[Cytokine responses after lobectomy for early non-small cell lung cancer: a prospective randomized comparison of video-assisted thoracic surgery and open thoracotomy].

OBJECTIVE: To compare video-assisted thoracic surgery (VATS) and open thoracotomy (OT) on acute inflammatory responses and immunosuppression after lobectomy for early non-small cell lung cancer (NSCLC). METHODS: Present prospective randomized study. OT or VATS lobectomy was performed in patients who met enter criteria and clinical data was collected. Plasma concentration of IL-6, IL-8 and IL-10 were measured before surgery and at postoperative day (POD) 1 and POD 3. There were 271 patients underwent lobectomy for early NSCLC, including of 133 patients in group VATS and 138 patients in group OT from January 2007 to June 2008. There were 132 males and 139 females, aging from 19 ∼ 70 years with a mean of (56 ± 8) years. RESULTS: Compared with OT group, shorter postoperative hospital stay [(8.2 ± 2.5) d vs. (9.8 ± 6.2) d, P = 0.03], lower morbidity rate (11.3% vs. 21.7%, P = 0.02) and lower increase of plasma concentration of IL-6 at POD 1 [(35 ± 25)% vs. (65 ± 43)%, P = 0.00], IL-6 at POD 3 [(14 ± 22)% vs. (55 ± 44)%, P = 0.00] and IL-10 at POD 1 [(25 ± 20)% vs. (43 ± 35)%, P = 0.00] were observed in patients of VATS group. CONCLUSION: VATS lobectomy for early NSCLC is associated with less acute inflammatory responses and less immunosuppression when compared with OT.

Reconstruction of the lower trachea using a pedicled autologous bronchial flap.

We describe a technique used in a patient for resection of adenoid cystic carcinoma arising from the left main bronchus and extending along the lateral wall of the lower trachea without carinal invasion. A flap was mobilized from the noninvolved lateral wall of the left main bronchus, which was left attached to the carina. This was used to close the defect in the lower trachea with the implantation of the left main bronchus, avoiding a tracheal sleeve pneumonectomy. Clinical course of this case was good. The pedicled autologous bronchial flap provides reliable material to repair and reconstruct a massive central airway defect.

[Surgical treatment of pulmonary tuberculosis combined with endobronchial tuberculosis].

OBJECTIVE: To evaluate the experience of surgical treatment of pulmonary tuberculosis with endobronchial tuberculosis. METHODS: The clinical data of 85 patients with pulmonary tuberculosis and endobronchial tuberculosis undergoing surgical resection from 1967 to 2004 were reviewed retrospectively. Forty-five cases were bronchial stenosis. Four cases were tracheal stenosis. Sixteen cases underwent right upper lobectomy. One case underwent right upper and middle lobectomy. Three cases underwent right middle lobectomy. Five cases underwent right middle and lower lobectomy. Two cases underwent right lower lobectomy. Twelve cases underwent left upper lobectomy. Four cases underwent left lower lobectomy. Eight cases were assisted with sleeve lobectomy. Six cases underwent right pneumonectomy (with partial tracheal resection and tracheal reconstruction in 3 cases). Thirty cases underwent left pneumonectomy. One case underwent left lower lobectomy who underwent left upper lobectomy 2 years ago. Four cases were assisted with sleeve pneumonectomy. Three cases underwent tracheal segment resection and tracheal reconstruction. One case underwent left upper bronchial and pulmonary artery sleeve resection. One case underwent biopsy. RESULTS: No surgical mortality occurred. There was 1 case of bronchopleural fistula and 1 case of empyema in the 35 cases (without sleeve lobectomy) who underwent lobectomy. There were 3 cases of bronchopleural fistula and 4 cases of empyema in the 33 cases (without sleeve pneumonectomy) who underwent pneumonectomy (P < 0.05). There were 5 cases of atelectasis in the 35 cases who underwent lobectomy and 3 cases of atelectasis in the 8 cases who underwent sleeve lobectomy (P < 0.01). In the follow-up of 3 to 10 years, 1 case died due to acute respiratory distress syndrome 7 years postoperatively. CONCLUSIONS: It is important to resect all the tissue which has been infected. With the routine anti-tuberculosis chemotherapy during the perioperative period, the effect of surgical treatment is superior to others. Fewer pneumonectomy is also important.

[The early outcome of video-assisted thoracic surgery lobectomy for primary lung carcinoma].

OBJECTIVE: To evaluate the early outcome of patients who underwent video-assisted thoracic surgery (VATS) lobectomy for primary lung carcinoma. METHODS: The records of 121 patients with lung cancer undergoing VATS lung resection from 1997 to 2004 were reviewed retrospectively, I stage: 101 cases, 34 cases underwent right upper lobectomy, 13 cases underwent right middle lobectomy, 17 cases underwent right down lobectomy, 21 cases underwent left upper lobectomy, 16 cases underwent left down lobectomy. Thirty-eight cases underwent VATS lobectomy without assisted mini-incision. RESULTS: There were 18 cases of morbidities (15%) and no surgical mortality. The 1-year, 2-year and 3-year survival rates of primary non-small cell lung cancer with I stage is: 99% (76/77), 96% (49/51) and 79% (15/19), respectively. There are statistic difference (P < 0.01) between adenocarcinoma and the others. There are no statistic difference (P > 0.05) between the VATS lobectomy with assisted mini-incision (n = 38) and without (n = 63), also no statistic difference (P > 0.05) between the VATS lobectomy and the standard procedure. CONCLUSION: Our findings suggest that VATS lobectomy is superior regarding its ability to achieve the same survival rates and little morbidities in comparison with the standard procedure.

[The clinical features of postoperative ventilator-associated pneumonia after lung surgery].

OBJECTIVE: To investigate the clinical features of postoperative ventilator-associated pneumonia (VAP) after lung surgery. METHODS: Of 104 patients who had undergone lung surgery and been treated with ventilator in our surgical intensive care unit between January 2003 and March 2005, 35 patients met with the criteria of both VAP and postoperative pneumonia (POP), and 41 cases had no evidences of pneumonia. The clinical and laboratory data of all 76 cases were recorded and analyzed by a statistical software package (SPSS). RESULTS: The diagnosis of postoperative VAP was established clinically in 35 patients (46.1%), and etiologically in 33 cases. Compared to the patients without postoperative VAP, the patients with postoperative VAP had a significantly longer mean interval between intubation and operation [(2.7 +/- 2.9) days vs. (1.6 +/- 1.7) days, P = 0.039], a longer duration of mechanical ventilation [(32.2 +/- 37.7) days vs. (4.2 +/- 2.9) days, P < 0.001], and higher morbidity (20.0% vs. 2.4%, P = 0.013). There was a significant difference in mean duration of mechanical ventilation between the 15 cases of early-onset VAP and 20 cases of late-onset VAP (17 +/- 15 days vs. 43 +/- 46 days, P = 0.042). Among the initially detected pathogen, Staphylococcus aureus remains the most common Gram-positive coccus whereas Acinetobacter Baumannii took the place of Pseudomonas aeruginosa as the top Gram-negative rod. CONCLUSION: Postoperative VAP after lung surgery has different clinical features from VAP in medical ICU.