肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤,是非小细胞肺癌(non-small cell lung cancer,NSCLC)的一个独特的临床亚型,占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。...肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤,是非小细胞肺癌(non-small cell lung cancer,NSCLC)的一个独特的临床亚型,占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。近几十年,肺上沟瘤的治疗取得了不断的进展,最新发布的几个临床试验证实了同期放化疗加手术切除能够改善肿瘤的完整切除率、局部控制率和病理缓解率,延长患者的总生存时间。已经成为肺上沟瘤的治疗最为有效的方式,并成为美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)和美国胸科医师协会(American College of Chest Physicians,ACCP)指南推荐的肺上沟瘤治疗方案。本文回顾国内外相关文献,简要介绍肺上沟瘤手术治疗及综合治疗的进展情况。展开更多
Background:Whether minimally invasive esophagectomy(MIE)is superior to open esophagectomy(OE)in the treatment of esophageal squamous cell carcinoma(ESCC)is still uncertain.Therefore,this multicenter prospective study ...Background:Whether minimally invasive esophagectomy(MIE)is superior to open esophagectomy(OE)in the treatment of esophageal squamous cell carcinoma(ESCC)is still uncertain.Therefore,this multicenter prospective study aimed to compare MIE with OE in postoperative parameters and long-term survival.Methods:All hospitalized patients with cT1b-3N0-1M0 thoracic ESCC treated by MIE or OE were enrolled from 19 selected centers from April 1,2015 to December 31,2018.The propensity score matching(PSM)was performed to minimize the selection bias.The basic clinicopathological characteristics and 3-year overall survival(OS)as well as disease-free survival(DFS)of two groups were compared by R version 3.6.2.Results:MIE were performed in 1,387 patients and OE in 335 patients.335 cases in each group were finally matched by PSM,and no significant differences in the essential demographic characteristics were observed be-tween the MIE and OE groups after PSM.Compared with OE,MIE had significantly less intraoperative bleeding,less total drainage volume,shorter postoperative hospital stay,and harvested significantly more lymph nodes(LNs)(all P<0.001).There were no significant differences in the major postoperative complications and death rates between MIE and OE.The 3-year OS and DFS were 77.0%and 68.1%in the MIE group versus 69.3%and 60.9%in the OE group(OS:P=0.03;DFS:P=0.09),and the rates were 75.1%and 66.5%in the MIE group versus 66.9%and 58.6%in the OE group for stage cII patients(OS:P=0.04,DFS:P=0.09),respectively.Conclusions:Compared with OE,MIE is a safe and effective treatment approach with similar mortality and morbidity.It has the advantages in harvesting more LNs,improving postoperative recovery and survival of stage cII ESCC patients.展开更多
文摘肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤,是非小细胞肺癌(non-small cell lung cancer,NSCLC)的一个独特的临床亚型,占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。近几十年,肺上沟瘤的治疗取得了不断的进展,最新发布的几个临床试验证实了同期放化疗加手术切除能够改善肿瘤的完整切除率、局部控制率和病理缓解率,延长患者的总生存时间。已经成为肺上沟瘤的治疗最为有效的方式,并成为美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)和美国胸科医师协会(American College of Chest Physicians,ACCP)指南推荐的肺上沟瘤治疗方案。本文回顾国内外相关文献,简要介绍肺上沟瘤手术治疗及综合治疗的进展情况。
基金supported by the National Science and Technology Support Program(grant number:NKTRDP-2015BAI12B08-01).
文摘Background:Whether minimally invasive esophagectomy(MIE)is superior to open esophagectomy(OE)in the treatment of esophageal squamous cell carcinoma(ESCC)is still uncertain.Therefore,this multicenter prospective study aimed to compare MIE with OE in postoperative parameters and long-term survival.Methods:All hospitalized patients with cT1b-3N0-1M0 thoracic ESCC treated by MIE or OE were enrolled from 19 selected centers from April 1,2015 to December 31,2018.The propensity score matching(PSM)was performed to minimize the selection bias.The basic clinicopathological characteristics and 3-year overall survival(OS)as well as disease-free survival(DFS)of two groups were compared by R version 3.6.2.Results:MIE were performed in 1,387 patients and OE in 335 patients.335 cases in each group were finally matched by PSM,and no significant differences in the essential demographic characteristics were observed be-tween the MIE and OE groups after PSM.Compared with OE,MIE had significantly less intraoperative bleeding,less total drainage volume,shorter postoperative hospital stay,and harvested significantly more lymph nodes(LNs)(all P<0.001).There were no significant differences in the major postoperative complications and death rates between MIE and OE.The 3-year OS and DFS were 77.0%and 68.1%in the MIE group versus 69.3%and 60.9%in the OE group(OS:P=0.03;DFS:P=0.09),and the rates were 75.1%and 66.5%in the MIE group versus 66.9%and 58.6%in the OE group for stage cII patients(OS:P=0.04,DFS:P=0.09),respectively.Conclusions:Compared with OE,MIE is a safe and effective treatment approach with similar mortality and morbidity.It has the advantages in harvesting more LNs,improving postoperative recovery and survival of stage cII ESCC patients.
