ObjectiveTo explore the application of Toumai® minimally invasive endoscopic robot in thoracic surgery, and to observe its safety and short-term surgical efficacy. MethodsThree patients were enrolled from October to December 2021, including 1 male (69 years) and 2 females (47 years and 22 years). All 3 patients received surgery with Toumai® endoscopic surgical robot, including radical lung cancer surgery in 2 patients and mediastinal tumor resection in 1 patient. ResultsAll 3 patients were successfully operated without conversion to thoracotomy, complication or death. For the male lobectomy patient, the total operation time was 120 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female lobectomy patient, the total operation time was 103 min, the intraoperative blood loss was 100 mL, the catheter drainage time was 4 days and the hospital stay time was 5 days. For the female mediastinal tumor patient, the total operation time was 81 min, the intraoperative blood loss was 50 mL, the catheter drainage time was 3 days and the hospital stay time was 3 days. ConclusionThe Toumai® minimally invasive endoscopic surgical robot is safe and effective in thoracic surgery. Compared with Da Vinci surgical robot, Toumai® has the same 3D visual field experience and smooth operation.
Objective To evaluate the short-term efficacy and safety of nedaplatin combined with gemcitabine compared with cisplatin combined with gemcitabine in the treatment of advanced lung squamous cell carcinoma. Methods The Cochrane Library, EMbase, PubMed, Web of Science, Wanfang, VIP, CNKI and China General Library of Biomedical Literature were searched. Literatures related to the efficacy and safety of nedaplatin combined with gemcitabine (nedaplatin group) versus cisplatin combined with gemcitabine (cisplatin group) in the treatment of advanced lung squamous cell carcinoma published from the inception to October 2021 were searched. The quality of included studies was assessed by Cochrane bias assessing tool and the meta-analysis was conducted by using RevMan 5.4. Results A total of 10 articles were included covering 914 patients. Meta-analysis showed that the objective remission rate (OR=1.51, 95%CI 1.13-2.01, P=0.005), disease control rate (OR=1.54, 95%CI 1.10-2.15, P=0.01) and 1-year survival rate (OR=2.29, 95%CI 1.25-4.18, P=0.007) of the nedaplatin group were better than those of the cisplatin group. In terms of side effects, the incidence of white blood cell and hemoglobin decline, nausea and vomiting, and diarrhea in the nedaplatin group was lower than that in the cisplatin group (P≤0.05). The differences in the platelet decline and liver and kidney damage between the two groups were not statistically significant (P>0.05). Conclusion For patients with advanced lung squamous cell carcinoma, the short-term efficacy of nedaplatin combined with gemcitabine may be better than cisplatin combined with gemcitabine, and the incidence of adverse reactions is lower.
Objective To systematically evaluate the efficacy and safety of thoraco-laparoscopy combined with Ivor Lewis surgery versus thoraco-laparoscopy combined with McKeown surgery in the treatment of esophageal carcinoma. MethodsPubMed, EMbase, The Cochrane Library, Web of Science, Wanfang database, VIP database and CNKI were searched by computer for the relevant literature comparing the efficacy and safety of Ivor Lewis surgery and McKeown surgery in the treatment of esophageal carcinoma from inception to January 2022. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of cohort studies, and the Cochrane risk of bias tool was used to evaluate the methodological quality of randomized controlled studies. Review Manager 5.4 software was utilized to perform a meta-analysis of the literature. ResultsA total of 33 articles were included, which consisted of 26 retrospective cohort studies, 3 prospective cohort studies and 4 randomized controlled trials. There were 11 518 patients in total, including 5 454 patients receiving Ivor Lewis surgery and 6064 patients receiving McKeown surgery. NOS score was≥7 points. Meta-analysis showed that, in comparison to the McKeown surgery, the Ivor Lewis surgery had shorter operative time (MD=–19.61, 95%CI –30.20 to –9.02, P<0.001), shorter postoperative hospital stay (MD=–1.15, 95%CI –1.43 to –0.87, P<0.001), lower mortality rate during hospitalization or 30 days postoperatively (OR=0.37, 95%CI 0.20 to 0.71, P=0.003), and lower incidence of total postoperative complications (OR=0.36, 95%CI 0.27 to 0.49, P<0.001). The McKeown surgery had an advantage in terms of the number of lymph nodes dissected (MD=–1.25, 95%CI –2.03 to –0.47, P=0.002), postoperative extubation time (MD=0.78, 95%CI 0.37 to 1.19, P<0.001) and 6-month postoperative recurrence rate (OR=1.83, 95%CI 1.41 to 2.39, P<0.001). The differences between the two surgeries were not statistically significant in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-overall survival (OS), and impaired gastric emptying (P>0.05). ConclusionCompared with McKeown surgery, Ivor Lewis surgery has shorter operative time, shorter postoperative hospital stay, lower mortality rate during hospitalization or 30 days postoperatively and lower incidence of total postoperative complications. However, in terms of the number of lymph nodes dissected, postoperative extubation time and 6-month postoperative recurrence rate, McKeown surgery has advantages. Both surgeries have comparable results in terms of intraoperative bleeding, postoperative 1 year-, 3 year- and 5 year-OS, and impaired gastric emptying.
Objective To systematically evaluate the efficacy and safety of immune checkpoint inhibitors (ICIs) as first-line treatment for advanced non-small cell lung cancer (NSCLC). MethodsPubMed, The Cochrane Library, and EMbase databases were searched for clinical randomized controlled trials (RCTs) of ICIs as first-line treatment for NSCLC patients. The search period was from database inception to January 2023. Quality evaluation was conducted using the improved Jadad scale, and meta-analysis was performed using RevMan 5.4 software. ResultsTwelve RCTs were included, all of which were assessed as high-quality literature, involving a total of 7 121 patients. Meta-analysis results showed that, compared with chemotherapy, ICIs as first-line treatment for NSCLC patients significantly improved median overall survival (OS) [HR=0.72, 95%CI (0.64, 0.80), P<0.001] and median progression-free survival (PFS) [HR=0.65, 95%CI (0.53, 0.78), P<0.001], and improved objective response rate (ORR) [RR=1.52, 95%CI (1.28, 1.79), P<0.001]. Subgroup analysis showed that, compared with the ICIs monotherapy group, the ICIs combination therapy group significantly improved OS, PFS, and ORR in NSCLC patients. In terms of safety, the risk of any grade treatment-related adverse events (TRAEs) and grade 3-5 TRAEs in the ICIs group was lower than that in the chemotherapy group. The incidence of TRAEs leading to treatment discontinuation was higher in the ICIs group than in the chemotherapy group. Subgroup analysis showed that the incidence of any grade, grade 3-5, and TRAEs leading to treatment discontinuation was higher in the immune combination therapy group than in the immune monotherapy group. Conclusion ICIs as first-line treatment for NSCLC patients can significantly improve OS, PFS, and ORR compared with chemotherapy. Compared to immune monotherapy, immune combination therapy can significantly improve the efficacy in NSCLC patients, but patients have a higher risk of TRAEs.
Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.
Lung cancer is the leading cause of cancer-related deaths worldwide. Despite growing efforts for its early detection by screening populations at risk, the majority of lung cancer patients are still diagnosed in an advanced stage. In the last decade, the treatment of non-small cell lung cancer (NSCLC) has been improved significantly. Emerging options of targeted therapies and immunotherapies have shifted the management of lung cancer to a more personalized treatment approach, significantly influencing the clinical course and outcome of the disease. At present, molecular biomarkers are becoming a powerful tool for diagnosing cancer, predicting treatment response outcomes, and assessing prognosis. In this review, we summarized the biomarkers relevant to the diagnosis, prediction, and prognosis of NSCLC as well as promising novel predictive biomarkers in the future.
Objective To systematically review the sex differences in efficacy of immune checkpoint inhibitors (ICIs) for non-small cell lung cancer (NSCLC) patients. Methods We conducted a computer search of Medline, The Cochrane Library, and EMbase from inception to November 2022 to identify randomized controlled trials (RCTs) assessing the efficacy of ICIs in patients with NSCLC. A meta-analysis was performed using RevMan 5.4 software. ResultsFinally 16 RCTs with a total of 9 653 patients were included, and the modified Jadad scale score was≥4 points. Meta-analysis results showed that in female NSCLC patients receiving immune therapy, the median overall survival (OS) [HR=0.72, 95%CI (0.61, 0.85), P<0.001] was longer than that in males [HR=0.73, 95%CI (0.69, 0.78), P<0.001]. Males [HR=0.64, 95%CI (0.58, 0.71), P<0.001] had an advantage over females [HR=0.76, 95%CI (0.57, 1.03), P=0.760] in median progression-free survival (PFS). Conclusion Females receiving ICIs have an advantage over males in terms of median OS. However, males tend to derive greater benefit from ICIs in terms of median PFS.
ObjectiveTo evaluate the efficacy and safety of robot-assisted thymectomy (RATS) versus video-assisted thoracoscopic thymectomy (VATS). MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, Wanfang, VIP and CNKI databases were searched by computer from inception to February 2022. Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened. The Newcastle-OttawaScale (NOS) was used to evaluate the quality of included cohort studies, and Review Manager 5.4 software was utilized to perform a meta-analysis. ResultsA total of 16 retrospective cohort studies were included, covering a total of 1 793 patients (874 patients in the RATS group and 919 patients in the VATS group). The NOS scores of the included studies were≥7 points. Meta-analysis results revealed that RATS had less intraoperative bleeding (MD=−22.45, 95%CI −34.16 to −10.73, P<0.001), less postoperative chest drainage (MD=−80.29, 95%CI −144.86 to −15.72, P=0.010), shorter postoperative drainage time (MD=−0.69, 95%CI −1.08 to −0.30, P<0.001), shorter postoperative hospital stay (MD=−1.14, 95%CI −1.55 to −0.72, P<0.001) and fewer conversion to thoractomy (OR=0.40, 95%CI 0.23 to 0.69, P=0.001) than VATS; whereas, the operative time (MD=8.37, 95%CI −1.21 to 17.96, P=0.090), incidence of postoperative myasthenia gravis (OR=0.85, 95%CI 0.52 to 1.40, P=0.530), overall postoperative complications rate (OR=0.80, 95%CI 0.42 to 1.50, P=0.480) and tumour size (MD=−0.18, 95%CI −0.38 to 0.03, P=0.090) were not statistically different between the two groups. ConclusionIn the aspects of intraoperative bleeding, postoperative chest drainage, postoperative drainage time, postoperative hospital stay and conversion to thoracotomy, RATS has unique advantages over the VATS.
ObjectiveTo compare the clinical efficacy of different surgical approaches for Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG). MethodsThe clinical data of the patients with Siewert type Ⅱ AEG who received sugeries in the Department of Thoracic Surgery of Gansu Provincial People's Hospital from August 2014 to December 2019 were retrospectively analyzed. The patients were divided into two groups according to the surgical approach: a transabdominal group (transabdominal diaphragmatic esophageal hiatus approach) and a combined group (thoracoabdominal combined with right thoracic approach). Perioperative clinical data and postoperative follow-up data were collected to compare the short- and long-term efficacy of the two groups. Results A total of 87 patients were enrolled. There were 48 patients (31 males and 17 females, with an average age of 60.85±8.47 years) in the transabdominal group, and 39 patients (25 males and 14 females, with an average age of 61.13±8.51 years) in the combined group. There was no statistical difference between the two groups in the baseline indicators such as gender, age, tumor size and stage (P>0.05). Compared with the combined group, the operation time, intraoperative blood loss, postoperative bed rest time, postoperative total drainage volume were shorter or less, and the visual analogue scale score on the 3rd day after surgery were lower in the transabdominal group (P<0.05). However, the total number of lymph nodes dissected, the number of thoracic lymph nodes dissected and the number of positive thoracic lymph nodes in the combined group were larger than those in the transabdominal group, and the differences were statistically significant (P=0.001). The median survival time in the combined group and transabdominal group was 25.85 months and 20.86 months, respectively. The 3-year overall survival rate of the combined group was higher than that of the transabdominal group (46.2% vs. 38.9%, χ2=5.995, P=0.014). However, there was no statistical difference between the two groups in the postoperative catheter time, esophageal and gastric resection margin distance, number of abdominal lymph nodes dissected, number of positive abdominal lymph nodes, or incidence of postoperative complications (P>0.05). ConclusionFor patients with Siewert type Ⅱ adenocarcinoma of esophagogastric junction, thoracoabdominal combined with right thoracic approach is safe and effective, and has advantages in thoracic lymph node dissection, bringing more benefits to the patients, so it is recommended to be popularized in clinical practice.
ObjectiveTo evaluate the short-term outcomes and hospital costs of robot-assisted thoracic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer. MethodsThe clinical data of patients who underwent lobectomy or sublobar resection for non-small cell lung cancer completed by the same operator in the Department of Thoracic Surgery, Gansu Provincial Hospital from June 2016 to June 2022 were retrospectively analyzed. According to the surgery approach, the patients were divided into a RATS group and a VATS group. The clinical data of the two groups were compared. ResultsA total of 516 patients were enrolled. There were 254 patients in the RATS group, including 103 males and 151 females, with a mean age of 60.0±4.2 years, and 262 patients in the VATS group, including 126 males and 136 females, with a mean age of 59.5±4.3 years. All patients in both groups successfully completed radical lung cancer surgery with no perioperative death. In terms of intraoperative bleeding (63.4±13.3 mL vs. 92.5±23.5 mL), postoperative drainage time (4.1±0.9 d vs. 4.7±1.2 d), postoperative hospital stay time (5.6±1.1 d vs. 6.7±1.4 d), number of lymph nodes dissected (17.9±2.1 vs. 13.9±1.4) and groups of lymph nodes dissected (5.4±0.8 groups vs. 4.4±1.0 groups), the RATS group had an advantage, and the difference was statistically significant (P<0.05). In terms of operative time and total postoperative chest drainage, the VATS group had an advantage, and the difference was statistically significant (P<0.05). There was no statistical difference between the two groups in terms of postoperative complications or intraoperative conversion to thoractomy (P>0.05). The total hospitalization, surgical and total consumables costs of the RATS group were higher than those in the VATS group (P<0.05). In terms of other costs and consumables costs (one-time costs of purely high-value consumables after deduction of robot-specific costs), the VATS group was higher than the RATS group (P<0.05). ConclusionRATS offers technical and short-term efficacy advantages, but comes with the disadvantage of high costs. Thoracic surgeons can make full use of the features of the robotic surgery system, exploiting its potential to continuously improve and optimize techniques and reduce the use of high-value consumables, thus achieving efficiency and cost reductions and allowing robotic surgery to reach more patients.