Bing-Yen Wang

Lung Cancer and Prognosis in Taiwan: A Population-Based Cancer Registry

Introduction: Lung cancer is the leading cause of cancer death in Taiwan. This study investigated the prognostic factors affecting survival of patients with lung cancer in Taiwan. Methods: Data were obtained from the National Health Insurance Research Database published in Taiwan. Clinicopathologic profiles and prognostic factors of 33,919 lung cancer patients were analyzed between 2002 and 2008 in this retrospective review. The impact of the clinicopathologic factors on overall survival was assessed. Results: Nearly two thirds of the patients were men. The 5-year survival rate was 15.9%, with a median survival of 13.2 months. The clinical staging of the patients included stage I (n = 4254; 12.5%), stage II (n = 1140; 3.4%), stage III (n = 10,161; 30.0%), and stage IV (n = 18,364; 54.1%). In the multivariate analysis, age more than 65 years, sex, cell type, histologic grade, and primary tumor location were identified as independent prognostic factors. Conclusion: In additional to tumor-nodes-metastasis (TNM) staging system, patient sex and age, tumor location, cell type, and differentiation were independent prognostic factors. We recommend incorporation of these factors to subclassify lung cancer patients.

Tumor Length as a Prognostic Factor in Esophageal Squamous Cell Carcinoma

BACKGROUND Tumor size is an important prognostic factor in many cancers, but its role in esophageal cancer remained undetermined. The aim of this study is to investigate the impact of tumor length on survival for patients with resected esophageal squamous cell carcinoma. METHODS A total 582 esophageal squamous cell carcinoma patients underwent surgical resection as the primary treatment was enrolled into this retrospective review. The longitudinal tumor length was defined as a uniformly measurement from the surgeons in the operating room immediately after completion of the esophagectomy. The impact of tumor length on patients overall survival was assessed and compared with the factors among the current tumor-nodes-metastasis (TNM) staging system published in 2009. RESULTS The overall 1-, 3-, and 5-year survival rates were 70.4%, 37.8%, and 30.0%, respectively, with a median for 22 months. The length adversely affected the overall survival, and the 5-year survival rate was 77.3%, 48.1%, 38.5%, and 23.3 % for tumor lengths of 1 cm, 2 cm, 3 cm, and more than 3 cm, respectively (p < 0.001). In multivariate survival analysis, tumor length (more or less than 3 cm) remained an independent prognostic factor (p = 0.020) as did the other current TNM factors. For subgroup analysis, the predictive value of tumor length was significant in patients with T1 or T2 disease (p < 0.001), T3 or T4 disease (p = 0.029), and patients with N0 disease (p < 0.001), but not for patients with N1, N2, or N3 disease. CONCLUSIONS Tumor length, which represents longitudinal spreading of the cancerous cells, could impact the overall survival of patients with resected esophageal squamous cell carcinoma, especially among those with nodal-negative disease. It may provide additional prognostic information to the current TNM staging system.

Single-Incision Thoracoscopic Lobectomy and Segmentectomy With Radical Lymph Node Dissection

BACKGROUND Reports of single-incision thoracoscopic lobectomy and segmentectomy are rare. In this article, we present our experience with single-incision thoracoscopic lobectomy and segmentectomy and radical mediastinal lymph node dissection. METHODS Nineteen patients with early-stage malignancy or benign lung disease were treated with single-incision thoracoscopic lobectomy and segmentectomy at our institution between November 2010 and May 2012. The surgical approach began with a single incision at the fifth or sixth intercostal space at the anterior axillary line. A 10-mm video camera and working instruments were used at the same time in this incision site throughout the surgery. The perioperative variables and outcomes were collected and analyzed retrospectively. RESULTS For the 19 patients included in the final analysis, 14 lobectomies and 5 segmentectomies were performed successfully without need for conversion. Among the 19 patients who underwent single-port video-assisted thoracoscopic surgery (VATS), 15 cases of cancer and 4 cases of benign pulmonary disease were noted. The mean operative time was 156±46 minutes, and the median number of lymph nodes retrieved was 22.9±9.8. Average blood loss was 38.4±25.9 mL. There were no deaths 30 days after surgery, and 2 cases of atelectasis were observed. CONCLUSIONS Single-port VATS lobectomy and segmentectomy is safe and feasible for selected patients.

Single-incision versus multiple-incision thoracoscopic lobectomy and segmentectomy: a propensity-matched analysis.

OBJECTIVE To compare the perioperative outcomes of single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy. BACKGROUND Reports of single-incision thoracoscopic lobectomy and segmentectomy for lung cancer are limited, and a comparison between single-incision and multiple-incision thoracoscopic lobectomy or segmentectomy for lung cancer has not been previously reported. METHODS From January 2005 to June 2013, a total of 233 patients with lung cancer underwent thoracoscopic lobectomy or segmentectomy via a single-incision or multiple-incision technique. A propensity-matched analysis, incorporating preoperative variables, was used to compare the short-term outcomes between single-incision and multiple-incision thoracoscopic lobectomy and segmentectomy. RESULTS Overall, 50 patients underwent single-incision thoracoscopic pulmonary resections, including 35 lobectomies and 15 segmentectomies, and 183 patients underwent multiple-incision thoracoscopic lobectomy or segmentectomy between January 2005 and December 2011. Propensity matching produced 46 patients in each group. The length of hospital stay and the complication rate were not significantly different between the 2 groups. Single-incision thoracoscopic lobectomy and segmentectomy were associated with shorter operative time (P = 0.029), more numbers of lymph nodes (P = 0.032), and less intraoperative blood loss (P = 0.017) than with the multiple-incision approach. No in-hospital mortality occurred in either group. CONCLUSIONS Single-incision thoracoscopic lobectomy and segmentectomy are feasible, and perioperative outcomes are comparable with those of the multiple-incision approach.

Survival benefits of postoperative chemoradiation for lymph node-positive esophageal squamous cell carcinoma.

BACKGROUND Little is known about the efficacy of chemoradiation therapy after surgery for patients with esophageal squamous cell carcinoma. This retrospective study aimed to determine whether postoperative chemoradiation improves survival compared with surgery alone. METHODS Of 290 patients with esophageal squamous cell carcinoma, 104 received postoperative chemoradiation therapy (CRT group) and 186 underwent surgery alone (S group). Propensity score matching analysis was used to identify 56 well-balanced pairs of patients to compare outcomes. RESULTS For N0 patients, overall survival (OS) and disease-free survival (DFS) were similar in both groups. For N+ patients, the median OS (31.0 versus 16.0 months) and the 3-year OS rate (45.8% versus 14.1%) were significantly higher in the CRT group than in the S group (p<0.001). Similarly, the median DFS (16.0 versus 9.0 months) and the 3-year DFS rate (24.1% versus 11.5%) were significantly higher in the CRT group than in the S group (p=0.002). In propensity-matched patients, a survival benefit was observed for N+ patients receiving postoperative chemoradiation (CRT versus S group: median OS 29.0 versus 16.0 months, 3-year OS rate 48.6% versus 16.8%; p=0.003). Disease-free survival (median DFS 11.0 versus 8.0 months, 3-year DFS rate 21.3% versus 12.5%) tended to be better in the CRT group than in the S group (p=0.057). CONCLUSIONS Postoperative chemoradiation therapy provided a survival benefit for patients with lymph node-positive esophageal squamous cell carcinoma.

Subxiphoid single-incision thoracoscopic left upper lobectomy

cose (F18) (INN fludeoxyglucose [18F]) uptake in the lesion without distant metastases. Computed tomographically guided biopsy of the mass lesion was performed, and the results of histopathologic analysis of the biopsy specimen were positive for adenocarcinoma, clinical stage T1N0M0. After written, informed consent was obtained from the patient, a thoracoscopic lobectomy was performed through a small subxiphoid incision. Radical mediastinal lymph nodesampling was also carriedout.Theintensityof postoperative pain was evaluated every 8 hours by means of a visual analog scale, which ranged from 0 (painless) to 10 (worst pain ever experienced). The mean pain scores at rest were 3, 2, and 0 immediately after the operation, the day after the operation, and 2 days after the procedure, respectively. Pain was limited to the subxiphoid area. The patient’s postoperative course was uneventful, and she was discharged on the third day after surgery. The resected tumor measured 3.5 cm, and the pathologic stagewas T2aN1M0. A total of 15 lymph nodes (2 at station 4L, 3 at station 5, 3 at station 7, 1 at station 10, 1 at station 11, and 5 at station 12/13/14) were dissected, and 2 segmental lymph nodes had positive results for malignancy.

The Prognostic Value of the Number of Negative Lymph Nodes in Esophageal Cancer Patients After Transthoracic Resection

BACKGROUND Although the number of positive lymph nodes (LN), the total number of resected LN, and the proportion of positive LN have been reported to be associated with survival in patients with esophageal cancer, little is known about the prognostic impact of the number of negative LN. METHODS A retrospective review of 754 patients receiving transthoracic esophagectomy for cancer between January 1995 and September 2011 was performed. The prognostic impact of the number of negative LN was analyzed. Log rank testing was used to compare survival curves, and Cox regression analysis was performed to identify significant prognostic factors. RESULTS A total of 707 patients were included. The mean follow-up time was 28.4±30.9 months. The 5-year overall survival for the entire cohort was 30.1%. Patients with a high number of negative LN (≥19) had better overall survival than patients with a low number of negative LN (5-year survival rate 33.4% versus 26.4%, p=0.005). Stratified analysis showed that the impact of the number of negative LN was significant in patients with T3/4 (p=0.027) and node-positive (p=0.002) esophageal cancers but not in patients with less advanced tumors. Multivariate Cox regression analysis demonstrated that the number of negative LN (in addition to age, sex, T stage, N stage, tumor length, and surgical approach) was an independent prognostic factor. CONCLUSIONS A higher number of negative LN is associated with better overall survival of esophageal cancer patients after resection. The correlation of a high number of negative LN (≥19) with survival was more prominent in patients with advanced (T3/4 stage, node-positive) tumors.

Recent advances in laparoscopic surgery

Laparoscopic surgery has been widely adopted and new technical innovation, procedures and evidence based knowledge are persistently emerging. This review documents recent major advancements in laparoscopic surgery. A PubMed search was made in order to identify recent advances in this field. We reviewed the recent data on randomized trials in this field as well as papers of systematic review. Laparoscopic cholecystectomy is the most frequently performed procedure, followed by laparoscopic bariatric surgery. Although bile duct injuries are relatively uncommon (0.15%–0.6%), intraoperative cholangiography still plays a role in reducing the cost of litigation. Laparoscopic bariatric surgery is the most commonly performed laparoscopic gastrointestinal surgery in the USA, and laparoscopic Nissen fundoplication is the treatment of choice for intractable gastroesophageal reflux disease. Recent randomized trials have demonstrated that laparoscopic gastric and colorectal cancer resection are safe and oncologically correct procedures. Laparoscopic surgery has also been widely developed in hepatic, pancreatic, gynecological and urological surgery. Recently, SILS and robotic surgery have penetrated all specialties of abdominal surgery. However, evidence‐based medicine has failed to show major advantages in SILS, and the disadvantage of robotic surgery is the high costs related to purchase and maintenance of technology. Laparoscopic surgery has become well developed in recent decades and is the choice of treatment in abdominal surgery. Recently developed SILS techniques and robotic surgery are promising but their benefits remain to be determined.

Multiinstitutional Analysis of Single-Port Video-Assisted Thoracoscopic Anatomical Resection for Primary Lung Cancer

BACKGROUND Multiinstitutional analysis of single-port video-assisted thoracic surgery (VATS) for anatomic pulmonary resection is rare. This study aimed to address the technical feasibility and applicability of single-port video-assisted anatomical resection for primary lung cancer. METHODS A total of 121 patients with primary lung cancer undergoing single-port video-assisted anatomical resection between 2011 and 2014 in 4 hospitals were included. The clinicopathologic variables and perioperative outcomes were collected and analyzed retrospectively. RESULTS Single-port VATS segmentectomies and lobectomies were performed in 24 (19.8%) and 97 (80.2%) patients, respectively. One hundred seven of 121 (88.4%) patients had adenocarcinoma and 93 of 121 (76.9%) had pathologic stage I lung cancer. The average operative time and estimated blood loss was 198.8 ± 65.4 minutes and 99.1 ± 147.6 mL, respectively. The conversion and complication rates were 2.5% (3 of 121 cases) and 14.0% (17 of 121 cases), respectively. There was no surgical mortality, and the average length of hospital stay was 6.6 ± 2.6 days. The mean resected lymph node was 22.6 ± 12.0. We also identified patient age of 60 years or more, male sex, and tumor size greater than 3 cm as unfavorable perioperative outcome predictors after single-port video-assisted anatomical pulmonary resection. CONCLUSIONS This first multiinstitutional single-port VATS study demonstrated that anatomical resection for primary lung cancer can be safely and effectively completed through a single-port VATS approach in hospitals experienced in VATS techniques.

Benzo[a]pyrene-induced cell cycle progression occurs via ERK-induced Chk1 pathway activation in human lung cancer cells

Benzo[a]pyrene (B[a]P) is a potent lung carcinogen derived from tobacco smoking and environmental contamination. This study aimed to investigate the signal transduction pathway responsible for B[a]P-induced non-small cell lung cancer (NSCLC) development. We exposed the human NSCLC cell lines Calu-1, CL3, H1299, CH27, H23, and H1355 to B[a]P and assessed cell cycle progression using flow cytometry. Expression of cell cycle mediators was measured using Western blot analyses and electrophoretic mobility shift assays (EMSAs). B[a]P exposure dramatically induced S-phase accumulation in H1355 cells. Phospho-p53 (Ser15 and Ser20), phospho-ERK, phospho-p38, and Bax were significantly increased in H1355 cells whereas phospho-Rb was decreased in these cells. In addition, B[a]P induced phosphorylation of checkpoint kinase-1 (Chk1) but not Chk2. EMSA experiments revealed a slower migrating band after c-Myc bound the E-box in response to B[a]P treatment, which was abolished upon the addition of the ERK inhibitor PD98059 in H1355 cells. Phospho-ERK inhibition and dominant negative mutant Chk1 expression reversed B[a]P-induced S phase accumulation and downregulated phospho-Chk1 and phospho-ERK expression. Taken together, these results suggest that activation of ERK and its downstream mediator Chk1 may contribute to B[a]P-induced S phase accumulation in H1355 cells. The results could help in the development of lung cancer treatments that target the Chk1 pathway through ERK.