With the continuous advancements in immunotherapy and targeted therapy, the treatment management and surgical resection assessment of locally advanced lung cancer have undergone significant changes. In October 2024, the Society of Thoracic Surgeons (STS) released the "STS expert consensus on the multidisciplinary management and resectability of locally advanced non-small cell lung cancer", which provides the latest insights on the evaluation of resectability and multidisciplinary management of locally advanced lung cancer, neoadjuvant (including perioperative) therapy, and adjuvant therapy. This article aims to interpret this consensus, with the goal of introducing the latest perspectives of the STS consensus to thoracic surgeons and providing a reference for the rational implementation of surgical resection, multidisciplinary management, and standardized comprehensive treatment models for non-small cell lung cancer in China.
The concept of enhanced recovery after surgery (ERAS) is composed of multidisciplinary, multimodal, and evidence-based approaches, providing a safe and cost-effective method for perioperative management to improve patient prognosis without increasing the incidence of complications. At present, ERAS for cardiac surgery has developed slowly. This article provides a review of the application and prospects of ERAS concept in the perioperative period of cardiac surgery. The measures for applying ERAS concept to the perioperative period of cardiac surgery are divided into three parts: preoperative, intraoperative, and postoperative. The aim is to provide information for the perioperative management of cardiac surgery patients and assist in their rapid recovery during the perioperative period.
摘要:目的:探讨老年人梗阻性大肠癌的围手术期处理。方法:回顾性分析2003年至2008年间71例60岁以上老年人梗阻性大肠癌的围手术期处理情况。 结果:术前发现并存病者43例,术中出现并发症19例,术后发生并发症37例得,除5例死亡外,均得到有效控制,死亡原因与并存疾病有关。结论:加强围手术期处理,积极治疗并存疾病,老年人梗阻性大肠癌的治疗同样能取得满意的效果。Abstract: Objective:To study the perioperative measures for the aged patients with Obstructive Colorectal Cancer. Methods: Seventyone cases above 60 years with Obstructive Colorectal Cancer were analysed retrospectively on their individual accompanied diseases and perioperative treatments, from 2003 to 2008.Results: Fortythree cases of them had suffered from other diseases. Midoperative complications occurred in 19 cases. Postoperative complications occurred in 37 cases. Except 5 cases of death, complications occurring in others cases were well controlled. The death causes mainly were correlated with accompanied chronic diseases. Conclusion: Strengthen care, active management of other chronic diseases are important significantly for senile patients with colorectal carcinoma to get satisfied outcome.
ObjectiveTo investigate the incidence of perioperative deep venous thrombosis (DVT) of lower extremities and its risk factors in elderly patients with femoral neck fracture. Methods The clinical data of 4 109 elderly patients with femoral neck fracture admitted between August 2012 and November 2020 and met the selection criteria were retrospectively analyzed. Among them, there were 1 137 males and 2 972 females; their ages ranged from 65 to 101 years, with an average of 77.0 years. The time from fracture to admission ranged from 1 to 360 hours, with an average of 35.2 hours. There were 1 858 cases of hemiarthroplasty, 1 617 cases of total hip arthroplasty, and 634 cases of internal fixation surgery. The preoperative age-adjusted Charlson comorbidity index (aCCI) was 4 (3, 5). Perioperative DVT occurred in 857 cases (20.9%). Univariate analysis was performed on age, gender, body mass index, fracture side, time from fracture to admission, operation type, anesthesia type, blood transfusion, blood pressure after admission, and preoperative aCCI in patients with and without perioperative DVT, and logistic regression analysis was used to screen the risk factors of perioperative DVT in elderly patients with femoral neck fracture. ResultsUnivariate analysis showed that there were significant differences in age, gender, time from fracture to admission, operation type, and preoperative aCCI between the two groups (P<0.05). Further logistic regression analysis showed that age>75 years, female patients, time from fracture to admission>24 hours, and preoperative aCCI>5 were risk factors for perioperative DVT (P<0.05). Conclusion Elderly patients with femoral neck fracture have a higher incidence of perioperative DVT. The advanced aged and female patients, patients with longer fracture time and more comorbidities need to pay special attention to the prevention of perioperative DVT to minimize the occurrence of DVT during femoral neck fractures.
The apical displacement of tricuspid valve leaflets complicated with significantly enlarged, thin and fibrotic wall of the right ventricle is prone to dysfunction of right heart. Therefore, the myocardial protection for the right ventricle is important. Based on the pathological changes, an algorithm of perioperative myocardial protection strategy is summarized. Firstly, we should clearly know that the right ventricular myocardium with severe lesions is much different from the unimpaired myocardium, because it is now on the margin of failure; secondly, right heart protection should be regarded as a systematic project, which runs through preoperative, intraoperative and postoperative periods, and requires close collaboration among surgeons, perfusionists, anesthesiologists and ICU physicians. In this article, we try to introduce the systematic project of the right heart protection, in order to improve the outcome of this population.
摘要:目的：评价围手术期预防性应用抗菌药物现状及合理性。方法：采用回顾性调查的方法，随机抽查2009年度Ⅰ类切口手术围手术期病案500份，设计外科围手术期预防性应用抗生素调查表，对预防用药的适应证、用药种类、联合用药、给药时机及持续时间进行统计分析。结果：未使用抗生素5例，预防性使用抗生素495例，其中不合理80例（16.00％）。预防性使用抗生素总品规数为540，其中头孢菌素类453例（83.89%），青霉素类（包括加酶抑制剂）26例（4.81%），喹诺酮类44例（8.15%）。选用头孢唑啉钠178例（32.96%）居第一位，头孢替唑钠第二，151例（2796%）。结论：Ⅰ类切口手术患者围手术期预防性使用抗菌药物较为合理，但仍存在用药指征把握不严，抗菌药物的选择、抗菌药物使用时间较长等问题，有待进一步规范化管理。Abstract: Objective: To understand the current application of perioperative preventive antibiotics, and their rationality. Methods: Five hundred perioperative records of patients with incision Ⅰ were randomly chosen and surveyed in 2009. A questionnaire for prophylactic use of antimicrobial was designed. The indication of antimicrobial use, the species, combination, timing and drug duration were analyzed. Results: Our of 500, 495 used antimicrobial and 80 were unreasonable; 540 kinds of antimicrobial were used, included cephalosporin 453 cases (83.89%), penicillin class (including plus enzyme inhibitors) in 26 cases (4.81%), quinolone 44 cases (8.15%). Cefazolin sodium (178 patients, 32.96%) ranked first, second was cefazolin sodium (151, 27.96%). Conclusion: Perioperative use of antimicrobial prophylaxis in patients with incision Ⅰ is reasonable, but standardization management should be strengthened in the indication, species, and duration.
Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
Objective To review the adverse event of hysterectomy caused by postoperative infection after cesarean section, formulate prevention and control strategies in combination with risk assessment tools, promote the standardization of perioperative management, reduce the medical burden on pregnant women, and improve patient satisfaction. Methods The two adverse events of hysterectomy caused by postoperative infection after cesarean section that occurred in the obstetrics ward between October and November 2024 were selected as the research objects. A root cause analysis and risk assessment team composed of personnel from multiple departments was established. Through interviews, observations, and data review, the potential failure modes and causes were sorted out. The risk priority number (RPN) was calculated to determine the high-risk factors. Improvement strategies were formulated and implemented. After two-month implementation, the RPN scores and the compliance of various measures before and after the implementation were compared. Results Before the improvement, the total RPN of the healthcare failure mode and effects analysis was 367.8. When rechecked in January 2025, the total RPN after the improvement dropped to 105.7, and no serious adverse events occurred again. The compliance and passing rates of various operations significantly increased: the intervention rate for maternal malnutrition rose from 17.5% to 48.6%, the passing rate of appropriate timing for prophylactic use of antimicrobial agents before surgery increased from 50.5% to 81.0%, the compliance rate of scrubbing the vagina with disinfectant before surgery increased from 15.0% to 60.0%, the implementation rate of standardized skin disinfection during surgery rose from 66.7% to 95.2%, the passing rate of aseptic techniques and hand hygiene operations during surgery increased from 75.0% to 95.2%, and the timely submission rate of specimens from infected patients increased from 29.4% to 47.6%, and all these differences were statistically significant (P<0.05). Conclusion The combination of healthcare failure mode and effect analysis and root cause analysis can effectively improve adverse events during the perioperative period, optimize the perioperative management of cesarean section, and reduce the risk of infection.
ObjectiveTo evaluate the safety and feasibility of non-nasogastric tube throughout the perioperative period of classical Whipple pancreaticoduodenectomy. MethodsA retrospective analysis was conducted on the clinical data of 63 patients who underwent Whipple pancreaticoduodenectomy at West China Hospital of Sichuan University from June 2020 to August 2023. According to whether nasogastric tube was placed throughout the perioperative period, the patients were divided into nasogastric tube group (NGT group, n=32) and no nasogastric tube group (no NGT group, n=31). The intraoperative indicators such as gastrointestinal anastomosis mode and outcome measures such as postoperative hospital stay were compared between the two groups. Results① Preoperative baseline data: the proportion of benign diseases (P=0.005) and preoperative pancreatitis (P=0.003) of the no NGT group were higher than those of the NGT group, and other preoperative baseline data, such as age and sex, were not statistically significant (P>0.05). ② Intraoperative index: the proportion of circular stapler (P=0.009) was smaller and the operation time was shorter (P<0.001), but there was no significant difference in the anastomosis, intraoperative blood transfusion and intraoperative bleeding (P>0.05). ③ Postoperative outcome measures: the postoperative length of hospital stay (P<0.001) and the incidence of delayed gastric emptying (P<0.001) of the no NGT group were lower than those in the NGT group, but the postoperative time of food intake, incidence of pancreatic fistula, incidence of postoperative bleeding, and Clavien-Dindo grade of complications were not significant (P>0.05), and on one died within 30 d after operation. ConclusionsThe results of this study preliminarily show that, it is safe and feasible not to place nasogastric tubes throughout the perioperativeperiod in patients undergoing classical Whipple pancreaticoduodenectomy. Compared with placing nasogastric tube, it can shorten the postoperative hospital stay, reduce the incidence of postoperative delayed gastric emptying.