The great clinical efficacy of an enhanced recovery after surgery (ERAS) program has been illustrated by the decreased incidence of perioperative complications and the shortened length of in-hospital stay. Furthermore, the ERAS programs have their own key techniques and strategies in the clinical application to the unique diseases and operative modes. The key technology of an ERAS program is the minimally invasive surgery, which has been widely utilized in the surgical specialties. The main strategy in an ERAS program consists of the intensive pulmonary rehabilitation and optimal perioperative care that aim to improve the in-hospital outcomes of lung cancer patients who are considered at high surgical risk. Pulmonary rehabilitation is regarded as the mainstay of the ERAS strategies but its clinical protocols still remain less mature. The purpose of this overview is to summarize the current pulmonary rehabilitation programs in terms of the suitable crowd, the feasible protocols and the clinical significance.
Tibetan population has been living in Tibet plateau for more than thousands of years ago. Although, the environment is unlikely to be an ideal place for residence. They have evolved genetical and physiological adaptions living in Tibetan highlands. In recent several years, foreign scientists have noticed that lung cancer mortality is reduced at high altitude. Many in vitro and in vivo experiments explored the mechanism of this phenomenon. In this review we discuss the lung cancer incidence and mortally of Tibetan population, as well as the possible underlying mechanism including oxygen level, radiation, inhalable particulate matter, metabolism, hypoxic induced factor pathway and immune system. But, the clinical data as well as basic researches of Tibetan population remain insufficient, which required further investigation.
Chest tube is routinely used after thoracoscopic lung cancer surgery for evacuating air and fluids. Development of enhanced recovery after surgery (ERAS) makes the disadvantages of traditional drainage clearly. In this review, we summarized the advantages and disadvantages of small-bore chest tube, the use of digital drainage system, the time of removing the chest tube, the indications of non chest tube, the improvements of drainage tube hole suture and the complications of chest tube placement after thoracoscopic lung cancer surgery.
Abstract： Currently, there are two significant tendencies in the advancement and progress of video-assisted thoracoscopic surgery（VATS）, firstly, the widening surgical indications for VATS techniques, and secondly, the use of single-port VATS which is less invasive and more cosmetic. This article focuses in particular on four aspects of single-port VATS, including；（1）the individualized incision approach and its characteristics of single-port VATS；（2）single-port VATS for the treatment of pneumothorax and the development of related techniques and equipment；（3）single-port VATS for the diagnosis and treatment of thoracic diseases such as lung lobectomy；（4）the advantages and disadvantages of single-port VATS in clinical practice.
ObjectivesTo construct a symptom assessment system suitable for surgical lung cancer patients, and to objectively evaluate the types and severity of postoperative symptoms in patients so as to provide evidence-based basis for the treatment of postoperative symptoms of lung cancer patients.MethodsPostoperative symptom items of lung cancer were formed according to previous researches, literature review, the current lung cancer symptom assessment tools, and expert interviews. The Delphi method was used to conduct two rounds of expert consultation and a postoperative symptom inventory was established for lung cancer patients.ResultsNine first-level symptom items were eventually formed: cough, pain, shortness of breath, fatigue, dizziness, nausea or vomiting, subcutaneous emphysema, insomnia, and constipation. The first round of active coefficient and authority coefficient of experts were 85.0% and 0.88, and the second round were 88.2% and 0.87. The Kendall coordination coefficients of the nine first-level symptom items were 0.47 (P<0.001) and 0.43 (P<0.001), respectively.ConclusionsThe evaluation system of postoperative symptom items for lung cancer patients is highly recognized by experts and has good consistency.
The postoperative symptom burden in patients with lung cancer is severe and adversely impairs their quality of life. Symptom management is the cornerstone of medical care. Patient-reported outcome (PRO)-based symptom management is being increasingly recognized as the best "patient-centered care" model in clinical practice. However, the precise implementation of this model in patients undergoing lung cancer surgery is hindered by the lack of a lung cancer surgery-specific scale, implementation standards, clinical application parameters and high-quality researches. The use of a precise and simple PRO scale and an electronic PRO platform may greatly improve the feasibility of implementing this model. Currently, the application of PRO-based symptom management in lung cancer surgery is still being explored and needs to be improved in clinical research and practice.
Objective To explore the association of pretreatment prognostic nutritional index (PNI) with the prognosis of small cell lung cancer (SCLC) patients. Methods The PubMed, Web of Science, Embase, China National Knowledge Infrastructure, WanFang and VIP databases were searched for relevant literature which identified the prognostic role of PNI in SCLC up to March 9th, 2022. The primary endpoint was overall survival (OS) and the secondary endpoint was progression-free survival (PFS). The hazard ratio (HR) and 95% confidence interval (CI) were combined by Stata 12.0 software. Results A total of 19 retrospective cohort studies were included, involving 5999 participates. The pooled results indicated that low pretreatment PNI predicted poorer OS [HR=1.58, 95%CI (1.37, 1.83), P<0.001] and PFS [HR=1.51, 95%CI (1.03, 2.22), P=0.037]. Conclusion Low pretreatment PNI may be a risk factor for poor prognosis of SCLC patients and could be applied for the evaluation of prognosis and formulation of therapy strategy.
[Abstract]Lung cancer exhibits the highest incidence and mortality rates among malignancies in China. As a critical component of comprehensive lung cancer management, pulmonary rehabilitation (PR) has emerged as a prominent research focus. PR employs multimodal interventions to improve functional capacity and quality of life in lung cancer patients, with applicability across all disease stages. However, challenges persist, including the lack of standardized protocols, uncertainty regarding optimal implementation timing, and suboptimal patient adherence. Technological innovations hold significant potential, and future efforts should prioritize personalized regimens and optimized interventions to advance its widespread clinical adoption.
MicroRNA (miRNA) is a noncoding RNA and protein involved in regulating gene expression in the transcription level. Epidermal growth factor receptor (EGFR) is a protein tyrosine kinase receptor and its mutations have been confirmed in non-small cell lung cancer (NSCLC) by a large number of studies in recent years. EGFR tyrosine kinase inhibitor (EGFR-TKI) is widely used for treatment of NSCLC patients with EGFR mutation. In recent years, miRNA is more and more important in tumor metastasis. The role of EGFR mutations in NSCLC has become a hot spot as well. New researches report that the relationship between miRNA and EGFR mutations plays an important role in NSCLC metastasis. Therefore, we write this review to discuss the mechanisms of miRNA and EGFR mutations in metastasis of NSCLC.
ObjectiveTo review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects.MethodsA total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed.ResultsIncluded patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2±4 680.3 mL vs. 4 911.2±3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2±2.7 d) was shorter than that of the non-surgical treatment group (12.3±6.8 d, P=0.204).ConclusionThe treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.