Hu Liao

Interleukin-17 and Prostaglandin E2 Are Involved in Formation of an M2 Macrophage-Dominant Microenvironment in Lung Cancer

Introduction: Tumor-associated macrophages (TAMs) are divided into M1 and M2 macrophages. M1 macrophages inhibit tumor growth, whereas M2 macrophages promote tumor growth and metastasis. The aim of this study was to examine the possible causes leading to the formation of an M2-macrophage–dominant tumor microenvironment in non–small-cell lung cancer. Methods: Forty-eight archived lung tumor samples were examined for the expression of interleukin-17 (IL-17) receptors, IL-17 receptor A (IL-17RA) and IL-17 receptor C (IL-17RC), and the number of TAMs using immunohistochemical staining. Twenty fresh lung tumors and matched normal lung tissues were examined for expression of IL-17, cyclooxygenase-2, and prostaglandin E2 (PGE2), using enzyme-linked immunosorbent assay and Western blot analysis. Macrophage-migration assays were performed using fresh lung tumor tissues and IL-17 as chemoattractants. Induction of M2-macrophage differentiation was analyzed using real-time quantitative polymerase chain reaction. Results: TAMs expressed IL-17RA and IL-17RC. Lung tumors expressed higher levels of IL-17, cyclooxygenase-2, and PGE2, compared with normal lung tissues. Lung tumor tissues attracted migration of mouse RAW264.7 macrophages and primary peritoneal macrophages through IL-17, which was mediated by IL-17RA and IL-17RC. IL-17 did not induce either M1- or M2-macrophage differentiation. However, human lung cancer A549 cells strongly induced M2-macrophage differentiation of RAW264.7 macrophages when the two cell lines were cocultured. The inductive factor secreted by A549 cells was identified to be PGE2. Conclusions: IL-17 recruits macrophages, and PGE2 induces M2-macrophage differentiation, hence the increased levels of IL-17 and PGE2 in lung cancer contribute to the formation of an M2-macrophage–dominant tumor microenvironment.

Prognostic impact of tumor-associated macrophage infiltration in non-small cell lung cancer: A systemic review and meta-analysis

Tumor-associated macrophages (TAMs) are important components of cancer microenvironment. In the present study, we searched PubMed, Embase, Cochrane library and Web of Science to perform a meta-analysis of 20 studies including a total of 2,572 non-small cell lung cancer (NSCLC) patients, in order to determine the association between TAMs and NSCLC prognosis. The combined hazard ratio (HR) of 9 studies showed that the density of total CD68+ TAMs in the tumor islet and stroma was not associated with overall survival (OS) of the patients. However, the pooled HR of 4 studies showed that high density of CD68+ TAMs in the tumor islet predicted better OS, while the pooled HR of 6 studies showed that high density of CD68+ TAMs in the tumor stroma was associated with poor OS. A high islet/stroma ratio of CD68+ TAMs was associated with better OS. A high density of M1 TAMs in the tumor islet was associated with better OS, while a high density of M2 TAMs in the tumor stroma predicted poor OS. These findings suggest that, although the density of total CD68+ TAMs is not associated with OS, the localization and M1/M2 polarization of TAMs are potential prognostic predictors of NSCLC.

Video-assisted thoracic surgery for pulmonary sequestration compared with posterolateral thoracotomy.

OBJECTIVES Pulmonary sequestration is a rare congenital malformation of the lungs. This study aims to evaluate the effectiveness of video-assisted thoracic surgery for the treatment of pulmonary sequestration in a larger series compared with posterolateral thoracotomy. METHODS The files of 42 patients with pulmonary sequestration treated via video-assisted thoracic surgery (18 cases) and posterolateral thoracotomy (24 cases) between September 2005 and May 2012 from a single institute were retrospectively reviewed. Data were collected regarding the patient demographics, medical history, preoperative investigations, intraoperative findings, and postoperative course. RESULTS All sequestration lung lesions were found in the lower lobes (31 on the left, 11 on the right), with feeding arteries arising from the thoracic aorta (34 cases) and the abdominal aorta (8 cases). Thirty-nine cases of sequestration were intralobar, and only 3 cases were extralobar. All patients achieved successful resection (including 37 lobectomies, 2 pneumonectomies, and 3 resections of the extralobar lesion). In the video-assisted thoracic surgery group, 1 case was converted to thoracotomy because of an injury to the aberrant artery; 1 case had injury to the left lower pulmonary vein and 1 case had injury to the aberrant artery, which were successfully treated without conversion. No significant differences were found between the 2 groups (video-assisted thoracic surgery vs posterolateral thoracotomy) in terms of the duration of operation, blood loss, amount of chest drainage, duration of chest drainage, length of postoperative hospital stay, and complications. CONCLUSIONS Video-assisted thoracic surgery resection for pulmonary sequestration is feasible, although it should be performed by an experienced surgeon with awareness of the potential risk of severe vascular injury.

Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery

BackgroundThis study aims to introduce an optimized method named “non-grasping en bloc mediastinal lymph node dissection (MLND)” through video-assisted thoracoscopic surgery (VATS).MethodsBetween February 2009 and July 2013, 402 patients with clinical stage I non-small cell lung cancer (NSCLC) underwent “non-grasping en bloc MLND” conducted by one surgical team. Target lymph nodes (LNs) were exposed following non-grasping strategy with simple combination of a metal endoscopic suction and an electrocoagulation hook or an ultrasound scalpel. In addition, dissection was performed following a stylized three-dimensional process according to the anatomic features of each station. Clinical and pathological data were prospectively collected and retrospectively reviewed.ResultsThe postoperative morbidity and mortality were 17.4% (70/402) and 0.5% (2/402), respectively. The total number of LNs (N1 + N2) was 16.0 ± 5.9 (range of 5–52), while the number of N2 LNs was 9.5 ± 4.0 (range of 3–23). The incidences of postoperative upstaging from N0 to N1 and N2 disease were 7.7% and 12.2%, respectively.ConclusionsNon-grasping en bloc MLND enables en bloc dissection of mediastinal LNs with comparable morbidity and oncological efficacy while saving troubles of excessive interference of instruments and potential damage to the target LN.

Surgical treatment of primary mediastinal myelolipoma

OBJECTIVES Primary mediastinal myelolipoma (PMM) is a rare benign tumour composed of haematopoietic tissue and mature adipose tissue. Here, we report the largest series aiming to investigate the outcomes of surgical treatment for patients with PMM. METHODS We retrospectively reviewed the data of 12 patients operated in a single institute during the period between April 2008 and December 2014. RESULTS There were 7 female and 5 male patients between 54 and 73 years old (median age, 64 years). Among them, 11 patients underwent unilateral (n = 10) or bilateral (n = 1) mass resection via video-assisted thoracic surgery (VATS), and 1 patient underwent a planned open thoracotomy due to a large tumour volume. The VATS operating time ranged from 20 to 65 min (median, 30 min) and intraoperative blood loss ranged from 20 to 60 ml (median, 30 ml). The open thoracotomy operating time was 120 min, and the blood loss was 1000 ml; thus, the patient received blood transfusion (2 units of RBCs). No operative mortalities or major postoperative complications were observed. All patients experienced a regular follow-up ranging from 2 to 80 months with a median follow-up of 18 months. No recurrence was observed at the time of evaluation. CONCLUSIONS Surgical treatment is recommended for the diagnosis and treatment of PMM, while VATS is a safe and feasible option in most cases.

Single-staged uniportal VATS major pulmonary resection for bilateral synchronous multiple primary lung cancers

It is difficult to make diagnosis and treatment decision for patient with bilateral multiple pulmonary foci. Surgical resection can offer sufficient specimens for diagnostic differentiation and the greatest chance for long-term survival in patient with presumptive synchronous multiple primary lung cancers (SMPLC). Since uniportal video-assisted thoracoscopic surgery (VATS) is a less invasive technique and has been attempted in lung cancer surgery, we transferred it into the management of SMPLC. In this paper, we report two cases of bilateral SMPLC managed through single-staged uniportal VATS with major pulmonary resection. This successful attempt provides an optimized idea to accomplish simplified mini-invasive diagnosis and synchronous treatment using the less invasive uniportal VATS technique for the management of SMPLC, especially for those with multiple bilateral lesions.

Initial experience of video-assisted thoracic surgery left upper sleeve lobectomy for lung cancer: Case report and literature review

Video‐assisted thoracic surgery (VATS) sleeve lobectomy continues to represent a great challenge to thoracic surgeons. Herein we report what we believe to be the first case of thoracoscopic left upper sleeve lobectomy for lung cancer. A 61‐year‐old male patient with centrally located lung cancer of the left upper lobe was successfully treated by this minimally invasive technique. Based on the success of the operation, we believe that VATS left upper sleeve lobectomy is also feasible, however, surgical approaches and procedures still require further improvement.

Successful resection of a huge mediastinal liposarcoma extended to the bilateral thorax

Liposarcoma arising in the mediastinum is extremely rare. Herein we present a case of a 47‐year‐old man with a huge posterior mediastinal tumor that extended to the bilateral thorax. The patient underwent a complete resection of the tumor and experienced an uneventful recovery. Postoperative pathology finally revealed liposarcoma. The patient underwent follow‐up for 25 months, during which time no recurrence was found.

Video-assisted thoracic surgery double sleeve lobectomy for non- small cell lung cancer: a report of seven cases

Background: Video-assisted thoracic surgery (VATS) double sleeve lobectomy has been rarely reported. We aimed to summarize the techniques and outcomes of this challenging procedure for non-small cell lung cancer (NSCLC) involving both the bronchus and pulmonary artery. Methods: From May 2012 to December 2016, seven patients were selected for VATS double sleeve lobectomy at our center, including four cases of left upper lobectomy and three cases of right upper lobectomy. Surgical procedures were performed with four ports for the first patient and three ports for the other patients. The “hollow out” process was designed for hilum dissection. The main pulmonary artery and interlobar artery were then blocked using two releasable atraumatic endoscopic Bulldog Clamps. Bronchovascular reconstruction was accomplished by the “two-needle-holder suturing technique” through directly watching a video monitor. Low-molecular heparin was subcutaneously administered during the first week after surgery. Results: The operations were uneventful. Surgical duration ranged from 250 to 480 min (median, 318 min) with blood loss between 30 to 200 mL (median, 200 mL). The average number of the dissected lymph nodes was 13 (range, 11–19). Two patients developed postoperative pneumonia with no mortalities. Prolonged air leak (>5 days) was observed in three patients. The median postoperative hospital stay was 15.5 days (range, 5–33 days). There were two cases of adenosquamous cell carcinoma and five cases of squamous cell carcinoma. One patient died of hemoptysis 50 days after surgery, and one died of metastatic lung cancer 2 years after surgery. The other five patients were alive without local recurrence at 4–58 months of follow-up. Conclusions: VATS bronchovascular double sleeve lobectomy is technically difficult but feasible for skilled thoracoscopic surgeons in experienced centers. More data are encouraged to assess the long-term outcomes of this new procedure.

Single-direction thoracoscopic lobectomy: left side

Lobectomy can be done either via thoracotomy or via video-assisted thoracic surgery (VATS) (1-3). In the recent years, VATS approach is adopted increasingly worldwide due to its advantages of less pain, lower complication rate, shorter hospital stay, and equivalent long term survival rate, comparing with thoracotomy (4-7). However, VATS lobectomy is complicated, especially VATS left upper lobe resection (8,9). The aim of this paper is to introduce the detailed procedures which presented in the videos of singledirection thoracoscopic left upper lobectomy and left lower lobectomy.