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Development of a CT image-based virtual atelectasis simulation model and noninvasive lung nodule localization system. 开发基于 CT 图像的虚拟肺不张模拟模型和无创肺结节定位系统。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-21 DOI: 10.21037/jtd-24-903
Intae Hwang, Sungwon Ham, Chohee Kim, Seong-Hak Lee, Cherry Kim, Jinwook Hwang

Background: In the process of video-assisted thoracoscopic surgery (VATS) for lung nodule resection, lung is leaded to atelectasis. However, preoperative computed tomography (CT) images are taken during inspiration, which means they differ significantly from the lung status observed during surgery. Consequently, this discrepancy can make the localization of small or subsolid nodules challenging during the operation. This study aimed to develop a CT-based virtual atelectasis simulation system for noninvasive lung nodule localization. By accurately simulating atelectasis, this study aimed to improve the precision of presurgical planning from lung nodule resections.

Methods: This study retrospectively examined 20 patients who had either subsolid nodules or small nodules less than 3 cm in size, selected from a cohort of 279 patients who underwent VATS surgery for lung nodules in Korea University Ansan Hospital between June 28, 2021, and January 22, 2024. Chest CT images of the lungs of 20 patients were acquired, and image data were converted three-dimensional models. The mesh points extracted from these lung models were manipulated to simulate the effects of gravity, by adjusting the lung shapes and nodule locations to align with the respective surgical postures of the patients. Subsequently, we assessed the similarity of the simulation by comparing the resulting deformed lung shapes and nodule locations with the corresponding perspectives observed in the surgical videos.

Results: The average volume of the entire lung among the patients was 2,336 cm3 (±588). After atelectasis simulation, the average lung shrinkage rate was 48.6% (±12.9%). Evaluations of an average of 15 pairs of images per case revealed significant conformity between atelectasis simulation images and surgical video snapshots, with average Dice and Jaccard similarity coefficient values of 90.27 and 88.25, respectively. Furthermore, the alignment of nodule locations between the simulations and surgical anticipation demonstrated notable accuracy, with an average Hausdorff distance of 6.39 mm.

Conclusions: We successfully developed a simulation of lung atelectasis based on preoperative CT scans that closely resembled actual surgical videos. The integration of this presurgical atelectasis simulation is anticipated to enhance the accuracy of nodule locations, thus contributing to more efficient and precise surgical planning.

背景:在视频辅助胸腔镜手术(VATS)进行肺结节切除术的过程中,肺部会出现回流。然而,术前计算机断层扫描(CT)图像是在吸气时拍摄的,这意味着它们与手术中观察到的肺部状态有很大差异。因此,这种差异会使手术中对小结节或亚实结节的定位具有挑战性。本研究旨在开发一种基于 CT 的虚拟肺不张模拟系统,用于无创肺结节定位。通过精确模拟肺不张,本研究旨在提高肺结节切除术前规划的精确度:本研究从 2021 年 6 月 28 日至 2024 年 1 月 22 日期间在韩国大学安山医院接受 VATS 肺结节手术的 279 名患者中选取了 20 名患者进行回顾性研究,这些患者均患有实性下结节或小于 3 厘米的小结节。采集了 20 名患者肺部的胸部 CT 图像,并将图像数据转换为三维模型。我们对从这些肺部模型中提取的网格点进行了处理,通过调整肺部形状和结节位置来模拟重力的影响,使其与患者各自的手术姿势相一致。随后,我们通过比较变形后的肺部形状和结节位置与手术视频中观察到的相应视角来评估模拟的相似性:结果:患者整个肺的平均体积为 2,336 立方厘米(±588)。模拟肺不张后,肺的平均收缩率为 48.6%(±12.9%)。对每个病例平均 15 对图像进行评估后发现,脑偏流模拟图像与手术视频快照之间的一致性非常高,平均 Dice 和 Jaccard 相似性系数分别为 90.27 和 88.25。此外,模拟图像与手术预测图像之间的结节位置对齐也表现出显著的准确性,平均豪斯多夫距离为 6.39 毫米:结论:我们根据术前 CT 扫描成功开发了一种肺不张模拟,与实际手术视频非常相似。这种术前肺偏流模拟的整合有望提高结节位置的准确性,从而有助于更高效、更精确地制定手术计划。
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引用次数: 0
Research progress in interventional therapy for acute intermediate-high-risk and high-risk pulmonary embolism. 急性中高危和高危肺栓塞介入疗法的研究进展。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-27 DOI: 10.21037/jtd-24-1049
Lulu Wang, Cheng Yu, Ke Hu, Yi Guo, Yuxuan Li, Shiwen Yu, Weici Wang

Acute pulmonary embolism (APE) has a high mortality rate worldwide. The cause of death from pulmonary embolism (PE) is predominantly progressive right heart failure, which is common in intermediate-high-risk and high-risk patients. The latest guidelines recommend reperfusion thrombolytic therapy for high-risk patients, but it is rarely practiced clinically, given the high rate of intracranial hemorrhage. Moreover, the optimal treatment for intermediate-risk patients remains undetermined. With the development of technology, a series of endovascular interventional treatments are widely used in patients with intermediate-high-risk or high-risk PE, such as standard catheter-directed thrombolysis (SCDT), ultrasound-assisted thrombolysis (USAT), pharmacomechanical catheter-directed thrombolysis (PM-CDT) and mechanical thrombectomy (MT). Current studies have shown that interventional therapy can effectively improve right heart function and reduce the incidence of cerebral hemorrhage. Future research should mainly focus on screening patients who benefit from interventional therapy, reducing mortality, and improving long-term sequelae. This article aimed to review these treatment devices and provide an update on the research progress related to interventional therapy for PE. In addition, we introduce a risk stratification assessment for APE in the updated guidelines and provide an overview of risk indicators and APE scores for judging prognosis. Finally, we discuss the long-term outcomes of APE in combination with interventional therapy.

急性肺栓塞(APE)在全世界的死亡率都很高。肺栓塞(PE)的死因主要是进行性右心衰竭,常见于中高危和高危患者。最新指南建议对高危患者进行再灌注溶栓治疗,但由于颅内出血发生率较高,临床上很少采用。此外,中危患者的最佳治疗方法仍未确定。随着技术的发展,一系列血管内介入疗法被广泛应用于中高危或高危 PE 患者,如标准导管引导溶栓疗法(SCDT)、超声辅助溶栓疗法(USAT)、药物机械导管引导溶栓疗法(PM-CDT)和机械取栓疗法(MT)。目前的研究表明,介入治疗能有效改善右心功能,降低脑出血的发生率。未来的研究应主要集中在筛选从介入治疗中获益的患者、降低死亡率和改善长期后遗症。本文旨在回顾这些治疗设备,并提供与 PE 介入治疗相关的最新研究进展。此外,我们还介绍了最新指南中的 APE 风险分层评估,并概述了用于判断预后的风险指标和 APE 评分。最后,我们讨论了 APE 联合介入治疗的长期疗效。
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引用次数: 0
The establishment of an ex vivo lung perfusion rat model: insights from Jiangxi, China. 体外肺灌注大鼠模型的建立:来自中国江西的启示。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-29 DOI: 10.21037/jtd-24-1754
Guowen Zou, Lei Jiang, Bin Xu, Jingyuan Xu, Zhikai Zeng, Lingchun Xia, Jian Tang, Bentong Yu

The scarcity of viable donor lungs is a formidable obstacle in lung transplantation (LTx) surgery. This issue significantly hinders the availability of this life-saving procedure for patients in need. To alleviate this shortage, researchers have turned to ex vivo lung perfusion (EVLP) technology as a means to evaluate and potentially repair marginal donor lungs, thereby increasing the donor pool and improving access to transplantation. However, it is important to note that the current capabilities of EVLP technology are still somewhat limited, and further research, development, and optimization are necessary to maximize its potential. To advance this field of study, animal experiments play a crucial role in providing a controlled environment for exploring the possibilities and limitations of EVLP. Among the various animal models available, the small animal EVLP platform for rats stands out by virtue of its simplicity, convenience, and cost-effectiveness. This platform offers researchers a unique opportunity to gain valuable insights into the workings of EVLP and its potential applications in LTx. However, conducting these experiments is not without its challenges. The complexity of the procedure requires a deep understanding of the relevant considerations and operational skills. To ensure the success of these experiments, it is essential that researchers have a comprehensive grasp of the intricacies involved. Drawing upon our practical experience over the past 3 years, our Jiangxi team has systematically refined and summarized the specific details of a rat EVLP experiment in this paper. It encompasses a comprehensive overview of the experimental setup, procedural steps, and potential pitfalls that should be kept in mind. We believe that this information will serve as a valuable resource for researchers in the field, providing them with a solid foundation upon which to build their own experiments and further advance the study of EVLP in LTx.

存活供体肺的稀缺是肺移植(LTx)手术的一个巨大障碍。这一问题严重阻碍了有需要的患者接受这种挽救生命的手术。为了缓解这一短缺问题,研究人员转而采用体外肺灌注(EVLP)技术来评估和修复边缘供体肺,从而增加供体库,改善移植手术的可及性。然而,需要注意的是,EVLP 技术目前的能力仍然有限,需要进一步研究、开发和优化,以最大限度地发挥其潜力。为了推进这一领域的研究,动物实验在提供受控环境以探索 EVLP 的可能性和局限性方面发挥着至关重要的作用。在现有的各种动物模型中,大鼠小动物 EVLP 平台因其简单、方便和成本效益高而脱颖而出。该平台为研究人员提供了一个独特的机会,使他们能够深入了解 EVLP 的工作原理及其在 LTx 中的潜在应用。然而,进行这些实验并非没有挑战。实验过程十分复杂,需要深入了解相关的注意事项和操作技能。为了确保这些实验的成功,研究人员必须全面掌握其中的复杂性。根据过去三年的实践经验,我们江西团队在本文中系统地提炼和总结了大鼠EVLP实验的具体细节。它全面概述了实验设置、程序步骤以及应注意的潜在陷阱。我们相信,这些信息将成为该领域研究人员的宝贵资源,为他们建立自己的实验提供坚实的基础,并进一步推动LTx中EVLP的研究。
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引用次数: 0
Impact of high spinal anesthesia in pediatric congenital heart surgery on postoperative recovery: a retrospective propensity score-matched study.
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-21 DOI: 10.21037/jtd-24-1157
Aravinthasamy Sivamurugan, Rakesh Sondekoppam, Alex Rier, Nada Sadek, Sudhakar Subramani, Srinivasan Rajagopal, Yatish Ranganath, Arun K Singhal, Satoshi Hanada

Background: High spinal anesthesia (HSA) has been utilized in cardiac surgery; however, there is limited evidence on its impact on facilitating postoperative recovery. This study aimed to evaluate the impact of HSA in pediatric congenital heart surgery on postoperative recovery.

Methods: A single center, propensity score-matched retrospective cohort study was designed using data from pediatric patients under 18 years old, who underwent congenital heart surgeries classified as Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score 3 or less. The comparison was made between the HSA group, who received HSA in addition to general anesthesia (GA), and the GA group, who received GA alone. The primary outcome was the odds of patients being extubated in the operating room. Secondary outcomes included the odds of patients being extubated within 6 hours after intensive care unit (ICU) admission, as well as the length of stay (LOS) in the ICU and the hospital.

Results: A total of 566 cases were eligible for this study, with 224 cases in the HSA group and 342 cases in the GA group. Propensity score-matching yielded a total of 197 pairs of patients. The rates of extubation in the operating room and within 6 hours after ICU admission were significantly higher in the HSA group compared to the GA group [65.5% vs. 33.5%, odds ratio 3.82, 95% confidence interval (CI): 2.5 to 5.8, P<0.001; 82.7% vs. 61.9%, odds ratio 2.95, 95% CI: 1.9 to 4.7, P<0.001, respectively]. The LOS in the ICU was significantly shorter in the HSA group while there was no significant difference in the LOS in the hospital between groups (5.1 vs. 8.0 days, P<0.001; 8.7 vs. 9.5 days, P<0.60, respectively).

Conclusions: The addition of HSA to GA in fast-track pediatric congenital heart surgery was associated with increased odds of extubation in the operating room, within 6 hours of ICU admission, and with a shorter LOS in the ICU. Future randomized controlled trials are needed to confirm these results.

背景:高位脊髓麻醉(HSA)已在心脏手术中得到应用;然而,关于其对促进术后恢复的影响的证据却很有限。本研究旨在评估在小儿先天性心脏病手术中使用高位脊麻对术后恢复的影响:方法:本研究设计了一项单中心倾向得分匹配回顾性队列研究,使用的数据来自于接受先天性心脏病手术的 18 岁以下小儿患者,这些患者被归类为先天性心脏病手术风险调整-1 (RACHS-1) 评分 3 分或更低。HSA组(在全身麻醉(GA)基础上接受HSA)与GA组(仅接受GA)进行了比较。主要结果是患者在手术室拔管的几率。次要结果包括患者在入住重症监护室(ICU)后 6 小时内拔管的几率,以及在重症监护室和医院的住院时间(LOS):共有 566 例患者符合研究条件,其中 224 例属于 HSA 组,342 例属于 GA 组。倾向评分匹配共产生了 197 对患者。与GA组相比,HSA组患者在手术室和入ICU后6小时内拔管的比率明显更高[65.5% vs. 33.5%,几率比3.82,95%置信区间(CI):2.5至5.8,Pvs. 61.9%,几率比2.95,95% CI:1.9至4.7,Pvs. 8.0天,Pvs. 9.5天,PConclusions:在快速通道小儿先天性心脏病手术中,在GA基础上加用HSA可增加在手术室拔管的几率,缩短入ICU后6小时内拔管的几率,缩短在ICU的LOS。未来需要进行随机对照试验来证实这些结果。
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引用次数: 0
Esophageal perforation mimicking an acute inferior myocardial infarction: a case report. 模仿急性下壁心肌梗死的食管穿孔:一份病例报告。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-21 DOI: 10.21037/jtd-24-1616
Meizi Han, Xiaojie Xia, Sofoklis Mitsos, Jules Lin, Christina M Stuart, Le Yu

Background: Esophageal perforation is a rare but life-threatening condition associated with a high mortality rate and often presents with nonspecific clinical manifestations that can lead to delayed diagnosis and treatment. When combined with ST-segment elevation on electrocardiography (ECG), it can be particularly challenging to distinguish esophageal perforation from acute inferior myocardial infarction, as the two conditions may share similar ECG findings.

Case description: We report the case of a 65-year-old man with a significant history of long-term alcohol consumption who presented to our hospital (the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine) with persistent oppressive pain in the anterior and posterior left chest. Initially, the patient was diagnosed with acute coronary syndrome based on the ECG findings, which showed Q-wave and ST-segment elevation in the inferior leads. However, further dynamic monitoring of myocardial necrosis markers, including myoglobin and troponin I, yielded negative results inconsistent with acute myocardial infarction. Subsequent enhanced computed tomography revealed thickening and discontinuity of the wall of the thoracic esophagus with an irregular, mixed-density shadowing of the surrounding soft tissue confirming the diagnosis of esophageal rupture. Despite prompt recognition and transfer to a hospital with surgical capabilities, the patient tragically succumbed to esophageal rupture and hemorrhage while awaiting surgery.

Conclusions: This case highlights the importance of maintaining a broad differential, including esophageal rupture, in patients exhibiting necrotic Q waves and ST-segment elevation in the inferior wall of the ECG, especially in the absence of reciprocal changes in the lateral leads and the lack of abnormal markers of myocardial necrosis. Prompt recognition of this rare but potentially fatal condition is crucial for initiating appropriate treatment and improving patient outcomes. Emergency physicians should be aware of this atypical presentation of esophageal perforation mimicking an acute myocardial infarction and consider this differential diagnosis when faced with discordant clinical and diagnostic findings.

背景:食管穿孔是一种罕见的危及生命的疾病,死亡率很高,而且常常表现为非特异性临床表现,导致诊断和治疗延误。当合并心电图(ECG)ST段抬高时,将食管穿孔与急性下壁心肌梗死区分开来尤其具有挑战性,因为这两种疾病可能具有相似的心电图结果:我们报告了一例 65 岁男性患者的病例,该患者有明显的长期饮酒史,因左胸前后持续压迫性疼痛到我院(辽宁中医药大学附属医院)就诊。根据心电图结果,患者下导联出现 Q 波和 ST 段抬高,初步诊断为急性冠脉综合征。然而,对心肌坏死标志物(包括肌红蛋白和肌钙蛋白 I)的进一步动态监测结果为阴性,与急性心肌梗死不符。随后的增强型计算机断层扫描显示,胸腔食管壁增厚且不连续,周围软组织呈不规则混合密度影,确诊为食管破裂。尽管患者被及时发现并转送至具备手术能力的医院,但在等待手术期间不幸因食管破裂和大出血而死亡:本病例强调了对心电图下壁出现坏死 Q 波和 ST 段抬高的患者进行广泛鉴别(包括食管破裂)的重要性,尤其是在侧导联没有互变和缺乏心肌坏死异常标记物的情况下。及时发现这种罕见但可能致命的病症对于启动适当的治疗和改善患者预后至关重要。急诊医生应注意这种模仿急性心肌梗死的食管穿孔非典型表现,并在临床和诊断结果不一致时考虑这种鉴别诊断。
{"title":"Esophageal perforation mimicking an acute inferior myocardial infarction: a case report.","authors":"Meizi Han, Xiaojie Xia, Sofoklis Mitsos, Jules Lin, Christina M Stuart, Le Yu","doi":"10.21037/jtd-24-1616","DOIUrl":"https://doi.org/10.21037/jtd-24-1616","url":null,"abstract":"<p><strong>Background: </strong>Esophageal perforation is a rare but life-threatening condition associated with a high mortality rate and often presents with nonspecific clinical manifestations that can lead to delayed diagnosis and treatment. When combined with ST-segment elevation on electrocardiography (ECG), it can be particularly challenging to distinguish esophageal perforation from acute inferior myocardial infarction, as the two conditions may share similar ECG findings.</p><p><strong>Case description: </strong>We report the case of a 65-year-old man with a significant history of long-term alcohol consumption who presented to our hospital (the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine) with persistent oppressive pain in the anterior and posterior left chest. Initially, the patient was diagnosed with acute coronary syndrome based on the ECG findings, which showed Q-wave and ST-segment elevation in the inferior leads. However, further dynamic monitoring of myocardial necrosis markers, including myoglobin and troponin I, yielded negative results inconsistent with acute myocardial infarction. Subsequent enhanced computed tomography revealed thickening and discontinuity of the wall of the thoracic esophagus with an irregular, mixed-density shadowing of the surrounding soft tissue confirming the diagnosis of esophageal rupture. Despite prompt recognition and transfer to a hospital with surgical capabilities, the patient tragically succumbed to esophageal rupture and hemorrhage while awaiting surgery.</p><p><strong>Conclusions: </strong>This case highlights the importance of maintaining a broad differential, including esophageal rupture, in patients exhibiting necrotic Q waves and ST-segment elevation in the inferior wall of the ECG, especially in the absence of reciprocal changes in the lateral leads and the lack of abnormal markers of myocardial necrosis. Prompt recognition of this rare but potentially fatal condition is crucial for initiating appropriate treatment and improving patient outcomes. Emergency physicians should be aware of this atypical presentation of esophageal perforation mimicking an acute myocardial infarction and consider this differential diagnosis when faced with discordant clinical and diagnostic findings.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"8117-8125"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Short-term outcomes of robotic- vs. television-assisted thoracoscopic segmental lung resection for early-stage non-small-cell lung cancer in the day surgery models.
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-19 DOI: 10.21037/jtd-24-1020
Yusheng Wang, Chaofan Meng, Liang Shi, Shuang Gu, Xiao Fan, Qianyun Wang
<p><strong>Background: </strong>At present, few articles compare the differences between robot-assisted thoracic surgeries (RATSs) and video-assisted thoracic surgeries (VATSs) in the day surgery model and there is also little literature on what factors influence delayed discharge from day surgery. This study aims to compare short-term outcomes between RATS and VATS for segmental lung resection in a day surgery setting, and to identify risk factors for delayed discharge.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 204 patients with early-stage non-small-cell lung cancer (NSCLC) who underwent segmental lung resection via RATS or VATS at the First People's Hospital of Changzhou City from January 2021 to December 2023. The clinical data and short-term efficacy of the two groups were compared, and the patients were divided into two subgroups based on whether the patients were discharged within 48 hours. One group was day surgery patients who were discharged within 48 hours, and the other group was day surgery patients with delayed discharge, so as to explore the factors affecting the delayed discharge of day surgery.</p><p><strong>Results: </strong>Compared to the VATS group, the RATS group had a shorter average surgery duration (58.59±12.20 <i>vs.</i> 66.12±21.56 min, P<0.001), less intraoperative blood loss (98.77±51.50 <i>vs.</i> 128.87±65.79 mL, P=0.02), lower total postoperative drainage (185.44±109.14 <i>vs.</i> 268.70±147.99 mL, P=0.007), and a shorter postoperative drainage duration (1.74±0.30 <i>vs.</i> 2.29±0.98 days, P=0.045). The patients experienced less pain, with lower total drug dose of intramuscular diclofenac sodium lidocaine injection and oral celecoxib capsules (111.76±40.52 <i>vs.</i> 167.74±67.20 mg, P<0.001) and reduced pain scores (3.29±0.66 <i>vs.</i> 4.31±0.81, P=0.003). Fewer patients in the RATS group experienced delayed discharges (11 <i>vs.</i> 39, P<0.001), and the incidence of postoperative complications was lower (nausea and vomiting: 3.9% <i>vs.</i> 3.9%, fever: 4.9% <i>vs.</i> 13.5%, pulmonary atelectasis: 0% <i>vs.</i> 2.0%, infection: 1.0% <i>vs.</i> 2.9%, air leakage: 6.9% <i>vs.</i> 8.8%, abnormal drainage fluid: 0% <i>vs.</i> 8.8%, P=0.23; recovery: P=0.27). Meanwhile, subgroup analysis revealed that the four indicators of 24-hour postoperative analgesic medication, operation time, intraoperative bleeding, and tumor history were statistically significant (tumor history: P=0.04; intraoperative bleeding: P=0.005; use of analgesic medication in the 24-hour postoperative period: P=0.001; duration of surgery: P=0.008).</p><p><strong>Conclusions: </strong>In the surgery setting, RATSs showed better outcomes compared to VATSs, including shorter surgical duration, reduced intraoperative blood loss, lower postoperative drainage volume, shorter drainage duration, and fewer postoperative complications. History of tumor, intraoperative bleeding, use of analgesic medication in the 24-hour posto
背景:目前,很少有文章比较机器人辅助胸腔镜手术(RATS)和视频辅助胸腔镜手术(VATS)在日间手术模式下的差异,也很少有文献研究影响日间手术延迟出院的因素。本研究旨在比较日间手术环境下 RATS 和 VATS 肺段切除术的短期疗效,并确定延迟出院的风险因素:方法:对2021年1月至2023年12月期间在常州市第一人民医院接受RATS或VATS肺段切除术的204例早期非小细胞肺癌(NSCLC)患者进行回顾性分析。比较两组患者的临床数据和短期疗效,并根据患者是否在48小时内出院将其分为两组。一组是在48小时内出院的日间手术患者,另一组是延迟出院的日间手术患者,以探讨影响日间手术延迟出院的因素:与VATS组相比,RATS组平均手术时间更短(58.59±12.20 vs. 66.12±21.56 min,Pvs. 128.87±65.79 mL,P=0.02),术后引流总量更少(185.44±109.14 vs. 268.70±147.99 mL,P=0.007),术后引流时间更短(1.74±0.30 vs. 2.29±0.98天,P=0.045)。患者疼痛较轻,肌肉注射双氯芬酸钠利多卡因注射液和口服塞来昔布胶囊的总药物剂量较低(111.76±40.52 mg vs. 167.74±67.20 mg,Pvs. 4.31±0.81,P=0.003)。RATS 组中出现延迟出院的患者较少(11 对 39,Pvs. 3.9%,发热:4.9% 对 13.5%,肺不张:0% 对 2.0%):0% vs. 2.0%,感染:1.0% vs. 2.0%):1.0% vs. 2.9%,漏气:6.9% vs. 8.8%,引流液异常:0% vs. 8.8%,P=0.23;恢复:0% vs. 8.8%,P=0.27):P=0.27).同时,亚组分析显示,术后24小时镇痛药物、手术时间、术中出血、肿瘤病史四项指标均有统计学意义(肿瘤病史:P=0.04;术中出血:P=0.05;肿瘤病史:P=0.05):P=0.04;术中出血:P=0.005;术后 24 小时使用镇痛药物:P=0.001;手术时间:P=0.008):P=0.008):结论:在手术环境中,RATS与VATS相比显示出更好的结果,包括更短的手术时间、更少的术中失血、更少的术后引流量、更短的引流时间和更少的术后并发症。肿瘤病史、术中出血、术后24小时内使用镇痛药物以及手术持续时间是导致日间手术延迟出院的风险因素。
{"title":"Short-term outcomes of robotic- <i>vs.</i> television-assisted thoracoscopic segmental lung resection for early-stage non-small-cell lung cancer in the day surgery models.","authors":"Yusheng Wang, Chaofan Meng, Liang Shi, Shuang Gu, Xiao Fan, Qianyun Wang","doi":"10.21037/jtd-24-1020","DOIUrl":"10.21037/jtd-24-1020","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;At present, few articles compare the differences between robot-assisted thoracic surgeries (RATSs) and video-assisted thoracic surgeries (VATSs) in the day surgery model and there is also little literature on what factors influence delayed discharge from day surgery. This study aims to compare short-term outcomes between RATS and VATS for segmental lung resection in a day surgery setting, and to identify risk factors for delayed discharge.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis was performed on 204 patients with early-stage non-small-cell lung cancer (NSCLC) who underwent segmental lung resection via RATS or VATS at the First People's Hospital of Changzhou City from January 2021 to December 2023. The clinical data and short-term efficacy of the two groups were compared, and the patients were divided into two subgroups based on whether the patients were discharged within 48 hours. One group was day surgery patients who were discharged within 48 hours, and the other group was day surgery patients with delayed discharge, so as to explore the factors affecting the delayed discharge of day surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared to the VATS group, the RATS group had a shorter average surgery duration (58.59±12.20 &lt;i&gt;vs.&lt;/i&gt; 66.12±21.56 min, P&lt;0.001), less intraoperative blood loss (98.77±51.50 &lt;i&gt;vs.&lt;/i&gt; 128.87±65.79 mL, P=0.02), lower total postoperative drainage (185.44±109.14 &lt;i&gt;vs.&lt;/i&gt; 268.70±147.99 mL, P=0.007), and a shorter postoperative drainage duration (1.74±0.30 &lt;i&gt;vs.&lt;/i&gt; 2.29±0.98 days, P=0.045). The patients experienced less pain, with lower total drug dose of intramuscular diclofenac sodium lidocaine injection and oral celecoxib capsules (111.76±40.52 &lt;i&gt;vs.&lt;/i&gt; 167.74±67.20 mg, P&lt;0.001) and reduced pain scores (3.29±0.66 &lt;i&gt;vs.&lt;/i&gt; 4.31±0.81, P=0.003). Fewer patients in the RATS group experienced delayed discharges (11 &lt;i&gt;vs.&lt;/i&gt; 39, P&lt;0.001), and the incidence of postoperative complications was lower (nausea and vomiting: 3.9% &lt;i&gt;vs.&lt;/i&gt; 3.9%, fever: 4.9% &lt;i&gt;vs.&lt;/i&gt; 13.5%, pulmonary atelectasis: 0% &lt;i&gt;vs.&lt;/i&gt; 2.0%, infection: 1.0% &lt;i&gt;vs.&lt;/i&gt; 2.9%, air leakage: 6.9% &lt;i&gt;vs.&lt;/i&gt; 8.8%, abnormal drainage fluid: 0% &lt;i&gt;vs.&lt;/i&gt; 8.8%, P=0.23; recovery: P=0.27). Meanwhile, subgroup analysis revealed that the four indicators of 24-hour postoperative analgesic medication, operation time, intraoperative bleeding, and tumor history were statistically significant (tumor history: P=0.04; intraoperative bleeding: P=0.005; use of analgesic medication in the 24-hour postoperative period: P=0.001; duration of surgery: P=0.008).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In the surgery setting, RATSs showed better outcomes compared to VATSs, including shorter surgical duration, reduced intraoperative blood loss, lower postoperative drainage volume, shorter drainage duration, and fewer postoperative complications. History of tumor, intraoperative bleeding, use of analgesic medication in the 24-hour posto","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7257-7270"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Single-port robot-assisted thoracoscopic right lower bronchial sleeve lobectomy utilizing the Shurui single-port robotic system.
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-21 DOI: 10.21037/jtd-24-957
Chang Li, Xin-Yu Zhu, Diego Gonzalez-Rivas, Jun Zhao

Sleeve lobectomy has solidified its position as a preferred alternative to pneumonectomy due to its significant advantage in preserving lung function, whereas right lower lobe sleeve lobectomy remains relatively uncommon because of the higher technical challenge. With the development of minimally invasive technology and experience acquired over the years, robot-assisted thoracoscopic surgery (RATS) has shown progress and distinct advantages compared to the traditional thoracotomy and video-assisted thoracoscopic surgery (VATS) approach. Owing to its 3D vision, bendable wrist joints, and tremor filtration capabilities, this surgical technique exhibits great advantages in complex thoracic operations demanding for reconstructive procedures compared to traditional thoracoscopic surgery. The Davinci Xi system has been employed in a substantial number of sleeve resections via a single-port approach. However, the Davinci Xi system was first designed for multi-port thoracic surgery, which poses challenges for adaptation to single-port surgery. Additionally, the newer Davinci SP system, with its 2.5 cm port diameter, cannot be inserted through an intercostal incision and can only be utilized for lung surgery via a subcostal incision, thus restricting its application in complex lung surgeries such as sleeve resection. Here we present a case report on a right lower sleeve lobectomy utilizing the innovative Shurui single-port robotic system which exhibits several advantages in the realm of lung surgery compared to traditional procedures.

袖带肺叶切除术因其在保留肺功能方面的显著优势,已巩固了其作为肺切除术首选替代方案的地位,而右下叶袖带肺叶切除术因其技术难度较高,仍相对少见。随着微创技术的发展和多年来积累的经验,机器人辅助胸腔镜手术(RATS)与传统的开胸手术和视频辅助胸腔镜手术(VATS)相比取得了进步和明显的优势。与传统胸腔镜手术相比,机器人胸腔镜手术凭借其三维视觉、可弯曲的腕关节和震颤过滤功能,在要求重建手术的复杂胸腔手术中表现出巨大优势。Davinci Xi 系统已在大量通过单孔方法进行的袖状切除术中得到应用。然而,Davinci Xi 系统最初是为多孔胸腔镜手术设计的,这给单孔手术的适应性带来了挑战。此外,较新的 Davinci SP 系统的端口直径为 2.5 厘米,无法通过肋间切口插入,只能通过肋下切口进行肺部手术,因此限制了其在袖状切除术等复杂肺部手术中的应用。与传统手术相比,Shurui 单孔机器人系统在肺部手术领域具有多项优势。
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引用次数: 0
An innovative and safe method to manage the inter-segmental plane using the "Inserted Multilateral Cutting Method" in pulmonary segmentectomy. 在肺段切除术中使用 "插入式多侧切割法 "管理肺段间平面的创新安全方法。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-18 DOI: 10.21037/jtd-23-1888
Guang Zhao, Liping Tong, Xiaoping Dong, Hongtao Duan, Yong Zhang, Xiaolong Yan, Honggang Liu

Background: Management of the intersegmental plane (ISP) remains a challenge in lung segmentectomy to minimize intra- or postoperative complications and damage to the lungs. The purpose of this study was to assess the novel method's clinical feasibility and safety for segmentectomy.

Methods: A total of 205 patients who underwent video-assisted thoracoscopic surgery (VATS) segmentectomy from May 2018 to January 2020 were retrospectively reviewed. We classified the patients into two groups according to the surgical procedure: the Inserted Multilateral Cutting Method (IMCM) group and the non-IMCM group using staplers or energy instruments to manage the ISPs. The operative characteristics and postoperative complications were compared between the two groups.

Results: All patients in the two groups underwent VATS segmentectomy with free margins. There were no significant differences in clinicopathological characteristics between the two groups. Compared with the non-IMCM group, the IMCM group was significantly associated with less intraoperative blood loss (85.5±64.3 vs. 106.6±64.7 mL; P=0.04), shorter operation time (101.7±22.2 vs. 118.3±30.9 minutes; P<0.01) and duration of chest drainage (3.8±1.3 vs. 4.2±1.4 days; P=0.03). No significant difference was found in hospital stays, prolonged air leaks, and pulmonary infection between the two groups. On multivariate analysis, the IMCM method for managing the intersegment plane was verified to be significantly correlated with lower postoperative complications (odds ratio: 0.263, P=0.01).

Conclusions: The IMCM during VATS segmentectomy showed excellent feasibility and safety and is worthy of popularization and application.

背景:肺段间平面(ISP)的管理仍是肺段切除术中的一项挑战,以最大限度地减少术中或术后并发症以及对肺部的损伤。本研究旨在评估这种新方法在肺段切除术中的临床可行性和安全性:回顾性分析了2018年5月至2020年1月期间接受视频辅助胸腔镜手术(VATS)段切除术的205例患者。我们根据手术方法将患者分为两组:插入式多侧切割法(IMCM)组和使用订书机或能量器械处理 ISP 的非 IMCM 组。比较两组患者的手术特点和术后并发症:结果:两组所有患者均接受了 VATS 切除术,切缘游离。两组患者的临床病理特征无明显差异。与非 IMCM 组相比,IMCM 组术中失血量明显减少(85.5±64.3 对 106.6±64.7 mL;P=0.04),手术时间明显缩短(101.7±22.2 对 118.3±30.9 分钟;Pvs.)两组在住院时间、漏气时间和肺部感染方面无明显差异。多变量分析证实,采用 IMCM 方法管理节段间平面与术后并发症的发生率显著相关(几率:0.263,P=0.01):结论:在 VATS 肺段切除术中使用 IMCM 显示出良好的可行性和安全性,值得推广和应用。
{"title":"An innovative and safe method to manage the inter-segmental plane using the \"Inserted Multilateral Cutting Method\" in pulmonary segmentectomy.","authors":"Guang Zhao, Liping Tong, Xiaoping Dong, Hongtao Duan, Yong Zhang, Xiaolong Yan, Honggang Liu","doi":"10.21037/jtd-23-1888","DOIUrl":"10.21037/jtd-23-1888","url":null,"abstract":"<p><strong>Background: </strong>Management of the intersegmental plane (ISP) remains a challenge in lung segmentectomy to minimize intra- or postoperative complications and damage to the lungs. The purpose of this study was to assess the novel method's clinical feasibility and safety for segmentectomy.</p><p><strong>Methods: </strong>A total of 205 patients who underwent video-assisted thoracoscopic surgery (VATS) segmentectomy from May 2018 to January 2020 were retrospectively reviewed. We classified the patients into two groups according to the surgical procedure: the Inserted Multilateral Cutting Method (IMCM) group and the non-IMCM group using staplers or energy instruments to manage the ISPs. The operative characteristics and postoperative complications were compared between the two groups.</p><p><strong>Results: </strong>All patients in the two groups underwent VATS segmentectomy with free margins. There were no significant differences in clinicopathological characteristics between the two groups. Compared with the non-IMCM group, the IMCM group was significantly associated with less intraoperative blood loss (85.5±64.3 <i>vs.</i> 106.6±64.7 mL; P=0.04), shorter operation time (101.7±22.2 <i>vs.</i> 118.3±30.9 minutes; P<0.01) and duration of chest drainage (3.8±1.3 <i>vs.</i> 4.2±1.4 days; P=0.03). No significant difference was found in hospital stays, prolonged air leaks, and pulmonary infection between the two groups. On multivariate analysis, the IMCM method for managing the intersegment plane was verified to be significantly correlated with lower postoperative complications (odds ratio: 0.263, P=0.01).</p><p><strong>Conclusions: </strong>The IMCM during VATS segmentectomy showed excellent feasibility and safety and is worthy of popularization and application.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7675-7685"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Effectiveness of the enhanced recovery after surgery (ERAS) program after lobectomy for lung cancer: a single-center observational study using propensity score matching in Vietnam. 肺癌肺叶切除术后加强术后恢复(ERAS)计划的效果:在越南进行的单中心观察性研究,采用倾向得分匹配法。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-12 DOI: 10.21037/jtd-24-1053
Ho Tat Bang, Tran Thanh Vy, Le Quan Anh Tuan, Nguyen Lam Vuong, Lam Thao Cuong, Ha Quoc Hung, Phan Ton Ngoc Vu, Nguyen Van Tap

Background: Postoperative complications and extended length of stays (LOS) following lobectomy for non-small cell lung cancer (NSCLC) remain significant healthcare and economic burdens, especially in developing countries with limited resources. This study evaluated the effectiveness of enhanced recovery after surgery (ERAS) protocols in addressing these issues.

Methods: This observational study compared two groups of patients, utilizing a prospective arm for ERAS and a retrospective arm for routine care. Outcomes measured included postoperative LOS, complications, re-operations, and re-admissions. Propensity score matching (PSM) was used to adjust for potential confounders between the two groups.

Results: Among 197 NSCLC patients (98 in the ERAS group and 99 in the routine care group), the PSM resulted in 63 patients in each group. After PSM, the ERAS group experienced a significantly shorter postoperative LOS compared to the routine group (median: 4.6 vs. 5.1 days, P=0.01). There were no significant differences in postoperative complication and re-operative rates between the two groups. However, the ERAS group had a significantly lower postoperative 30-day re-admission rate of 1.6%, compared to 14.3% in the routine care group (P=0.02).

Conclusions: In NSCLC patients who underwent lobectomy, ERAS protocols improve postoperative outcomes by reducing LOS and re-admission rates. Therefore, ERAS should be considered a replacement for routine protocols in developing countries to minimize healthcare and economic burdens.

背景:非小细胞肺癌(NSCLC)肺叶切除术后并发症和延长住院时间(LOS)仍然是重大的医疗和经济负担,尤其是在资源有限的发展中国家。本研究评估了加强术后恢复(ERAS)方案在解决这些问题方面的有效性:这项观察性研究对两组患者进行了比较,前瞻性部分采用ERAS,回顾性部分采用常规护理。测量的结果包括术后住院时间、并发症、再次手术和再次入院。采用倾向评分匹配法(PSM)来调整两组患者之间的潜在混杂因素:在197名NSCLC患者中(ERAS组98人,常规护理组99人),倾向得分匹配法使两组各有63名患者。PSM 后,ERAS 组的术后 LOS 明显短于常规组(中位数:4.6 天 vs. 5.1 天,P=0.01)。两组的术后并发症和再次手术率没有明显差异。然而,ERAS组术后30天再次入院率为1.6%,明显低于常规护理组的14.3%(P=0.02):在接受肺叶切除术的 NSCLC 患者中,ERAS 方案可通过降低 LOS 和再入院率来改善术后效果。因此,在发展中国家,ERAS应被视为常规方案的替代方案,以最大限度地减轻医疗和经济负担。
{"title":"Effectiveness of the enhanced recovery after surgery (ERAS) program after lobectomy for lung cancer: a single-center observational study using propensity score matching in Vietnam.","authors":"Ho Tat Bang, Tran Thanh Vy, Le Quan Anh Tuan, Nguyen Lam Vuong, Lam Thao Cuong, Ha Quoc Hung, Phan Ton Ngoc Vu, Nguyen Van Tap","doi":"10.21037/jtd-24-1053","DOIUrl":"10.21037/jtd-24-1053","url":null,"abstract":"<p><strong>Background: </strong>Postoperative complications and extended length of stays (LOS) following lobectomy for non-small cell lung cancer (NSCLC) remain significant healthcare and economic burdens, especially in developing countries with limited resources. This study evaluated the effectiveness of enhanced recovery after surgery (ERAS) protocols in addressing these issues.</p><p><strong>Methods: </strong>This observational study compared two groups of patients, utilizing a prospective arm for ERAS and a retrospective arm for routine care. Outcomes measured included postoperative LOS, complications, re-operations, and re-admissions. Propensity score matching (PSM) was used to adjust for potential confounders between the two groups.</p><p><strong>Results: </strong>Among 197 NSCLC patients (98 in the ERAS group and 99 in the routine care group), the PSM resulted in 63 patients in each group. After PSM, the ERAS group experienced a significantly shorter postoperative LOS compared to the routine group (median: 4.6 <i>vs.</i> 5.1 days, P=0.01). There were no significant differences in postoperative complication and re-operative rates between the two groups. However, the ERAS group had a significantly lower postoperative 30-day re-admission rate of 1.6%, compared to 14.3% in the routine care group (P=0.02).</p><p><strong>Conclusions: </strong>In NSCLC patients who underwent lobectomy, ERAS protocols improve postoperative outcomes by reducing LOS and re-admission rates. Therefore, ERAS should be considered a replacement for routine protocols in developing countries to minimize healthcare and economic burdens.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7686-7696"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neoadjuvant immunology therapy in patients with non-small cell lung cancer and chronic obstructive pulmonary disease. 非小细胞肺癌和慢性阻塞性肺病患者的新辅助免疫疗法。
IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM Pub Date : 2024-11-30 Epub Date: 2024-11-08 DOI: 10.21037/jtd-24-811
Qing Chang, Jiaqi Li, Yan Zhu, Huiping Qiang, Haijiao Lu, Yinchen Shen, Shuyuan Wang, Jialin Qian, Tianqing Chu

Background: For patients with early non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), the efficacy and safety of immunotherapy are still unclear. This study was designed to investigate the effect and safety of neoadjuvant immunotherapy for patients with resectable NSCLC including those with coexisting COPD and the effect on patients' lung function.

Methods: Data of patients with resectable NSCLC who received neoadjuvant immunotherapy at the Shanghai Chest Hospital were retrospectively analyzed.

Results: A total of 57 patients were enrolled and 18 of those were with coexisting COPD. For COPD patients, the objective response rate (ORR), major pathological response (MPR), and pathological complete response (pCR) were 44.4%, 55.6%, and 38.9%, respectively, which were not statistically different from those of non-COPD patients. The 2-year event-free survival (EFS) and overall survival (OS) rates were 73.7% and 88.5%, respectively, which were lower than those of patients without COPD, but the difference was not statistically significant. After neoadjuvant immunotherapy, the ratio of forced expiratory volume in 1 second (FEV1), the ratio of FEV1 to the predicted value (FEV1%pred), forced vital capacity (FVC), and the ratio of FVC to the predicted value (FVC%pred) all improved, however, carbon monoxide diffusing capacity (DLCO) and DLCO adjusted by hemoglobin (DLCOc) were lower. For patients with COPD, only FEV1 improved after immunotherapy.

Conclusions: For resectable NSCLC patients with COPD, neoadjuvant immunotherapy could achieve better pathological response, survival benefit and improve patients' lung function.

背景:对于并发慢性阻塞性肺疾病(COPD)的早期非小细胞肺癌(NSCLC)患者,免疫治疗的有效性和安全性尚不明确。本研究旨在探讨新辅助免疫疗法对可切除NSCLC患者(包括合并慢性阻塞性肺疾病的患者)的疗效和安全性,以及对患者肺功能的影响:方法:回顾性分析在上海市胸科医院接受新辅助免疫治疗的可切除NSCLC患者的数据:结果:共有57名患者入组,其中18名患者合并有慢性阻塞性肺疾病。COPD患者的客观反应率(ORR)、主要病理反应率(MPR)和病理完全反应率(pCR)分别为44.4%、55.6%和38.9%,与非COPD患者相比无统计学差异。2年无事件生存率(EFS)和总生存率(OS)分别为73.7%和88.5%,低于非COPD患者,但差异无统计学意义。新辅助免疫疗法后,1秒用力呼气容积(FEV1)、FEV1与预测值之比(FEV1%pred)、用力肺活量(FVC)和FVC与预测值之比(FVC%pred)均有所改善,但一氧化碳弥散容量(DLCO)和经血红蛋白调整的DLCO(DLCOc)却有所降低。对于慢性阻塞性肺病患者,免疫疗法后只有FEV1有所改善:结论:对于患有慢性阻塞性肺病的可切除NSCLC患者,新辅助免疫疗法可获得更好的病理反应、生存获益并改善患者的肺功能。
{"title":"Neoadjuvant immunology therapy in patients with non-small cell lung cancer and chronic obstructive pulmonary disease.","authors":"Qing Chang, Jiaqi Li, Yan Zhu, Huiping Qiang, Haijiao Lu, Yinchen Shen, Shuyuan Wang, Jialin Qian, Tianqing Chu","doi":"10.21037/jtd-24-811","DOIUrl":"10.21037/jtd-24-811","url":null,"abstract":"<p><strong>Background: </strong>For patients with early non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD), the efficacy and safety of immunotherapy are still unclear. This study was designed to investigate the effect and safety of neoadjuvant immunotherapy for patients with resectable NSCLC including those with coexisting COPD and the effect on patients' lung function.</p><p><strong>Methods: </strong>Data of patients with resectable NSCLC who received neoadjuvant immunotherapy at the Shanghai Chest Hospital were retrospectively analyzed.</p><p><strong>Results: </strong>A total of 57 patients were enrolled and 18 of those were with coexisting COPD. For COPD patients, the objective response rate (ORR), major pathological response (MPR), and pathological complete response (pCR) were 44.4%, 55.6%, and 38.9%, respectively, which were not statistically different from those of non-COPD patients. The 2-year event-free survival (EFS) and overall survival (OS) rates were 73.7% and 88.5%, respectively, which were lower than those of patients without COPD, but the difference was not statistically significant. After neoadjuvant immunotherapy, the ratio of forced expiratory volume in 1 second (FEV1), the ratio of FEV1 to the predicted value (FEV1%pred), forced vital capacity (FVC), and the ratio of FVC to the predicted value (FVC%pred) all improved, however, carbon monoxide diffusing capacity (DLCO) and DLCO adjusted by hemoglobin (DLCOc) were lower. For patients with COPD, only FEV1 improved after immunotherapy.</p><p><strong>Conclusions: </strong>For resectable NSCLC patients with COPD, neoadjuvant immunotherapy could achieve better pathological response, survival benefit and improve patients' lung function.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7546-7560"},"PeriodicalIF":2.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of thoracic disease
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