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Impact of compromised pulmonary function on major lung resection for non-small cell lung cancer： retrospective study of 127 cases

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Chinese Medical Journal 2012年第19期125卷 3465-3471页

作者： ZHANG Yi JIANG Ge-ning GAO Wen CHEN Chang Department of Thoracic Surgery Shanghai Pulmonary Disease HospitalTongji UniversityShanghai 200433China

Background Radical lung resection is the best chance for cure in patients with anatomically resectable non-small cell lung cancer. A retrospective study was performed in an attempt to investigate general rules of major lung resection for non-small cell lung cancer in patients with compromised pulmonary function. Methods Between June 2002 and December 2008, major lung resection was performed in 127 non-small cell lung cancer patients at our institution, who met the criteria of compromised pulmonary function defined as preoperative forced vital capacity 〈50% of prediction or preoperative forced expiratory volume in one second 〈50% of prediction. Clinical data of the patients were retrospectively reviewed. Results The patients consisted of 108 males （85.0%） and 19 females （15.0%） with a mean age of 61.7 years. The morbidity rate was 44.1% （56/127） and the mortality rate was 4.7% （6/127）. Multivariate analysis identified PaCO2 （P=0.023, OR=2.959, 95% Cl 1.164-7.522）, the percent predicted postoperative diffusing capacity of the lung for carbon monoxide （P=0.001, OR=0.176, 95% Cl 0.064-0.480） and comprehensive preoperative preparation （P=0.048, OR=0.417, 95% Cl 0.176-0.993） as the independent predictors of postoperative cardiopulmonary complications that were found in 45 cases. Overall 1-, 3- and 5-year survival rates were 90%, 55% and 37% respectively. For overall survival, multivariate analysis revealed that TNM staging （P=0.004, OR=1.585, 95% Cl 1.154-2.178） was the only independent prognostic factor. Conclusions On the premise of integrated preoperative evaluation and comprehensive preoperative preparation, major lung resection provides an optimal therapeutic for selected non-small cell lung cancer patients with compromised pulmonary function. Hypercapnea and the percent predicted postoperative diffusing capacity of the lung for carbon monoxide 〈40% could be considered as the independent predictive factors for operative risk in those Datients.

关键词： non-small cell lung cancer compromised pulmonary function major lung resection

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Non-intubated minimally-invasive lung surgery in Germany-current status and outlook

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中华胸部外科电子杂志 2021年第4期8卷 205-208页

作者： Patrick Zardo Norman Zinne Alaa Selman Hayan Merhej Tobias Goecke Henning Starke Daniel Jaeger Jan Karsten Axel Haverich Department of Cardiothoracic Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany Department of Anaesthesiology Hannover Medical SchoolHannoverGermany

lung surgery under spontaneous ventilation(non-intubated video-assisted thoracoscopic surgery,niVATS)picked up a lot of momentum during the past few *** and anesthetists alike want to forgo known risks of orotracheal intubation and mechanical ventilation,ranging from local complications,like mucosal injury or even deleterious tracheal laceration and rupture,to increased release of pro-inflammatory cytokines and diaphragmatic dysfunction secondary to muscle *** initial adoption of VATS in Germany having been slow due to a general reticence towards it in smaller units,major thoracic centers nowadays have well-established minimally invasive programs and even perform minor non-intubated procedures on a regular *** with major niVATS cases still is sparse across Western Europe,and limited to specialized and highly trained centers,where exceptionally complex and often multimorbid patients can safely undergo lung surgery under spontaneous *** group pioneered niVATS lobectomy in Germany back in 2018,and since then we tried to spread the technique by means of multidisciplinary Masterclass-courses held at our center,in which the participant’s initial reticence to perform niVATS often changed to enthusiasm for the *** in turn led several visiting units to start with their own programs,and some of them even reported their initial *** article offers a short historic overview of VATS in general,gives an insight into how niVATS got pioneered in Germany and presents the current state of affairs.

关键词： Video-assisted thoracoscopic surgery(VATS) Non-intubated video-assisted thoracoscopic surgery(niVATS) lung surgery in Germany major lung resection

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