The great clinical efficacy of an enhanced recovery after surgery (ERAS) program has been illustrated by the decreased incidence of perioperative complications and the shortened length of in-hospital stay. Furthermore, the ERAS programs have their own key techniques and strategies in the clinical application to the unique diseases and operative modes. The key technology of an ERAS program is the minimally invasive surgery, which has been widely utilized in the surgical specialties. The main strategy in an ERAS program consists of the intensive pulmonary rehabilitation and optimal perioperative care that aim to improve the in-hospital outcomes of lung cancer patients who are considered at high surgical risk. Pulmonary rehabilitation is regarded as the mainstay of the ERAS strategies but its clinical protocols still remain less mature. The purpose of this overview is to summarize the current pulmonary rehabilitation programs in terms of the suitable crowd, the feasible protocols and the clinical significance.
Tibetan population has been living in Tibet plateau for more than thousands of years ago. Although, the environment is unlikely to be an ideal place for residence. They have evolved genetical and physiological adaptions living in Tibetan highlands. In recent several years, foreign scientists have noticed that lung cancer mortality is reduced at high altitude. Many in vitro and in vivo experiments explored the mechanism of this phenomenon. In this review we discuss the lung cancer incidence and mortally of Tibetan population, as well as the possible underlying mechanism including oxygen level, radiation, inhalable particulate matter, metabolism, hypoxic induced factor pathway and immune system. But, the clinical data as well as basic researches of Tibetan population remain insufficient, which required further investigation.
Chest tube is routinely used after thoracoscopic lung cancer surgery for evacuating air and fluids. Development of enhanced recovery after surgery (ERAS) makes the disadvantages of traditional drainage clearly. In this review, we summarized the advantages and disadvantages of small-bore chest tube, the use of digital drainage system, the time of removing the chest tube, the indications of non chest tube, the improvements of drainage tube hole suture and the complications of chest tube placement after thoracoscopic lung cancer surgery.
Abstract： Currently, there are two significant tendencies in the advancement and progress of video-assisted thoracoscopic surgery（VATS）, firstly, the widening surgical indications for VATS techniques, and secondly, the use of single-port VATS which is less invasive and more cosmetic. This article focuses in particular on four aspects of single-port VATS, including；（1）the individualized incision approach and its characteristics of single-port VATS；（2）single-port VATS for the treatment of pneumothorax and the development of related techniques and equipment；（3）single-port VATS for the diagnosis and treatment of thoracic diseases such as lung lobectomy；（4）the advantages and disadvantages of single-port VATS in clinical practice.
ObjectivesTo construct a symptom assessment system suitable for surgical lung cancer patients, and to objectively evaluate the types and severity of postoperative symptoms in patients so as to provide evidence-based basis for the treatment of postoperative symptoms of lung cancer patients.MethodsPostoperative symptom items of lung cancer were formed according to previous researches, literature review, the current lung cancer symptom assessment tools, and expert interviews. The Delphi method was used to conduct two rounds of expert consultation and a postoperative symptom inventory was established for lung cancer patients.ResultsNine first-level symptom items were eventually formed: cough, pain, shortness of breath, fatigue, dizziness, nausea or vomiting, subcutaneous emphysema, insomnia, and constipation. The first round of active coefficient and authority coefficient of experts were 85.0% and 0.88, and the second round were 88.2% and 0.87. The Kendall coordination coefficients of the nine first-level symptom items were 0.47 (P<0.001) and 0.43 (P<0.001), respectively.ConclusionsThe evaluation system of postoperative symptom items for lung cancer patients is highly recognized by experts and has good consistency.
Objective To investigate the expression of Jumonji domain-containing protein 3 ( JMJD3) in lung cancer tissue. Methods The cancer tissue slides from 53 lung cancer patients with different TNMstages were immunostained with JMJD3 antibody. The relationship between the expression of JMJD3 and type of pathology, TNM stage, survival time was analyzed. Results 94. 3% lung cancer tissue expressed JMJD3 protein. The expression of JMJD3 was negatively correlated with TNMstage( r = - 0. 347,P =0. 002) . The patients with decreased JMJD3 expression had shorter survival time than the patients with high JMJD3 expression ( X2 = 17. 83, P = 0. 001) . Conclusion Decreased expression of JMJD3 may promote the lung cancer progression.
Objective To systematically review the effect of inspiratory muscle training (IMT) on postoperative clinical outcomes among esophageal cancer patients. Methods The PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, WanFang Data and VIP databases were searched from inception to January 16th, 2022 for randomized controlled trials (RCTs) and cohort studies on the clinical application of IMT among postoperative esophageal cancer patients. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results Eight studies were included, including 7 RCTs and 1 cohort study, involving 728 participants. The results of the meta-analysis demonstrated that IMT significantly enhanced postoperative respiratory muscle function [maximum inspiratory pressure (MIP): MD=5.75, 95%CI 0.81 to 10.70, P=0.02; maximum expiratory pressure (MEP): MD=8.19, 95%CI 4.14 to 12.24, P<0.001] and pulmonary function (FEV1%: MD=6.94, 95%CI 5.43 to 8.45, P<0.001; FVC%: MD=4.65, 95%CI 2.70 to 6.60, P<0.001; MVV: MD=8.66, 95%CI 7.17 50 10.14, P<0.001; FEV1/FVC%: MD=8.04, 95%CI 4.68 to 11.40, P<0.001). Additionally, the results indicated that IMT could substantially improve postoperative functional performance [six-minute walk test (6MWT): MD=66.99, 95%CI 10.13 to 123.85, P=0.02; Borg index: MD=−1.03, 95%CI −1.26 to −0.81, P<0.001]. However, no significant reduction in the incidence of postoperative complications was observed. Conclusion IMT can improve the postoperative clinical outcomes of esophageal cancer patients and facilitate patient recovery after surgery, which has high clinical value. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Detection of the fraction of exhaled nitric oxide (FeNO) is a safe, simple and easy method to assess airway inflammation noninvasively. Thus, FeNO detection has been paid more attention to diagnosis and guide treatment of pulmonary diseases. The common feature of pneumonia, asthma, chronic obstructive pulmonary disease and chronic cough is the existence of varying degrees of airway inflammation. In this review, FeNO production and its potential pathologic and physiologic role in various pulmonary diseases were discussed.
Abstract： Objective To explore the method and effect of single utility port video-assisted thoracoscopic surgery （VATS） for the treatment of pulmonary diseases. Methods From Jan. 2008 to Jun. 2010, 158 patients with pulmonary diseases were treated by single working pore VATS in the Department of Thoracic Surgery of West China Hospital, Sichuan University. Their diseases included 6 kinds of different lesions, such as pneumothorax（inflammatory pseudotumor, hamartoma, lymphangiomyomatosis） , lung tuberculoma, and lung carcinoma. Seventy patients had definite diagnosis before their operation, and the others had their final diagnosis by intraoperative frozen section evaluation and postoperative pathology examination. All the resections were carried out by pure thoracoscopic procedures with two ports, one working pore and one observing pore. A 28-Fr chest tube was placed to the pleural apex. Limited lung resection was performed in 151 patients, single lobectomy in 7 patients, and simultaneous bilateral operation in 6 patients. Results For limited lung resection patients, the average operation time was 18 （5-60） min, and the average blood loss was 33 （5-95） ml. No patient needed intraoperative blood transfusion . Ten patients received an increased pore, including 6 patients with pleural cavity obliteration or abundant pleural adhesions, and 4 patients with intraoperative bleeding . The average postoperative length of stay was 2.5 （2-4） days, and the average medical cost was 17 884 （15 476-25 387） Yuan. For patients undergoing lobectomy and lymph node dissection, the average operation time was 128 （50-220） min, and the average blood loss was 180 （80-478） ml. No patient needed intraoperative blood transfusion. One patient received an increased pore. The average postoperative length of stay was 4.7 （4-7） days, and the average medical cost was 42 385 （38 965-57 695） Yuan. No perioperative death or severe complications were observed in present series. Conclusion Single utility port VATS is a safe and efficient procedure with good patient recovery. It is a method of choice for selected patients with pulmonary diseases.
ObjectiveTo explore the association of pretreatment hyponatremia with clinicopathological and prognostic characteristics of non-small cell lung cancer (NSCLC) patients. MethodsThe PubMed, EMbase, Web of Science, VIP, CNKI and WanFang databases were searched from the inception to July 12, 2021 for relevant literatures. The quality of included studies was assessed by the Newcastle-Ottawa Scale (NOS) score. The relative risk (RR) and hazard ratio (HR) with 95% confidence interval (CI) were combined to assess the relationship between pretreatment hyponatremia and clinicopathological and prognostic characteristics. The prognostic indicators included the overall survival (OS) and progression-free survival (PFS). All statistical analysis was conducted by the STATA 15.0 software. ResultsA total of 10 high-quality studies (NOS score≥6 points) involving 10 045 patients were enrolled and all participants were from Asian or European regions. The pooled results demonstrated that male [RR=1.18, 95%CI (1.02, 1.36), P=0.026], non-adenocarcinoma [RR=0.86, 95%CI (0.81, 0.91), P＜0.001] and TNM Ⅲ-Ⅳ stage [RR=1.17, 95%CI (1.12, 1.21), P＜0.001] patients were more likely to experience hyponatremia. Besides, pretreatment hyponatremia was significantly related to worse OS [HR=1.83, 95%CI (1.53, 2.19), P＜0.001] and PFS [HR=1.54, 95%CI (1.02, 2.34), P=0.040]. Pretreatment hyponatremia was a risk factor for poor prognosis of NSCLC patients. ConclusionMale, non-adenocarcinoma and advance stage NSCLC patients are more likely to experience hyponatremia. Meanwhile, the pretreatment sodium level can be applied as one of the prognostic evaluation indicators in NSCLC and patients with hyponatremia are more likely to have poor survival. However, more researches are still needed to verify above findings.