Yutian Lai

Systematic short-term pulmonary rehabilitation before lung cancer lobectomy: a randomized trial

OBJECTIVES The goal of this study was to assess the impact of a preoperative 1-week, systematic, high-intensity inpatient exercise regimen on patients with lung cancer who had risk factors for postoperative pulmonary complications (PPCs). METHODS We conducted a randomized controlled trial with 101 subjects of a preoperative, 7-day systematic, integrated, high-intensity pulmonary exercise regimen. The control group received standard preoperative care. We analysed the occurrence of PPCs in both groups as the primary outcome; other outcomes included changes in blood gas, quality of life, peak expiratory flow rate, the 6-min walk distance and others. RESULTS The 6-min walk distance showed an increase of 22.9 ± 25.9 m in the intervention group compared with 4.2 ± 9.2 m in the control group, giving a between-group difference of 18.7 m (95% confidence interval: 8.8-28.6; P < 0.001); the peak expiratory flow increased by 25.2 ± 24.6 l/min, compared with 4.2 ± 7.7 l/min (between-group difference: 21.0 m, 95% confidence interval: 7.2-34.8; P = 0.003). The intervention group had a shorter average total (15.6 ± 3.6 vs 17.7 ± 5.3 days, P = 0.023) and postoperative length of stay (6.1 ± 3.0 vs 8.7 ± 4.6 days, P = 0.001) than the control group; the incidence of PPCs (9.8%, 5/51 vs 28.0%, 14/50, P = 0.019) was significantly lower. A multivariable analysis of the risk of PPCs identified short-term rehabilitation intervention to be an independent risk factor (odds ratio = 0.156, 95% confidence interval: 0.037-0.649, P = 0.011). CONCLUSIONS The study results suggested that a systematic, high-intensity pulmonary exercise programme was a practical strategy when performed preoperatively in patients with lung cancer with risk factors for PPCs. CLINICAL TRIAL REGISTRATION ChiCTR-IOR-16008109.

Prognostic significance of soluble mesothelin in malignant pleural mesothelioma: a meta-analysis

Background Soluble mesothelin is beneficial to detect the progression and the treatment response of malignant pleural mesothelioma. However, the prognostic value of soluble mesothelin in malignant pleural mesothelioma remains unclear. Methods Hazard ratio with 95% CI was used to evaluate the prognostic value of soluble mesothelin and the effect of clinicopathological characteristics on the survival of malignant pleural mesothelioma. Results Eight eligible studies involving 579 patients were selected for this meta-analysis. The results showed that soluble mesothelin level was significantly correlated with the survival of malignant pleural mesothelioma (pooled HR: 1.958, 95%CI: 1.531-2.504, p = 0.000; heterogeneity test: I2 = 1.1%, p = 0.421). In addition, the survival of malignant pleural mesothelioma was significantly correlated with some clinicopathological characteristics such as tumor histology (HR = 3.214, 95% CI = 2.071-4.988, p = 0.000; heterogeneity test: I2 = 0.0%, p = 0.623) and tumor stage (HR = 2.007; 95% CI = 1.477-2.727; p = 0.000; heterogeneity test: I2 = 0.0%, p = 0.966). Conclusions The survival of malignant pleural mesothelioma is significantly correlated with tumor histology and tumor stage. Furthermore, high soluble mesothelin level may lead to a poor prognosis for malignant pleural mesothelioma patients.

Short-term inpatient-based high-intensive pulmonary rehabilitation for lung cancer patients: is it feasible and effective?

Background This study was conducted to develop a preoperative in-hospital short-term rehabilitation program for surgical lung cancer patients, and investigate its feasibility, potential cost benefit and effectiveness on outcome measures including reduction of postoperative pulmonary complications (PPCs) and postoperative length of stay. Methods A 7-day inpatient-based high-intensive rehabilitation regimen was performed between March 01, 2014 and June 30, 2015. It was combined with inspiratory muscles training (IMT) and aerobic endurance training and was tested in an enriched cohort study with 939 lung cancer patients undergoing lobectomy in a regional thoracic unit. Results Finally, 939 patients were divided into pulmonary rehabilitation (PR) group (n=197) and non-PR (NPR) group (n=742), according to whether they received the 7-day preoperative in-hospital systematic rehabilitation. The PR group had a shorter total length of stay (14.7±4.0 vs. 16.7±6.2 days, P<0.001) as well as postoperative length of stay (6.2±3.3 vs. 8.3±5.6 days, P<0.001) than the NPR group. Lower incidences of total PPCs (18.3%, 36/197 vs. 26.1%, 194/742, P=0.022), pneumonia (11.2%, 22/197 vs. 17.3%, 128/742, P=0.024) and atelectasis (6.6%, 13/197 vs. 12.3%, 91/742, P=0.038) were found in the PR group compared with NPR group. Meanwhile, a multivariable analysis of risk to PPCs, atelectasis and pneumonia, revealed that the PR intervention was the independent risk factor of the occurrence of the PPCs (OR =0.57, 95% CI: 0.47 to 0.93, P=0.033) and atelectasis (OR =0.49, 95% CI: 0.26 to 0.91, P=0.024). Conclusions The study showed the effectiveness of this systematic and high-intensive PR combining IMT and aerobic exercise in reductions of the length of stay and occurrence of PPCs without increase in in-hospital cost, suggesting the potential of this rehabilitation pattern as a practicable strategy performed preoperatively in surgical lung cancer patients.

Short-term high-intensity rehabilitation in radically treated lung cancer: a three-armed randomized controlled trial

BACKGROUND The feasibility and practicality of preoperative rehabilitation (PR) programs remains quite controversial in the treatment of lung cancer (LC). This study explored whether a short-term high-intensity rehabilitation program could improve postoperative outcomes compared to those achieved with conventional inspiratory muscle training (IMT). METHODS A three-armed randomized controlled trial comparing the two training modalities and routine care was conducted in surgical LC patients. Patient groups received one of three treatment regimens: (I) high-intensity pulmonary rehabilitation (PR) that combined IMT with conventional resistance training (CRT) (combined PR group); (II) conventional PR (single IMT group); or (III) routine preoperative preparation (control group). The primary endpoint was a change in the occurrence of post-operative pulmonary complications (PPCs) that occurred within 30 days after surgery, while secondary endpoints included changes in length of hospital stay, quality of life (QoL) scores, 6-min walk distance (6-MWD) and peak expiratory flow (PEF). RESULTS A total of 90 enrolled patients were randomized into three groups with a computer-based 1:1:1 ratio. The intention-to-treat analysis of the study revealed that, compared with the Control Group, the Combined PR Group had a significant increase in ∆6-MWD (by 32.67 m, P=0.002), ∆PEF (by 14.3 L/min, P=0.001), ∆global scores (by 3.7, P=0.035); and a reduced ∆average total hospital stay (by 3.2 d, P=0.001) and ∆postoperative stay (by 3.6 d, P=0.001). With regard to PPC rate, the Combined PR Group had a somewhat lower PPC severity (grade II-V) compared to the Control Group. CONCLUSIONS This hospital-based short-term program of PR combining high-intensity IMT with CRT was significantly superior to the conventional IMT program, indicating that this approach would be a feasible strategy for treating LC patients, especially those waiting operations with surgery-related risk factors.

Status and perspectives of detection by low-dose computed tomography or computed radiography in surgical patients with lung cancer, based on a five-year study

A retrospective study involving 502 lung cancer patients who had received pulmonary resection from 2009–2013 was conducted in order to compare the clinical characteristics of patients whose diagnosis was detected by low‐dose computed tomography (LDCT) and computed radiography (CR).

Method for discriminating synchronous multiple lung cancers of the same histological type: miRNA expression analysis.

Abstract With the development of imaging technology, an increasing number of synchronous multiple lung cancers (SMLCs) have been diagnosed in recent years. Patients with >1 tumor are diagnosed with either synchronous multiple primary lung cancers (SMPLCs) or other primary tumors and metastases. Clinical guidelines, histological characteristics, and molecular diagnostics have been used to discriminate SMPLCs from other multiple lung cancers. However, there is still ambiguity in the diagnosis of SMPLCs of the same histological type. We enrolled 24 patients with the same histological type of SMLCs and assessed their status using established clinical guidelines, comprehensive histological subtyping, and molecular analysis. The sum value of the differential microRNA (miRNA) expression profiles (&Dgr;&Dgr;Ct) with matched tumors was evaluated to discriminate SMPLCs of the same histological type from metastases. Twelve patients with lymph node metastases were included for comparison, and the sum value of the &Dgr;&Dgr;Ct of 5 miRNAs between primary tumors and lymph node metastases was <9. Patients definitively diagnosed with SMPLCs by integrated analysis were also classified as SMPLCs by miRNA analysis; 6 patients showed conflicting diagnoses by integrated and miRNA analysis and 14 were given the same classification. Analysis of miRNA expression profiles is considered to be a useful tool for discriminating SMPLCs from intrapulmonary metastases.

It is safe and feasible to omit the chest tube postoperatively for selected patients receiving thoracoscopic pulmonary resection: a meta-analysis

Background To access the feasibility and safety of no chest tube (NCT) placement after thoracoscopic pulmonary resection. Methods A comprehensive search of online databases (PubMed, Embase, Web of Science, and Cochrane library) was performed. Studies investigating the safety and feasibility of NCT compared with chest tube placement (CTP) after VATS pulmonary resection were eligible for our meta-analysis. Perioperative outcomes were extracted and synthesized. Specific subgroups (wedge resection) were examined. The methodological quality of the included articles was evaluated with the methodological index for non-randomized studies (MINORS) tool. Results Analysis of 9 studies including a total of 918 patients was performed. Four hundred sixty-one patients underwent NCT and 457 patients underwent CTP. The length of stay (LOS) postoperatively in the NCT group was significant shorter than in the CTP group [standardized mean difference (SMD) = -0.80; 95% confidence interval (CI), -1.13 to -0.47, P=0.000]. Patients in the NCT group experienced slighter pain than patients in the CTP group in postoperative day (POD) one (SMD = -0.41; 95% CI, -0.75 to -0.07, P=0.02), and POD two (SMD = -0.41; 95% CI, -0.75 to -0.07, P=0.02). While, there was no significant difference about the 30-day morbidity for patients who underwent NCT and CTP [relative ratio (RR) =1.01; 95% CI, 0.59-1.74, P=0.04) and the rate of re-intervention (RR =0.89; 95% CI, 0.33-2.40, P=0.57). No perioperative mortality was observed in both groups. The sensitivity analysis suggested that the relative effects between 2 groups have already stabilized. Subgroup analysis revealed an effect modification by operation approach regarding perioperative morbidity, but not for LOS. Conclusions This meta-analysis conforms that it is feasible and safe to omit chest tube after thoracoscopic pulmonary resection for patients carefully selected. Randomized controlled trails (RCTs) are urgently needed to verify this conclusion.

Perioperative changes of serum albumin are a predictor of postoperative pulmonary complications in lung cancer patients: a retrospective cohort study

Background A decrease in serum albumin is commonly observed after lung cancer surgery, however, whether it is associated with postoperative outcomes is unknown. The objective of this study was to evaluate whether the reduction of serum albumin (ΔALB) on postoperative day one could serve as a predictor of postoperative pulmonary complications (PPCs) after thoracoscopic anatomical resection in lung cancer patients. Methods Patients characteristics were compared between groups of whether they experienced PPCs or not. The cutoff value of ΔALB was examined by receiver operating characteristic curve to find out the threshold value of ΔALB in predicting PPCs. Logistic regression analysis was conducted to identify potential risk factors for PPCs. Results Totally 533 patients were included into analysis, and among them, 52 experienced PPCs. The ΔALB was significant in the PPCs group than in the non-PPCs group (P<0.001), and ΔALB was observed an independent risk factor for PPCs (OR =2.268, 95% CI: 1.153-4.460). The cutoff value of ΔALB in predicting PPCs was 14.97%. Patients with ΔALB ≥14.97% were more likely to have PPCs (P<0.001). Conclusions A reduction of serum albumin with a cut-off value of 14.97% can be served as a predictor to identify patients at high risk of developing PPCs following thoracosopic anatomical lung cancer surgery.

Is it safe and practical to use a Foley catheter as a chest tube for lung cancer patients after lobectomy? A prospective cohort study with 441 cases

OBJECTIVE This study was conducted to explore the feasibility and safety of postoperative chest drainage with a Foley catheter for lung cancer patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy. METHODS Data from lung cancer patients who underwent a VATS lobectomy with insertion of a catheter (Foley catheter or 28-F chest tube) were analysed. A total of 441 patients were included preoperatively for participation, with 208 patients in the Foley catheter group and 233 in the 28-F group. RESULTS In the Foley catheter group, a shorter mean number of days was required until chest tube removal after lobectomy (2.6 ± 1.3 vs. 3.5 ± 2.0 d, P < 0.001) and postoperative length of stay was shorter (3.8 ± 2.5 vs. 5.2 ± 4.1 d, P < 0.001); The 28-F group had a higher average VAS score than did the Foley catheter group at 6 h (P = 0.025), and 48 h (P < 0.001) after VATS lobectomy as well as at 6 h, 24 h, 48 h, 72 h, 30 days and 90 days after chest tube removal (P < 0.001). Regarding postoperative pulmonary complications (PPCs) and chest tube removal-related complications, the rate of PPCs was not found to be significant, and a significantly higher proportion of disordered wound healing at the drainage site was observed in the 28-F group (5.8%, 12/208 vs. 11.6%, 27/233; P = 0.043). CONCLUSION The study indicated that placement of Foley catheter vs. 28-F chest tube was associated with a statistically significant but clinically modest reduction in pain, with shorter mean days until chest tube removal after lobectomy, shorter in-hospital stay, and a smaller proportion of disordered wound healing at the drainage site. These results indicate the feasibility and safety of postoperative chest drainage with a Foley catheter for lung cancer patients undergoing VATS lobectomy. CLINICAL REGISTRATION NUMBER ChiCTR1800014816.

Microsatellite alteration in plasma DNA discriminates multiple primary lung cancer from metastatic lung cancer

Background: To develop a novel molecular approach as a noninvasive test for differentiation of tumor origin, and to evaluate the feasibility of distinguishing multiple primary lung cancer (MPLC) from metastatic lung cancer (MLC) through the analysis of microsatellite genomic instability of plasma DNA. Methods: Matched normal, tumor, and plasma samples were obtained from 12 patients with single lesions. After DNA extraction, the samples were subjected to microsatellite analysis using 6 markers (D2S1363, D6S1056, D7S1824, D10S1239, D15S822, and D22S689). Tumor and plasma samples were collected from 12 patients with multiple lesions. Of them, 6 patients were diagnosed as multiple primary tumors and 6 patients as pulmonary metastasis according to the last version of guideline proposed by American College of Chest Physicians. Results: In the single lesion group, 33 (45.8%) of 72 plasma tests displayed positive polymerase chain reaction (PCR)-results. Of the 43 tumor samples with positive PCR-results, 31 (72.1%) could also be detected in plasma. In the multiple lesion group, 8 and 4 patients showed the “contradictory trend” and the “unique trend”, respectively in the plasma analysis. However, in the tumor analysis, 10 and 2 patients showed the “contradictory trend” and the “unique trend”, respectively. The sensitivity and specificity of plasma tests to identify multiple primary tumors are 80% (8/10) and 100% (2/2), respectively. Conclusions: Identical microsatellite alteration could be observed in both circulating DNA and the tumor. With polymorphic microsatellite markers, the “contradictory trend” representing multiple primary tumors that is detected in tumor cells and plasma DNA could assist in discriminating MPLC and MLC.