Great progress has been made in immunotherapy for esophageal squamous cell carcinoma in recent years. However, for thoracic surgeons, immunotherapy is still a new thing and they lack enough experience. Therefore, this paper attempts to discuss some hot issues of immunotherapy, including the indications, side effects, clinical efficacy and evaluation of efficacy. The author hopes that this article will help and attract the attention of thoracic surgeons.
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+EUS+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve ctDNA and radiomics for risk stratification to advance precision organ-preserving strategies.
Patients with thoracic malignancy have a high incidence of perioperative venous thromboembolism (VTE), but its onset is insidious, often asymptomatic or atypical, and is easily overlooked. Early identification and standardized prevention of VTE can effectively reduce the risk of VTE. "Guideline for the prevention and management of perioperative venous thromboembolism in thoracic malignancies in China (2022 version)" has been officially released recently. This article closely follows the context, significance, core implications, and the impact of future VTE prevention in thoracic surgery. It is hoped that through our joint efforts, we can reduce the incidence of perioperative VTE and mortality of thoracic surgery, and strive to improve the long-term survival of patients with lung cancer and esophageal cancer.
目的 建立犬开放性气胸海水浸泡的实验模型 ,探讨实验动物早期死亡原因。 方法 2 0条健康成年杂种犬随机分为两组。对照组 :实验动物受伤后直接观察 ;实验组 :动物受伤后置入人工配制的海水中。监测血流动力学、呼吸、血液渗透压、血液电解质、动脉血气变化以及肺部病理改变。 结果 实验组死亡率明显高于对照组 ,平均生存时间为 45分钟。实验组经海水浸泡后有急性呼吸和循环功能衰竭、严重电解质平衡紊乱、高渗血症、重度肺损伤以及严重代谢性和呼吸性酸中毒。 结论 开放性气胸后海水浸泡可引起一系列严重的病理生理变化 ,其结果是导致实验动物早期死亡的重要原因。
目的 研究质子泵抑制剂在反流性食管炎维持治疗的临床疗效。 方法 将2009年3月-月门诊及住院的121例反流性食管炎并胃镜证实病灶已愈合，且停药1周内症状又复发者，随机分为A、B、C 3组，3组均选用兰索拉唑。A组为兰索拉唑15 mg，1次/d，早餐前服；B组为兰索拉唑15 mg，1次/d，晚餐前服；C组兰索拉唑15 mg，2次/d，餐前服。3组疗程均为4周。疗程结束后进行临床症状疗效评定，并予复查胃镜，评价3组胃镜下总有效率，并观察3组不良反应。 结果 三种方案有效率分别为77.5%、95.0%、92.7%。 结论 晚餐前15 mg 1次/d的兰索拉唑为反流性食管炎较佳维持治疗方案。
Abstract: Objective To explore the significance of peripheral serum hepatocyte growth factor (HGF) and transforming growth factor-β (TGF-β) in preoperative staging of patients with nonsmall cell lung cancer. Methods Fifty patients, including 30 males and 20 females, with complete clinical data and final pathological diagnosis of nonsmall cell lung cancer were treated in Beijing Chaoyang Hospital from September 2006 to November 2007. Their age ranged from 36 to 76 years old (62.4±10.0 years old). Among the patients, there were 26 patients of adenocarcinoma, 23 patients of squamous cell carcinoma and one patient of large cell carcinoma. Twenty other normal subjects were chosen to form normal control, including 11 males and 9 females, aged from 18 to 67 years old (43.8±14.2 years old). Peripheral serum HGF and TGF-β were measured with enzymelinked immunosorbent assay (ELISA), and the relationship between the level of HGF, TGF-β and preoperative staging was analyzed. Results The peripheral serum HGF and TGF-β level has no relation with patient’s age, sex, smoking history or histology type. The level of HGF in the T2 and T3 patients was significantly higher than that of normal control (373.90±234.00 pg/ml vs. 211.30±154.60 pg/ml, t=2.759, P=0008; 563.80±316.10 pg/ml vs. 211.30±154.60 pg/ml, t=4076, P=0.000). The level of TGF-β in the T-3 patients was significantly higher than that of normal control (3.34±2.80 ng/ml vs. 1.82±0.90 ng/ml, t=2.190, P=0.037). The level of TGF-β in the N1-2 patients was significantly higher than that of the N0 patients (2.60±2.00 ng/ml vs. 1.53±0.74 ng/ml, t=-2.387, P=0.021). TGF-β level (5.97±2.65 ng/ml) in patients with distant metastasis (stage Ⅳ) was significantly higher than that of patients in other stages. Conclusion The HGF and TGF-β level is related to the staging of lung cancer. Such examinations combined before operation may present a reference value for preoperative staging and providing the best treatment plan for the patients.
Objective To explore the shortterm clinical effects of complex transplantation among the acellular dermal matrix(ADM) of heterogenic or heterocatal and autogenic split on the burnt wound as to find out a permanent substitution for the treatment on full skin thickness defect without scar. Methods Two kinds of ADM were used on the 18 patients with full thicknessburn wound through complex transplantation with autogenic splits. The patients with medialthickness autograft was used as control group. Survival rate was obtained 2 weeks after operation; contraction rate and the scores of Vancouver burn scale were obtained 8 weeks after operation. Results No significant difference was observed in survival rate among the three groups 2 weeks after operation(P＞0.05); no significant difference was observed in contraction rate of autografts and scores of Vancouver burn scale among the three groups 8 weeks after operation(P＞0.05). Conclusion ADM of heterogenic and ADM of heterocatal have similar effect on the reconstruction of skin, so the piglet ADM made in this way could be used as a substitution.
It has been absent from an accepted criteria for normalization and quality control of the thoracic surgery until now. The ideal assessing instrument which will be used to evaluate the technical skills and surgical procedures should present a few vital characterizations below: objectivity, speciality in the content, detailed structure, and quantifiability. Objective structured assessment of technical skills (OSATS) has developed as a reliable method of surgical skills measurement. This article focuses on the history of OSATS and its prospect in the thoracic surgery area by reviewing relevant literatures.