Chaoyang Liang

Survival benefit of neoadjuvant chemotherapy in non-small cell lung cancer: an updated meta-analysis of 13 randomized control trials

Introduction: The survival effectiveness of neoadjuvant chemotherapy in non-small cell lung cancer (NSCLC) is still unclear based on the study of most up-to-date literatures. This article contributes to this problem by conducting an updated meta-analysis. Methods: Based on Burdett et als (J Thorac Oncol 2006;1:611–621) systematic review, this meta-analysis was conducted. Articles were searched electrically. The possible survival benefit of neoadjuvant chemotherapy was assessed by hazard ratio (HR) in terms of overall survival. A subgroup meta-analysis with only stage III NSCLC was also conducted. The software of Review Manager was used for data management. Results: Thirteen randomized control trials, 6 of which were new ones, were included into this meta-analysis. The overall survival of NSCLC patients in neoadjuvant chemotherapy arm were improved significantly, comparing with those in surgery-alone arm (combined HR = 0.84; 95% confidence interval, 0.77–0.92; p = 0.0001). When only patients with stage III NSCLC were considered, the result was similar (combined HR = 0.84; 95% confidence interval, 0.75–0.95; p = 0.005). Conclusion: Neoadjuvant chemotherapy, as an addition of surgery, would significantly improve the overall survival of operable NSCLC patients, including patients with stage III NSCLC.

Choice of therapeutic strategies in intrathoracic anastomotic leak following esophagectomy.

BackgroundThe aim of this study was to analyze our experience with management of intrathoracic anastomotic leak after esophagectomy.MethodsClinical data from 33 patients who developed intrathoracic anastomotic leak were evaluated retrospectively. These patients were selected from 1867 patients undergoing resection carcinoma of the esophagus and reconstruction between January 2003 and December 2012.ResultsSurgical intervention and the reformed “three-tube method” were applied in 13 and 20 patients, respectively. The overall incidence of intrathoracic anastomotic leakage was 1.8%. The median time interval from esophagectomy to diagnosis of leak was 9.7xa0days. Sixteen patients were confirmed as having leakage by oral contrast computed tomography (CT). Age and interval from surgery to diagnosis of leak were identified as statistically significant parameters between contained and uncontained groups. Moreover, patients with hypoalbuminemia had a longer time to leak closure than patients without hypoalbuminemia. Six patients died from intrathoracic anastomotic leak, with a mortality rate of 18.2%. There was no statistically significant difference in the time to leak closure between patients who underwent surgical exploration and those who received conservative treatment.ConclusionsIntrathoracic anastomotic leak after esophagectomy was associated with significant mortality. Once intrathoracic anastomotic leakage following esophagectomy was diagnosed or highly suspected, individualized management strategies should be implemented according to the size of the leak, extent of the abscess, and status of the patient. In the majority of patients with anastomotic leak, we preferred the strategy of conservative treatment.

Lung cancer presenting as thin-walled cysts: An analysis of 15 cases and review of literature.

Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign‐like cyst.

Small satellite pulmonary nodules in operable lung cancer: Diagnosis and therapeutic strategy

Objective: The use of high-resolution computed tomography (HRCT) has improved the management of non-small cell lung cancer (NSCLC), but has also increased the detection of indeterminate satellite nodules. Obtaining differential diagnosis of nodules less than 10 mm is difficult but essential for choosing optimal therapeutic strategies. Here, we evaluated the characteristics of small satellite nodules in patients with operable NSCLC and examined the optimal diagnostic and therapeutic approach in patients with small satellite nodules. Methods: Using data from a prospective database, all surgically treated patients diagnosed with NSCLC from 2008 to 2011 were retrospectively reviewed. Patients presenting with small pulmonary non-GGO nodule(s) were identified. Results: A total of 1206 patients underwent complete resection for NSCLC, out of which 45 patients presented with 60 nodules less than 10 mm on thoracic CT. Twenty-six nodules (43%) were malignant, 31 (52%) were benign, and 3 (5%) were of undetermined nature. Tumor histology (adenocarcinoma vs. nonadenocarcinoma), TNM stage (advanced stage vs. early stage), and nodule size (6–10 vs. uf0a3 5 mm) were associated with nodule malignancy. The incidence of metastatic nodules in patients with stage III NSCLC was significantly higher than that in patients with stage I NSCLC. In contrast, the incidence of multiple primary lung cancers in patients with stage I NSCLC was significantly higher than that in patients with stage III NSCLC. Conclusion: Differential diagnosis of indeterminate satellite lesions in patients with operable NSCLC is critical. Surgery should be performed cautiously in patients with stage III NSCLC having nodules larger than 5 mm.

[Thin-walled cystic lung cancer: an analysis of 24 cases and review of literatures].

BACKGROUNDnLung cancer presenting as cystic lesions was first described by Anderson and Pierce in 1954. Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign-like cyst. This study investigated the clinical characteristics, diagnosis and treatment of lung cancer presenting as cysts.nnnMETHODSnWe conducted a retrospective analysis of the clinical records of 24 patients who underwent surgery for a primary lung cancer presenting as cysts in our department between 2007 and 2013. We defined a Thin-walled cyst as a cavitary lesion with a wall thickness of 4 mm or less along at least 75% of the circumference of the lesion. The whole group underwent post-operative follow-up.nnnRESULTSnThe incidence of cystic lung cancer was 0.49% (24/4,897) of surgical cases. The subjects age ranged from 19 to 77 yr with a median age of 56.5 yr. Ten cases presented with respiratory symptoms while 14 showed abnormal shadows on a chest CT without symptoms. Histological analysis showed that 18 cases were of adenocarcinoma, three of squamous cell carcinoma, one of small cell carcinoma, one of adenosquamous carcinoma and one of large cell carcinoma. Three patients were dead, and the remaining 21 patients are alive and disease free at the end of follow-up.nnnCONCLUSIONSnCystic lung cancer should be kept in mind during the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnose can be obtained.