specimens, and the major allelic expression pattern was fast type (Tyr113) in exon 3 (90.3%) and slow type (His139) in exon 4 (100%). Immunohistochemical staining showed that mEH was expressed in 326 of 423 (77.0%) tumor (lung tissue) specimens and in 48 of 93 (51.6%) metastatic lymph nodes. A significant difference in patient survival was found when mEH expression and adriamycin-containing chemotherapy were used to group patients (p=0.0167). In conclusion, with the combination of fast type (Tyr113) and slow type (His139), the mEH enzyme expressed in most NSCLC patients may have intermediate activity. Our findings indicate that with respect to cancer risk and disease progression, the expression level of mEH is as important as genetic polymorphism. In addition, mEH expression in NSCLC could be involved in drug resistance and prognosis of patients.

Overexpression of aldo-keto reductase 1C2 as a high-risk factor in bladder cancer.

Intravesical adjuvant chemotherapy and neoadjuvant chemotherapy has been respectively administered for superficial transitional cell carcinoma (TCC) of urinary bladder and advanced TCC for years. However, the therapeutic efficacy is limited. Recently, overexpression of aldo-keto reductase (AKR) in lung, esophageal, uterine cervical and ovarian cancers was shown to be closely associated with disease progression and drug resistance. In this study, we used immunohistochemistry to determine AKR expression in pathological specimens of 347 patients with urinary bladder cancer (UBC). Some of these patients were from areas with a high risk of black foot disease (BFD), a disease that is closely associated with arsenic contamination of drinking water. The presence of AKR was confirmed by immunoblotting, matrix-assisted laser desorption/ ionization time of flight mass spectrometry (MALDI-TOF) and reverse transcription-polymerase chain reaction (RT-PCR). AKR isotype was determined by cDNA sequencing. Our results showed overexpression of AKR1C2 in 226 (65.1%) patients. BFD areas had a higher frequency of patients expressing AKR1C2 in UBC. Among AKR1C2-positive UBC, 148 (65.5%) were invasive, 70 (31.0%) were non-invasive and 8 (3.5%) were carcinoma in situ (CIS). These data indicated that AKR1C2 expression could be significantly associated with cancer invasiveness (p<0.001) and disease progression. Because BFD has been closely related to arsenic ingestion, our results suggested that continual intake of arsenic in drinking water might provoke AKR1C2 expression that could in turn induce drug resistance in UBC, and AKR1C2 could be a tumor marker for UBC.

Aberrant promoter methylation of EDNRB in lung cancer in Taiwan.

Hypermethylation has been shown in the promoter region of the endothelin receptor B (EDNRB) gene in several human tumors, but its role in lung cancer formation is unclear. In this study, genomic DNA from lung cancer patients was subjected to methylation-specific PCR to determine the methylation status of the EDNRB gene in lung cancer. Aberrant methylation of the EDNRB gene was detected in 32.9% (26 of 79) lung cancer patients. Promoter hypermethylation of EDNRB was found to significantly differ with histological type but was not correlated to other clinicopathological characteristics. Decreased mRNA transcripts were correlated to aberrant methylation. Treatment with 5-aza-deoxycytidine reversed the methylation status and re-expression of the EDNRB gene in the H1355 human lung cancer cell line. Our results suggest that inactivation of the EDNRB gene through epigenetic alteration is highly prevalent in lung cancer in Taiwan.

Cigarette smoking induces overexpression of hepatocyte growth factor in type II pneumocytes and lung cancer cells.

We examined gene expression of hepatocyte growth factor (HGF) and HGF receptor (HGFR), or product of proto-oncogene c-met (c-met), in smokers and nonsmokers with adenocarcinoma (ADC) by suppression subtractive hybridization and microarray techniques. Expression of HGF and c-met was confirmed by RT-PCR. HGF content in the respective tumor mass and nontumor lung tissue was measured by ELISA. HGF in pathologic samples was localized by immunohistochemistry and in situ hybridization. Our results indicate that overexpression of HGFR was frequently detected in ADC cells, whereas overexpression of HGF was detected in alveolar type II (ATII) cells. Overexpression of HGF was correlated with cigarette smoking and tumor stages. In vitro, HGF expression was evaluated in isolated murine ATII cells and in 12 ADC cell lines, and we found that nicotine activated HGF expression in ATII cells and lung cancer cells.

An association of DNMT3b protein expression with P16INK4a promoter hypermethylation in non-smoking female lung cancer with human papillomavirus infection.

Our recent report indicated that HPV infection may be associated with an increased frequency of p16INK4a promoter hypermethylation to cause p16 inactivation. In this study, we further speculated that the HPV infection may be linked with the expression of DNA methyltransferase (DNMT) protein in lung cancer patients and it was observed that an association of p16INK4a promoter hypermethylation with HPV infection existed, but only in female cases (P<0.0001). Interestingly, DNMT3b protein expression was significantly correlated with p16INK4a promoter hypermethylation (P=0.023) and HPV 16/18 infections (P<0.001), respectively. Moreover, the correlation between p16INK4a promoter hypermethylation and DNMT3b protein expression was exclusively seen in female cases (P=0.035). These results strongly suggested that the involvement of HPV infection in nonsmoking female lung tumorigenesis may be mediated, at least to a certain extent, through the increase of DNMT3b protein expression to cause p16INK4a promoter hypermethylation.

NAT2 fast acetylator genotype is associated with an increased risk of lung cancer among never-smoking women in Taiwan.

The correlation between cooking oil fumes, containing relatively higher amounts of heterocyclic amines, and female lung cancer has been revealed. The association of genetic polymorphisms of CYP1A2 and NAT2, two major enzymes responsible for the metabolism of heterocyclic amines, with lung cancer has been investigated with inconclusive results. In this study targeted on never-smoking population with 162 lung cancer patients and 208 non-cancer controls, while the distributions of CYP1A2 phenotypes in lung cancer patients were comparable to that in controls, NAT2 fast acetylators had an OR of 2.44 (95% CI 1.40-4.23, P=0.002) and 2.56 (95% CI 1.37-4.80, P=0.003) for lung cancer in overall and female cases, respectively, but not in males. These results suggested never-smoking females with NAT2 fast acetylator were more prone to lung cancer and reflected the possibility that exposure to heterocyclic amines may contribute to the female lung cancer development in Taiwan.

Comparison between video-assisted thoracoscopic thymectomy and transternal thymectomy for myasthenia gravis (analysis of 82 cases).

Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for myasthenia gravis (MG). We compared the results of video-assisted thoracoscopic thymectomy (VATT) and transternal thymectomy (TT) in Taiwanese people with MG. From January 1997 to August 2002, we enrolled a total of 82 patients with MG who underwent TT and anterior mediastinal adipose tissue removal in our study. Of those, 51 patients underwent VATT, and 31 patients underwent TT. The men-to-women ratios were 18:33 and 15:16 in the VATT and TT groups, respectively. The mean age was 37.9 +/- 17.56 years in the VATT group and 35.6 +/- 16.8 years in the TT group (P = 0.55). Preoperative Osserman's classification revealed the following: class I: 11 (21.6%), 13 (41.9%); class IIA: 18 (35.3%), 11 (35.5%); class IIB: 18 (35.3%), 5 (16.1%); class III: 2 (3.9%), 0; and class IV: 2 (3.9%), 2 (6.5%), respectively, in the two groups (P = 0.06). During VATT, all but two patients were placed supine in the 45 degrees left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1-cm incision wounds over anterior axillary line at the third, fifth, and sixth intercostal spaces were necessary. A total of 82 patients (51 with VATT and 31 with TT) were studied. There were no statistical differences between the two groups of patients in terms of sex, age, and severity of MG. In VATT and TT groups, postoperative hospital stays were 6.1 +/- 3.3 and 26.9 +/- 14.1 days, respectively (P = 0.001). Intensive care unit stays were 1.5 +/- 1.1 and 3.2 +/- 2.3 days, respectively (P = 0.018). Operative times were 180.0 +/- 53.4 and 248.2 +/- 71.9 minutes, respectively (P = 0.004). Thymus weights were 43.7 +/- 22.5 and 52.2 +/- 29.6 g, respectively (P = 0.141). Fifty-one VATT procedures were performed through a right-side approach without conversion. Most patients were extubated in the operating room or recovery room. The harvested thymus glands had an average weight of 49.4 g (range, 21.4-90 g). There were no surgical mortality cases. There was no statistically significant difference (P = 0.574) in the postoperative improvement classification between the two groups, with a mean of 4 years of follow-up. In the VATT group, 14 (27.5%) patients had complete remission without any medication, 14 (27.5%) patients were in class II, 21 (41.1%) patients were in class III, 2 (3.9%) patients were in class IV, and 0 (0%) patients were in class V, according to postoperative classification of DeFilippi et al. We concluded that VATT is technically feasible and safe and is associated with a favorable postoperative outcome compared with the transsternal approach.

Traumatic hemothorax resulting from rupture of mediastinal teratoma: a case report.

Ruptured cystic mature teratoma of anterior mediastinum is rare. This 45-year-old woman complained of sudden onset of chest pain and dyspnea after a traffic accident. Physical examination revealed decrease of breath sounds over the left chest. Chest X-ray showed pleural fluid accumulation of the left pleural cavity. Computed tomography scan of the chest revealed a heterogenous cystic mass lesion approximately 11.5 x 10 x 7 cm in size in the left anterior mediastinum and left pleural effusion. Under the impression of mediastinal tumor and traumatic hemothorax, she received excision of the mediastinal mass and evacuation of left pleural fluid through a left lateral thoracotomy. She recovered uneventfully after operation and was discharged on postoperative day 11.

Endoscopic thoracic sympathetic block by clipping for recurrent palmar hyperhidrosis.

Postoperative complications of endoscopic thoracic sympathectomy may be troublesome in some patients. Between January 1998 and September 2002, a total of 16 patients with recurrent palmar hyperhidrosis underwent video-assisted thoracoscopic T2 and T3 sympathetic block. There were seven men and nine women, with a mean age of 21.1 years (range, 12-35 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the T2 sympathetic block for patients with still intact T2 ganglion using an 8-mm, 0 degrees thoracoscope. An additional T3 block should be given if patients received either previous T2 sympathectomy or elevated palmar temperature <1 degrees C after T2 sympathetic block. The mean operation time was 30 minutes. The level of sympathetic blocks were the T2 and T3 in five patients, only T2 block in four, patients, and only T3 block in seven patients. Improvement of palmar hyperhidrosis can be obtained in all patients. One patient received a reverse operation 12 days after the T2 and T3 clipping and obtained improvement of troublesome compensatory sweating and dry hands 1 day after removal of all clips. All patients obtained improvement of palmar hyperhidrosis without recurrence after a mean of 37.1 months of follow-up (range, 12-56 months). Endoscopic thoracic T2 with or without T3 sympathetic block by clipping is a safe and effective method in treating patients with recurrent palmar hyperhidrosis.

Combination of video-assisted thoracoscopic surgery and hand-assisted laparoscopic surgery for early cancer of the thoracic esophagus.

From June 1997 to July 2002, we enrolled 10 patients with T1 esophageal squamous cell carcinoma according to the findings of chest computerized tomography scans and transesophageal ultrasound. There were nine men and one woman. The average age was 57.1 years (range, 43-70 years). We performed a combination of video-assisted thoracoscopic surgery including endoscopic esophageal mobilization and mediastinal lymph nodes dissection for early thoracic esophageal carcinoma as well as hand-assisted laparoscopic gastric mobilization as an esophageal substitute under double-lumen intubated anesthesia. The average operative time was 330 minutes (range, 290-425 minutes). The average hospital stay was 11.2 days (range, 9-17 days). There was no surgical mortality or severe complication except one mild leakage of cervical esophagogastrostomy. All patients have tolerated solid food well and are still alive, without evidence of tumor recurrence, after a mean of 37.2 months of follow-up (range, 9-62 months). In conclusion, we suggest that a combination of video-assisted thoracoscopic esophageal mobilization and mediastinal lymph nodes dissection and hand-assisted laparoscopic mobilization of stomach via a hand-port device for esophageal reconstruction is a safe and feasible operation for patients with T1 thoracic esophageal carcinoma.

Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis.

The bronchiectasis process is irreversible, and only resection of the involved bronchiectatic segments offers the possibility of potential cure. We present our experience in video-assisted thoracoscopic lobectomy for localized right middle lobe bronchiectasis in 16 patients. From July 1994 to June 2002, we enrolled 16 patients with right middle lobe bronchiectasis. There were nine women and seven men, with a mean age of 39.7 years (range, 21-67 years). The mean duration of symptoms such as hemoptysis and chronic purulent productive cough was 7.3 years (range, 2-19 years). Surgical indications included repeat pulmonary infection with often abundant purulent, sometimes fetid, expectoration in eight patients (50%), frequent massive hemoptysis in four patients (25%), and both repeat pulmonary infection and hemoptysis in four patients (25%). During operation, all patients were placed in left lateral position under double-lumen intubated anesthesia. Three incisions were needed. One 1-cm incision for the camera port was created at the seventh intercostal space along the anterior axillary line and the other 1- and 4-cm incisions were created at the seventh and fifth intercostal spaces along the midclavicular line. Right middle lobectomy could be completed by use of either traditional or endoscopic instruments. The mean total operative time was 87 minutes (range, 60-110 minutes). The mean hospital stay was 6 days (range, 4-11 days). One patient suffered from a mild hemothorax complication that needed 10 days of pleural drainage. There was no surgical mortality in this study. The mean follow-up period was 45 months (range, 10-94 months). Overall, 14 (87.5%) patients were asymptomatic, and the other 2 (12.5%) obtained apparent symptomatic improvement after operation. Video-assisted thoracoscopic lobectomy for right middle lobe bronchiectasis is technically feasible using our approach and is potential safe in treating patients with localized right middle lobe bronchiectasis.

Gender difference in human papillomarvirus infection for non-small cell lung cancer in Taiwan.

Our previous reports have indicated that high risk human papillomarvirus (HPV) 16/18 were much more frequently detected in lung tumors of female patients as compared to that of male patients and HPV 16/18 in lung tumors were evolutionally correlated with those in blood circulation. In the other hand, it is well known that HPV 6/11 are frequently associated with upper aerodigestive and respiratory diseases. HPV 6/11 DNA were detected in lung tumors by nested PCR and in situ hybridization to investigate if any difference in prevalent types of HPV exists between genders. Our data showed that HPV 6 infection was detected in 28.4% (40 of 141) lung tumors, which was significantly higher than that in non-cancer controls (1.7%, 1 of 60; P < 0.0001), however, such high prevalence was not observed for HPV 11. Among studied clinico-pathological parameters, HPV 6 infection was significantly related with gender (P = 0.002) and smoking status (P = 0.014). After being stratified by gender and smoking status, HPV 6 infection rate in lung tumors of non-smoking male patients was much higher than that in non-smoking female patients (33.3% versus 11.1%; P = 0.023), but no difference between smoking and non-smoking male patients (38.1% versus 33.3%). With adjustments for age, tumor type, and tumor stage, smoking male lung cancer patients had a much higher OR value (OR, 7.35; 95%CI, 2.11-25.58) for HPV 6 infection compared with 3.93 (95% CI, 1.17-13.12) of non-smoking male patients. Moreover, a higher prevalence of HPV 6 was detected in lung tumors of smoking male patients with early tumor stage than those with advanced stages (P = 0.008), but not in non-smoking male and female patients. A higher prevalence of HPV 6 in male lung cancer patients, as compared with female lung cancer patients, indicating not only different HPV infection routes for different genders, but also that HPV 6 infections may act as a prospective early risk marker of lung cancer for smoking male patients in Taiwan.

Expression spectra of matrix metalloproteinases in metastatic non-small cell lung cancer.

By combining suppression subtractive hybridization and microarray to examine gene expressions between metastatic and non-metastatic non-small cell lung cancer (NSCLC), we have identified differential expression spectra of matrix metalloproteinases (MMP). Among MMPs, expressions of MMP-13, -14, -15 and -24 decreased, those of MMP-9, -11, -12, -16, -17, -19 and -23B did not change, and those of MMP-1, -2, -7, -8 and -10 increased dramatically. Overexpressions of MMP-1, -2, -7 and -10 were confirmed by reverse transcription-polymerase chain reaction. In this study we further assessed the clinical significance of MMP-1, -2, -7 and -10. Specimens from 472 patients with completely resected NSCLC were examined by immunohistochemistry. The median follow-up period was 38 months (range, 2-113 months). Overexpression of MMP-1 was observed in 72.9% (n=344) of 472 patients, that of MMP-2 was 77.9% (n=352), MMP-7 63.3% (n=299) and that of MMP-10 was 27.1% (n=128). For patients with lymph node metastasis, MMP-1 and -2 overexpressions were not only independent prognostic factors for unfavorable outcome, but also associated with decreased survival (p=0.0015, and p=0.011 respectively). The present study showed that MMP expression spectrum in NSCLC was heterogeneous: expression of some MMP increased, some unchanged, while some decreased. Therefore, it should be worth determining MMP expression pattern as a regimen reference for NSCLC patients who were scheduled to receive MMP inhibitor, which was class-specific, as adjuvant therapeutic agent.

Treatment of palmar hyperhidrosis using needlescopic T2 sympathetic block by clipping: analysis of 102 cases.

Endoscopic thoracic sympathicotomy, or sympathectomy by a 2-mm scope, is an effective method for treating palmar hyperhidrosis. However, postoperative compensatory sweating may be troublesome in some patients. We report needlescopic T2 sympathetic block by clipping, which may provide reverse operation for patients encountering compensatory sweating. Between January 1998 and January 2002, a total of 102 patients with palmar hyperhidrosis underwent video-assisted thoracoscopic sympathetic blocking of the T2 ganglion. There were 47 males and 55 females (mean age, 24.1 years; range, 9-50 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed T2 sympathetic block by clipping at the second and third intercostal spaces using a 2-mm, 0 degrees thoracoscope. Among these 102 patients, all bilateral T2 sympathetic blockings were achieved. The operation was usually accomplished within 30 minutes (range, 16-40 minutes). All patients were discharged within 4 hours after the operation. There were no surgical complications or surgical mortality cases. The mean postoperative follow-up period was 37.1 months (range, 16-64 months). Improvement of palmar hyperhidrosis can be obtained in all patients. Eighty-six patients (84%) have developed compensatory sweating of the trunk and lower limbs. Two patients had a reverse operation and had improvement of compensatory sweating at 2 and 13 days after removal of endo clips. Needlescopic T2 sympathetic block by clipping is a safe and effective method for treating palmar hyperhidrosis; compensatory sweating may be improved after reverse operation removal of endo clip.

Prognostic significance of CD44v5 expression in human thymic epithelial neoplasms.

BACKGROUND: Cell surface glycoproteins of the CD44 family play roles in cell-cell and cell-matrix interactions. Their aberrant expression has been implicated in tumor invasion and metastasis of a variety of neoplasms, but not, to date, of thymic epithelial tumors. METHODS: To investigate the expression of CD44 molecules, immunohistochemical staining using monoclonal antibodies against human CD44 standard form (CD44 s) and two common splicing variant (CD44v) isoforms, CD44v5 and CD44v6, was performed on 64 resected thymomas and 20 normal thymuses. These tumors were categorized histologically according to the World Health Organization (WHO) histologic classification, and the pathologic staging was classified according to the definitions of Masaoka. RESULTS: The positive expression rates in these patients were as follows: CD44 s (normal thymuses, 10%; thymomas, 22%), CD44v5 (normal thymuses, 0%; thymomas, 67%), and CD44v6 (normal thymuses, 0%; thymomas, 26%). CD44 s and CD44v5 immunoreactivity showed a positive correlation with tumor stages (p = 0.034 and 0.027, respectively). The CD44v5 expression of neoplastic cells in tumor capsules has significant correlation with tumor stages (II, 5%; III, 70%; IVA, 100%; p < 0.001). On the basis of univariate survival analysis, the Masaoka staging system, WHO histologic classification, and CD44v5 expression showed a statistically significant positive relation to survival (p < 0.001, 0.002, 0.011, respectively). Using Cox's regression model, increasing CD44v5 expression, the Masaoka staging, and the WHO classification system were found to be significant independent prognostic factors. CONCLUSIONS: CD44v5 expression is independently positively correlated with the aggressiveness of thymic epithelial tumors. The expression of CD44v5 may be a potential trigger of tumor invasion in thymomas.

Hand-assisted laparoscopic colon mobilization for esophageal reconstruction.

BACKGROUND: New techniques for hand-assisted laparoscopic colon surgery have been adopted quickly for the treatment of numerous colorectal diseases. However, reports of laparoscopic colonic mobilization for esophageal reconstruction are rare. In this report we describe an improved procedure for esophageal reconstruction with transverse colon. METHODS: From January 1999 to April 2001, we recruited seven patients (5 women and 2 men) who acquired esophageal stricture after swallowing hydrogen chloride or lye. The mean age of the patients was 42.7 years. For surgery, the patients were placed in lithotomy position under single-lumen intubated anesthesia. First, hand-assisted laparoscopic colon mobilization was performed with the assistance of the Harmonic Scalpel (AutoSuture Company, Norwalk, CT, USA) through a 7-cm upper abdominal incision. Then using cervical esophagocolostomy through the retrosternal route, coloenterostomy and colocolostomy were achieved. RESULTS: The mean operative time was 3.9 h (range, 3.2-5 h). The mean hospital stay was 9.1 days (range, 8-13 days). Mean blood loss was 100 ml (range, 50-350 ml). All the patients obtained successful outcomes. There was one mild abdominal wound infection, and no surgical mortality. At this writing, the seven patients can eat solid food very well after a mean follow-up period of 18.2 months. CONCLUSIONS: Hand-assisted laparoscopic colonic mobilization for esophageal reconstruction is a safe and feasible operation for treating patients with esophageal stricture.

Uniportal endoscopic thoracic sympathectomy for treatment of palmar and axillary hyperhidrosis: analysis of 2000 cases.

OBJECTIVE: Primary hyperhidrosis of the upper limbs is a common and troublesome condition in Taiwan. Therefore, we present our experience in treating hyperhidrosis via uniportal endoscopic thoracic sympathectomy. METHODS: Between April 1993 and March 2000, a total of 2000 patients underwent endoscopic thoracic sympathectomy for treatment of palmar or axillary hyperhidrosis. There were 1520 patients with palmar hyperhidrosis and 480 patients with axillary hyperhidrosis. There were 788 male and 1212 female patients, with a mean age of 22.9 years (range, 9-60 yr). All patients were placed in a semi-sitting position, with single-lumen-intubation anesthesia. We performed T2 sympathectomy at the second and third rib beds for patients with palmar hyperhidrosis, using an 8-mm, 0-degree, offset thoracoscope (Karl Storz GmbH & Co., Tuttlingen, Germany), via a 0.8-cm incision below each axilla. Similar procedures were used for T3 and T4 sympathectomies at the third, fourth, and fifth rib beds for patients with axillary hyperhidrosis. Questionnaires were sent to all patients after surgery. RESULTS: Among these 2000 patients, successful bilateral sympathectomies were performed for 1992 patients. The operations were usually completed within 20 minutes (range, 10-30 min). Most patients were discharged within 4 hours after surgery. The surgical complications were minimal, including pneumothorax (10 cases, 0.5%), segmental atelectasis (7 cases, 0.35%), hemothorax (2 cases, 0.1%), and mild wound infections (2 cases, 0.1%). There were no surgery-related deaths. The mean postoperative follow-up period was 51.7 months (range, 6-89 mo). A total of 1720 patients (86%) developed compensatory sweating of the trunk and lower limbs. The recurrence rates for palmar and axillary hyperhidrosis after surgery were 0 and 4.1% in the first year, 0.1 and 8.2% in the second year, 0.5 and 10.4% in the third year, 0.6 and 14.1% in the fourth year, and 1.3 and 16.7% in the fifth year, respectively. CONCLUSION: Uniportal endoscopic thoracic sympathectomy is a safe, effective method for the treatment of patients with palmar or axillary hyperhidrosis. For surgery, both a semi-sitting position and single-lumen-intubation anesthesia are recommended.