ObjectiveTo explore the value of multidisciplinary team (MDT) discussion in the comprehensive treatment of HER-2 positive breast cancer.MethodThe clinical data of 2 patients with HER-2 positive breast cancer admitted to the Affiliated Hospital of Southwest Medical University after MDT discussions were analyzed retrospectively.ResultsCase 1 was a 32-year-old woman diagnosed with left breast non-special type invasive carcinoma at admission, cT2N1M0, stage ⅡB, WHO grade 2, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 20%). After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 6 cycles, and the efficacy evaluation was partial response, received left breast conserving surgery and axillary lymph node dissection (ALND), postoperative staging ypT1aN1ycM0, stage ⅡA, Miller-Payne grade 4, the patient was satisfied with the shape of breast, received radiotherapy and anti-HER-2 therapy after surgery. At present, there was no recurrence and metastasis during anti-HER-2 therapy. Case 2 was diagnosed with right breast non-special type invasive carcinoma at admission, cT3N0M0, stage ⅡB, WHO grade 3, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 40%), local advanced breast cancer. After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 2 cycles, and the efficacy evaluation was progressive disease. After the replacement of two neoadjuvant chemotherapy regimen, the efficacy evaluation was still progressive disease. Finally after MDT discussion, the patient received right breast mastectomy and ALND, postoperative staging ypT4bN1ycM0, stage ⅢB, Miller-Payne grade 1, received radiotherapy, adjuvant treatment with pyrotinib and capecitabine after surgery. The patient was followed up for 3 months by telephone, the patient did not follow the doctor’ instructions, no recurrence and metastasis was found in the review.ConclusionUnder the precision medical system, comprehensive treatment of breast cancer based on the MDT model could target patients’ disease characteristics, physical conditions, previous diagnosis and treatment, family situation, and other individual factors, formulate the best personal treatment plan for patients, and bring greater benefits to patients.
ObjectiveTo explore value of multidisciplinary team (MDT) discussion in comprehensive downstaging treatment of liver cancer.MethodThe clinical data of 2 patients with liver cancer who could not undergo the radical surgery admitted to the Affiliated Hospital of Southwest Medical University were analyzed retrospectively.ResultsCase 1 was diagnosed as the liver cancer with extensive double lung metastasis at admission. The clinical stage was stage Ⅲb; After MDT discussion, the patient was treated with chemotherapy and embolization via hepatic artery and bronchial artery; At the same time, the patient was treated with apatinib; At present, the metastasis of both lungs disappeared completely; The clinical stage was stage ⅡB, and the radical resection was proposed. Case 2 was diagnosed as the right liver cancer at admission. The clinical stage was stage Ⅰ b. The preoperative examination showed that the hepatic reserve function was poor and the patient could not tolerate the half hepatectomy; After MDT discussion, the patient was treated with the combination of chemotherapy and embolization via the hepatic artery and apatinib in the same period; At the same time, the patient was treated with liver protection. The clinical stage was reduced to stage Ⅰ a. The hepatic reserve function improved and the laparoscopic right hemihepatectomy was performed, no recurrence or metastasis was found after 3 months follow-up.ConclusionComprehensive downstaging treatment based on MDT model could bring better clinical outcomes for patients with liver cancer who are unable to undergo one-stage radical surgery.
Objective To explore the treatment of a case of clonorchiasis with Budd-Chiari syndrome through multidisciplinary team (MDT) discussion. Methods A case of clonorchiasis with Budd-Chiari syndrome was treated in the Second Affiliated Hospital of Chongqing Medical University in August 2021. We summarized the discussion of MDT and the process of diagnosis and treatment. Results The patient was admitted because of “more than 8 years after partial hepatectomy and more than 1 year of abdominal distension”. Eight years before admission, the patient underwent right hepatic trisegmentectomy and left hepaticojejunostomy due to a huge space occupying right liver. Postoperative pathological examination revealed multifocal necrosis with granulomatous reaction, and parasitic infection was considered. One year before admission, the patient began to have ascites, and the medical treatment was ineffective. The CT examination of the upper abdomen after admission showed hepatic segmental stenosis of the inferior vena cava, unclear display of the hepatic veins and a large amount of ascites. After MDT discussion, this patient underwent direct intrahepatic portosystemic shunt (DIPS) and percutaneous transluminal angioplasty (PTA) , and the stent was unobstructed in the 9-month follow-up after discharge, and no recurrence of ascites was found. Conclusions DIPS combined with PTA can significantly improve the clinical symptoms of clonorchiasis with Budd-Chiari syndrome. Discussion through MDT mode can improve the effectiveness of treatment and obtain better prognosis.
ObjectiveTo explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center.MethodsWe retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT.ResultsA total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but benign nodules were still considered as lung cancer at the first diagnosis in 10 patients.ConclusionAI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
In recent years, the Chengdu Municipal Thoracic Surgery Quality Control Center has preliminarily established a regional quality control system for thoracic surgery through the development of standards, data reporting, and on-site supervision, achieving phased improvements. This review summarizes the current development of Chengdu’s thoracic surgery quality control system, including its organizational structure and scoring methodology, quality indicators based on structure–process–outcome, information technology infrastructure, and multicenter collaboration experiences, and outlines trends in surgical volume, minimally invasive procedure rates, human resources, and care quality metrics. It also analyzes existing challenges such as inter-hospital quality disparities and insufficient interoperability among information platforms. Drawing on domestic and international best practices, we propose development strategies to further enhance the homogenization and continuous improvement of thoracic surgery quality in the region. The Chengdu experience could offer a valuable model for building regional thoracic surgery quality control systems nationwide and for integration with the national quality control platform.
ObjectiveTo evaluate the role and value of multidisciplinary team (MDT) in the decision-making for the treatment of elderly patients with large hepatocellular carcinoma (HCC) with multiple organ dysfunction. MethodThe clinicopathologic data of an elderly patient with large HCC with multiple organ dysfunction admitted to Dongguan Hospital of Southern Medical University were analyzed retrospectively. ResultsThe patient was an 82 years old male patient with asthmatic bronchitis, long-term hormone use, severe pulmonary ventilation dysfunction, moderate pericardial effusion, hypertension, and poor liver function compensation. After MDT discussion including 10 departments and full communication with the patient and his families, the open hepatectomy for hepatic S5 and S4b and cholecystectomy were proposed to perform. The operation process was smooth, and the patient was discharged on the 15th day after the operation without any complications. After discharge, lenvatinib was taken and thymosin alpha for injection was injected. At present, the patient’s quality of life was better, and there was no tumor recurrence or metastasis. ConclusionsFor the elderly patients with large HCC with severe cardiopulmonary dysfunction, the risk of treatment is higher. By MDT mode, the optimum treatment scheme for patient could be formulated to ensure efficient and accurate diagnosis and ensure high-quality treatment process, so as to maximally benefit patient.
ObjectiveTo summarize the experience of diagnosis and treatment of 2 cases of intrathyroid thymic carcinoma(ITTC).MethodThe clinical data of 2 patients with ITTC treated in West China Hospital of Sichuan University since July 2019 were analyzed retrospectively.ResultsAfter the discussion of the multidisciplinary team (MDT), the diagnosis and treatment of 2 cases of ITTC were discussed together, and the prognosis of the patients was actively improved through multidisciplinary cooperation.ConclusionMDT cooperative therapy mode should be adopted in the clinical diagnosis and treatment of patients with ITTC in order to provide a better treatment plan.
ObjectiveTo introduce the research progress of conservative treatment, internal fixation, hip arthroplasty, and multidisciplinary team (MDT) modes in the treatment of femoral neck fracture in the elderly.MethodsBy consulting domestic and foreign literature in recent years, the characteristics and application of various treatment methods and new treatment modes for femoral neck fracture in the elderly were summarized and analyzed.ResultsThe elderly non-displaced femoral neck fracture should be treated surgically, and conservative treatment has a high risk of secondary displacement. The displaced fracture should be operated as soon as possible. There is no difference in long-term functional outcome between hemiarthroplasty and total hip arthroplasty. Hemiarthroplasty has less intraoperative blood loss, shorter operation time, and is suitable for the elderly patients with poor basic condition. Total hip arthroplasty is suitable for the elderly patients with better basic condition and higher demand of life quality. MDT can effectively reduce preoperative waiting time and length of stay, reduce the incidence of medical complications, improve the nutritional status of patients, and reduce the mortality of patients.ConclusionSignificant results have been achieved in the treatment of femoral neck fractures in the elderly by methods such as internal fixation, hip arthroplasty, and MDT.
Objective To investigate the value of multidisciplinary team (MDT) diagnosis and treatment model in the conversion therapy of liver cancer. Method The clinical data of a patient with high-risk giant liver cancer of the right liver who was admitted to People’s Hospital of Leshan in April 2019, and who was successfully conversion therapy and safely underwent hepatectomy after MDT discussion was retrospectively analyzed. Results A 62 years old male patient was admitted to our hospital with “abdominal distension for more than 1 month, and liver mass was found for 10 days”. The relevant auxiliary examinations were perfected. The patient was diagnosed as huge primary hepatocellular carcinoma in the right liver. One-stage surgical resection cannot be performed safely due to the huge tumor. After MDT discussion, transcatheter arterial chemoembolization (TACE) combined with sorafenib targeted therapy was decided to reduce the lesions, and two-stage surgical resection was performed safely after conversion therapy. After two cycles of TACE combined with sorafenib targeted drug therapy, MDT discussed the feasibility of safe surgical resection, and underwent fluorescence-guided laparoscopic right posterior lobectomy. The postoperative pathological examination revealed moderately differentiated hepatocellular carcinoma. The patient recovered and was discharged from the hospital one week later. Outpatient followed-up for 32 months showed no obvious abnormality. Conclusions MDT discussion can formulate a more individualized treatment plan, improve the conversion rate and resectable rate of advanced liver cancer, and has important value in the diagnosis and treatment of advanced liver cancer.