Journal of Chest Surgery最新文献

Background: Anastomotic leak at the cervical anastomosis following esophagectomy remains a significant problem. However, diagnostic accuracy for this condition is limited, and interpretation varies. This study aimed to share our institution's experience regarding the diagnostic value of esophagram and drain fluid amylase testing.

Methods: We retrospectively reviewed patients with esophageal cancer who underwent McKeown esophagectomy. Esophagram was scheduled on postoperative day (POD) 7. Drain fluid amylase levels were measured twice, on POD 3 and POD 7. Diagnostic criteria were established based on the values measured at these time points and the relationship between them.

Results: Overall, 103 patients were eligible for evaluation. Of these, 48 underwent drain fluid amylase testing, 67 underwent esophagram, and 12 received both examinations. The sensitivity and specificity of esophagram for detecting anastomotic leak were 28.6% and 95%, respectively. The positive predictive value, negative predictive value, and diagnostic accuracy were 40.0%, 91.9%, and 88.1%, respectively. Among patients who underwent drain fluid amylase testing, the criteria for detecting leaks were defined as follows: (1) an increasing trend (i.e., an amylase level higher on POD 7 than on POD 3) and (2) an amylase level >80 IU/L on POD 7. The sensitivity and specificity of these criteria were 75% and 96.5%, respectively, while the positive and negative predictive values were 75% and 96.5%. The diagnostic accuracy was 93.9%.

Conclusion: Compared with esophagram, drain fluid amylase testing is easier to perform and may represent a more accurate method for predicting anastomotic leak.

Primary pulmonary paraganglioma (PPP) is an extremely rare neuroendocrine tumor. We present the case of a 71-year-old woman referred for dyspnea who was incidentally diagnosed with both a mediastinal mass and a pulmonary nodule. Chest computed tomography revealed an anterior mediastinal mass and a right-sided paracardiac pulmonary nodule. The mediastinal mass was excised via median sternotomy, and the pulmonary lesion was removed by wedge resection. Histopathological analysis identified the pulmonary lesion as a moderately differentiated paraganglioma, while the mediastinal mass consisted of ectopic thyroid tissue. Although the lesions were discovered simultaneously, their histopathological features were entirely unrelated, indicating a coincidental coexistence. Nevertheless, thorough histopathological examination is essential to exclude syndromic or metastatic associations. PPP should be considered in the differential diagnosis of pulmonary tumors, and surgical resection remains the mainstay of diagnosis and treatment.

Background: Pathological complete response (pCR) refers to the absence of residual tumor cells after neoadjuvant chemoradiotherapy (nCRT) and is associated with favorable outcomes. However, 25%-33% of such patients still experience disease recurrence. This study aimed to evaluate the prognostic value of circulating tumor cells (CTCs) for risk stratification in patients with esophageal carcinoma (EC) who achieved pCR following nCRT.

Methods: We measured post-nCRT CTC counts in the peripheral blood of patients with EC who attained pCR after undergoing nCRT. The impact of CTC counts on survival was then analyzed, accounting for the potential confounding effects of established clinical and pathological risk factors.

Results: The study included 24 patients, of whom 18 (75%) had detectable CTCs. The mean CTC concentration was 5.1 per mL of blood. Univariable Cox regression analysis showed that CTC count was the only independent predictor of disease-free survival (hazard ratio, 1.113; 95% confidence interval, 1.008-1.229; p=0.034). Receiver operating characteristic curve analysis determined an optimal cutoff value of 4.5 CTCs per mL. The 3-year disease-free survival rate was significantly higher in the low-CTC group (92.9%) than in the high-CTC group (50.0%, p=0.032).

Conclusion: In patients with EC who achieve pCR following nCRT, CTC quantification may help identify those at increased risk of poor survival outcomes.

Background: Video-assisted transthoracic esophagectomy (VATE) is typically performed with double-lumen tube intubation (DLTI) to facilitate 1-lung ventilation. Single-lumen tube intubation (SLTI) with CO₂ insufflation offers an alternative approach, enabling 2-lung ventilation with artificial pneumothorax, which may improve surgical exposure and reduce pulmonary complications. This study compared the efficacy and safety of SLTI with CO₂ insufflation versus DLTI in VATE.

Methods: This retrospective study included 94 male patients who underwent VATE for esophageal cancer at 108 Military Central Hospital between November 2018 and September 2023. Patients were divided into 2 groups: SLTI with CO₂ insufflation (n=44) and DLTI (n=50). The assessed outcomes included lymph node yield, operative time, postoperative complications, intensive care unit (ICU) admission, and length of hospital stay.

Results: The SLTI group had a significantly higher left recurrent laryngeal nerve lymph node yield (2.22±2.65 vs. 0.77±2.14, p=0.008) and a greater total lymph node harvest (23.91±9.22 vs. 19.00±11.75, p=0.02) than the DLTI group. Operative time was longer in the SLTI group for the thoracic phase (168.64±23.69 minutes vs. 142.12±24.17 minutes, p=0.04) and overall (311.82±43.67 minutes vs. 272.68±35.97 minutes, p=0.001). Postoperative complication rates and length of hospital stay did not differ significantly between groups, although ICU admission was more frequent with SLTI (84.1% vs. 56.0%, p=0.003).

Conclusion: SLTI with CO₂ insufflation is a safe and feasible alternative to DLTI in VATE, enabling more extensive recurrent laryngeal lymph node dissection but requiring longer operative times.

Video-assisted thoracoscopic surgery (VATS) has emerged as a less invasive technique for treating resected lung cancer compared with open surgery. In recent years, the uniportal VATS technique has gained popularity for lung resection in small nodules and ground glass lesions. However, it remains unclear whether single-port VATS offers more favorable perioperative outcomes than multi-port approaches. This study aims to evaluate the perioperative outcomes of single-port versus 2-port and 3-port VATS in patients with early-stage non-small cell lung cancer. A literature search was conducted across 5 online databases (PubMed, CENTRAL, ProQuest, SAGE, and ScienceDirect). Meta-analysis was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Study quality was assessed using the risk of bias tool in randomized trials (RoB 2) and the Newcastle-Ottawa Scale, while meta-analysis was conducted with Review Manager (RevMan) 5.4. This study was registered in PROSPERO under protocol number CRD42025634395. A comprehensive initial search identified 9,178 records, of which 22 studies were included in the systematic review and 19 were incorporated into the meta-analysis, with a total of 3,324 participants. Compared with 3-port VATS, single-port VATS was associated with significantly lower intra-operative blood loss (mean difference [MD], -10.52; 95% confidence interval [CI], -17.37 to -3.66; p=0.003), shorter chest tube duration (MD, -0.71; 95% CI, -1.07 to -0.35; p<0.001), lower postoperative drainage volume (MD, -68.25; 95% CI, -117.64 to -18.87; p=0.007), shorter postoperative hospital stay (MD, -1.00; 95% CI, -1.65 to -0.35; p=0.003), and lower pain scores on postoperative day 1 and day 3 (MD, -0.73; 95% CI, -1.19 to -0.28; p=0.002; MD, -0.59; 95% CI, -0.85 to -0.32; p<0.001), as well as a reduced rate of postoperative complications (MD, 0.83; 95% CI, 0.69 to 0.99; p=0.04). No significant differences were observed between single-port and 2-port or 3-port VATS regarding operation time and number of dissected lymph nodes. The risk of bias was low, and the overall certainty was moderate. Single-port VATS is safe and feasible, with short-term outcomes comparable to those of 2-port and 3-port approaches.

Background: This study investigated the long-term results of mitral valve replacement (MVR) using mechanical prostheses in children under 3 years of age.

Methods: We retrospectively reviewed 24 patients who underwent MVR with mechanical prostheses before the age of 3 years between 1996 and 2019. Underlying diagnoses included isolated congenital mitral regurgitation (n=4), congenital mitral stenosis (n=4), and various congenital heart defects (n=16). The median follow-up duration was 9.8 years (interquartile range [IQR], 7.3-13.2 years).

Results: The median age and weight at MVR were 16.6 months (IQR, 5.3-24.7 months) and 7.6 kg (IRQ, 4.9-9.5 kg), respectively. The median prosthesis size was 19 mm (range, 16-29 mm). Supra-annular implantation was performed in 12 patients (50%), who were significantly younger and smaller at the time of surgery and received smaller prostheses than those receiving annular implants. Early mortality occurred in 2 patients (8.3%), and 2 late deaths were recorded. The overall survival rate was 83.3% at 15 years. Redo MVR was performed in 9 patients during follow-up. The median increase in valve size was 4 mm. The interval from initial to redo MVR was positively correlated with the increase in valve size (Spearman ρ=0.64, p=0.07). Freedom from redo MVR was 86.3% at 5 years and 75.8% at 10 years.

Conclusion: MVR with mechanical prostheses in children under 3 years of age can yield acceptable long-term survival, although redo MVR is often required. Mechanical MVR remains a viable salvage option in small children when valve repair is not feasible.