Qingshu Cheng

CT-guided percutaneous microwave ablation of pulmonary malignancies: Results in 69 cases

BackgroundMicrowave ablation (MWA) has attracted a worldwide attention gradually in treating inoperable pulmonary malignancies. However, in the lung tissues treated with MWA recurrence of tumor may still occur and few data in large patient groups till now were reported about the safety or effectiveness of microwave ablation in treating primary lung cancer and metastatic pulmonary malignancies. The purpose of this study is to evaluate the clinical curative effect (local control, survival data) MWA and its safety as well.MethodsFrom 1 January 2005 to 1 January 2008, retrospective analyses, 69 patients underwent computed tomography (CT)-guided percutaneous MWA of pulmonary malignancies. All patients were deemed medically inoperable. The correlation of tumor sizes and local progression after ablation was analyzed and the survival rates within 3 years post surgery were compared between non-small-cell lung cancer and pulmonary metastases groups also.ResultsPneumothorax was the most frequent complication and occurred in 24.64% patients after ablation. Neither needle track implantation was found nor did patient death occur in these patients within 30 days. The 1-, 2-, and 3-year overall survival rates were 66.7%, 44.9% and 24.6%, respectively. The overall survival rates for NSCLC patients in 1 year, 2 years, and 3 years were 75.0%, 54.2%, and 29.2%, respectively. The overall survival rates for pulmonary metastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 23.8%, and 14.3%, respectively. The recurrence-free survival rates for NSCLC patients in 1 year, 2 years, and 3 years were 72.9%, 50.0%, and 27.1%, respectively. The mortality rates for pulmonary metastatic tumor patients in 1 year, 2 years, and 3 years were 47.6%, 19.0%, and 14.3%, respectively.ConclusionsPercutaneous microwave coagulation therapy was one safe and effective method and could be beneficial for the improvement of inoperable pulmonary malignancies treatment effect.

Is radiofrequency thermal ablation a safe and effective procedure in the treatment of pulmonary malignancies

OBJECTIVE Radiofrequency ablation (RFA) has been recently applied as an alternative option of pulmonary surgery in the treatment of pulmonary malignancies. In this study, we assessed the risk associated with percutaneous RFA, and discussed its safety and efficacy. METHODS The clinical data of 329 consecutive patients with primary (n = 237) and metastatic (n = 92) lung tumor treated with RFA from 1999 to 2006 in this hospital were considered for this study, and the character and clinical data of these patients were analyzed. Complications, local progression, and overall survival at 1, 2 and 5 years of these patients were evaluated. RESULTS Following the procedure 63 (19.1%) patients presented with pneumothorax, 14 (4.2%) with hemoptysis (one death), 10 (3.0%) hemothorax, 15 (4.5%) pneumonia, and three (0.9%) pericardial tamponade (one death); the 30-day mortality after the procedure was 0.6%. Needle-track implantation was observed in six (1.8%) patients. Median progression-free interval was 21.6 months. The overall survival at 1, 2 and 5 years was 68.2%, 35.3%, and 20.1%, respectively. A total of 78 (23.7%) patients developed local progression during the follow-up. Significant difference in the risk of local progression was found in tumors more than 4 cm; however, no significant difference was found in tumors less than 3 cm and 3-4 cm in our group. CONCLUSION RAF is a safe and well-tolerated procedure with satisfied efficacy in the treatment of malignant lung nodules. To avoid complications with potential fatal outcome, adequate training and careful patient selection by a multidisciplinary team might be helpful.

Repair of massive stent-induced tracheoesophageal fistula.

OBJECTIVE The purpose of this report was to discuss a new surgical procedure in treating esophageal stent related large tracheoesophageal fistula without tracheal resection. METHODS Clinical records of 5 patients with esophageal stent-related large tracheoesophageal fistulas treated in this hospital between 1997 and 2006 were reviewed. RESULT All patients had insertion of a covered self-expanding esophageal stent, 1 for benign esophageal stricture and 4 for esophageal perforation resulting from various causes. A double patch technique, in which the esophageal wall was used as a protective patch repairing the defect on the trachea, was performed with an esophagectomy and gastric replacement. No significant complications occurred in the perioperative period. All patients recovered uneventfully. CONCLUSIONS Use of the adjacent esophageal wall as a patch to close a defect on the trachea is a safe procedure with a favorable outcome. It should therefore be recommended as a reliable surgical procedure in treating massive stent-induced tracheoesophageal fistulas and other complicated tracheoesophageal fistulas that tracheal resection could not safely address. However, the esophagus was damaged to a certain degree.

Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer

It is well accepted that recurrent laryngeal nerve paralysis is a severe complication of esophagectomy or lymphadenectomy performed adjacent to the recurrent laryngeal nerves. Herein, determination of the effectiveness of implementing continuous recurrent laryngeal nerve monitoring to reduce the incidence of recurrent laryngeal nerve paralysis after esophagectomy was sought. A total of 115 patients diagnosed with esophageal cancer were enrolled in the thoracic section of the Tangdu Hospital of the Fourth Military Medical University from April 2008 to April 2009. Clinical parameters of patients, the morbidity, and the mortality following esophageal resection were recorded and compared. After the surgery, a 2-year follow up was completed. It was found that recurrent laryngeal nerve paralysis and postoperative pneumonia were more frequently diagnosed in the patients that did not receive continuous recurrent laryngeal nerve monitoring (6/61 vs. 0/54). Furthermore, positive mediastinal lymph nodes (P = 0.015), total mediastinal lymph nodes (P < 0.001), positive total lymph nodes (P = 0.027), and total lymph nodes (P < 0.001) were more often surgically removed in the patients with continuous recurrent laryngeal nerve monitoring. These patients also had a higher 2-year survival rate (P = 0.038) after surgery. It was concluded that continuous intraoperative recurrent laryngeal nerve monitoring is technically safe and effectively identifies the recurrent laryngeal nerves. This may be a helpful method for decreasing the incidence of recurrent laryngeal nerve paralysis and postoperative pneumonia, and for improving the efficiency of lymphadenectomy.

Our experience on management of Boerhaave's syndrome with late presentation

A retrospective review of 18 patients treated for Boerhaaves syndrome in our center from 1954 to 2006 was undertaken. The patients were divided into two groups: group 1, the time delayed before treatment was less than 24 hours; group 2, the time delayed was more than 24 hours. The time interval between perforation and the onset of treatment in group 2 was from 50 hours to 30 days. Roentgenograms of the chest and esophagogram with a water-soluble contrast medium are able to reveal the perforation in most cases, and thoracentesis or thoracic drainage after swallow methylene blue may provide help as well. Surgical intervention was adopted in all three patients in group 1 and 12 in group 2, and conservative intervention in three in group 2. In group 1, two patients recovered uneventfully, the other one developed a postoperative respiratory infection, and he recovered after the infection was controlled. The mortality in group 2 was 33.3% (5/15), and the mortality in patients with conservative intervention was 100% (3/3). Five complications occurred after surgical intervention in group 2, including four fistulae and one incision infection. In conclusion, it may be appropriate to manage patients aggressively with primary repair and adequate mediastinal and pleural drainage when patients present late. Because of the syndromes initial severity and a tendency to postoperative complications, patients should be closely monitored, and correct antibiotic therapy and adequate nutrition are very important in treatment.

Bronchiolitis obliterans complicating a pneumothorax after Stevens-Johnson syndrome induced by lamotrigine

Bronchiolitis obliterans (BO) was defined as a nonreversible obstructive lung disease in which the bronchioles are always compressed and narrowed by fibrosis or inflammation. In the severe event of lung collapse after BO, surgical intervention is often recommended, and conservative therapy is thought to be ineffective. Here, we report the case of a 9-year old girl clinically diagnosed as having bronchiolitis obliterans with abrupt occlusion of the right B4b bronchus. After a lamotrigine-induced Stevens-Johnson syndrome (SJS) occurred, she presented with total collapse of the right lung on admission, which was subsequently complicated by a pneumothorax during conservative treatment, but with the re-expansion of the right upper lobe after intervention. The case indicates the possibility of reversing pulmonary atelectasis in BO. Thus, surgery may not be necessary.

Effects of Lipid Emulsions in Parenteral Nutrition of Esophageal Cancer Surgical Patients Receiving Enteral Nutrition: A Comparative Analysis

Background: Olive oil-based lipid emulsion (LE) and medium chain triglyceride/long chain triglyceride (MCT/LCT) emulsion are both LEs with low ω-6 polyunsaturated fat acids (PUFAs) content. However, which one of these LEs is associated with a lower infection risk in patients receiving parenteral nutrition (PN) remains unclear. The aim of the study was to compare the effects of the two LEs in PN in esophageal cancer patients undergoing surgery. Methods: Patients with resectable esophageal carcinoma were recruited and allocated randomly to two groups. The test group was given enteral nutrition (EN) with PN containing olive oil-based LE after tumor resection for ≥7 days, and the patients in the control group were supported by EN with MCT/LCT emulsion-based PN after surgery for the same time period. Immunological markers and inflammatory indicators were tested and perioperative clinical outcomes were determined. The trial was registered in the Chinese Clinical Trial Register, number ChiCTR-TRC-13003562. 94 Patients were recruited, and grouped (olive oil-based LE, n = 46 and MCT/LCT, n = 48), matched for sex, age, body mass index, histological type, TNM stage, and nutrition risk screening (NRS) 2002 score. Results: There were no differences in perioperative fever (>38 °C), infectious complications, length of hospital stay (>14 days), length of critical care stay (>2 days), time for oral food intake, and in-hospital mortality between the two groups. The test group showed a higher increase in IgG level compared with the MCT/LCT group (p = 0.028). There was no difference in other immunological markers and inflammatory indicators between the two groups. Conclusion: PN containing olive oil-based or MCT/LCT LEs had similar effects on perioperative outcome, cell-mediated immune function and inflammatory response in esophageal cancer patients who had undergone surgery and were receiving EN.