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.
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.
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.
ObjectiveTo evaluate the curative effect of robot-assisted thoracic surgery (RATS) and video-assisted thoracic surgery (VATS) for early stage lung cancer patients.MethodsWe retrospectively analyzed the clinical data of 80 patients with radical resection of lung cancer in Gansu Provincial Hospital between January 2016 and December 2017. The patients were divided into two groups: 43 patients in a VATS group and 37 in a RATS group. There were 51 males and 29 females. Data were processed with STATA v14.0 statistical software.ResultsThere were significant differences in the operative time, duration of hospital stay and operative costs between the two groups. In the RATS group, operative duration was longer (172.21 minutes versus 162.20 minutes, P=0.018), cost was higher (74 076.69 yuan versus 54 814.73 yuan, P<0.001), and required significantly shorter hospital stay (8.27 days versus 10.76 days, P=0.001) compared with those of the VATS group. There was no statistical difference between the two groups in terms of conversion (3 versus 0, P=0.144), blood loss during operation (61.29 ml versus 90.63 ml, P=0.213), dissected lymph node number (17.38 versus 12.63, P=0.095), drainage volume (1 406.76 ml versus 1 514.60 ml, P=0.617) and the drainage time (7.92 days versus 7.20 days, P=0.440).ConclusionIn the early lung cancer patients who underwent thoracic surgery, the postoperative hospitalization time of the RATS group is shorter than that of the VATS group, and the operation time is longer than that of the VATS group. The other short-term surgical indexes are similar to those of thoracoscopic surgery. However, the robot has great advantages in the treatment of patients with difficult lymph node dissection, serious pleural adhesion and complicated anatomical relationship.
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 differences in the learning curve and surgeon's perception for pulmonary lobectomy performed by a single surgeon using the da Vinci surgical robot versus a domestically-made robotic system. Methods A retrospective analysis was conducted on the clinical data of the first 70 consecutive patients who underwent lobectomy with the da Vinci robot and the first 70 with a domestic robot. All procedures were performed by a single thoracic surgeon at Gansu Provincial Hospital who initiated the use of both systems concurrently between 2021 and 2024. Data were analyzed using SPSS 26.0, and learning curves for both groups were plotted and analyzed using the cumulative sum (CUSUM) method. Results The da Vinci group included 41 males and 29 females with a mean age of (66.0±6.83) years and the domestic robot group included 42 males and 28 females;with a mean age of (65.09±6.14) years. For the da Vinci group, the mean operative time was (196.14±29.63) min. The CUSUM learning curve was best fitted by a cubic equation (R2=0.986; CUSUM=0.012X3−1.799X2+69.149X−59.239, where X was the surgical volume), which peaked at the 26th case, delineating the learning and mastery phases. Statistically significant differences were observed between these phases in operation time, setup time, console time, intraoperative blood loss, postoperative day 1 drainage, and number of lymph nodes dissected (all P<0.01). For the domestic robot group, the mean operative time was (187.57±24.62) min. Its CUSUM learning curve also followed a cubic fit (R2=0.910; CUSUM=0.008X3−1.152X2+40.465X+91.940), peaking at the 18th case. Significant improvements between the learning and mastery phases were also found for the same surgical metrics (all P<0.05). The surgeon's perception score was significantly higher for the da Vinci system compared to the domestic system (4.21±0.88 vs. 3.29±1.02, P<0.05). ConclusionCUSUM analysis effectively distinguishes the learning and mastery phases for both systems. The learning curve for da Vinci robotic lobectomy is overcome after 26 cases, whereas the domestic robot required 18 cases. In the mastery phase, operative time, setup time, intraoperative blood loss, and postoperative day 1 drainage are significantly lower, while the number of lymph nodes dissected is significantly higher compared to the learning phase for both systems. There are no significant differences in short-term efficacy or safety between the two groups. However, the da Vinci system provids a superior surgeon experience.
ObjectiveTo systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. MethodsThe PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. ResultsA total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. ConclusionPORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.