Publications by authors named "Shuben Li"

37 Publications

Sleeve lobectomy after neoadjuvant chemoimmunotherapy/chemotherapy for local advanced non-small cell lung cancer.

Transl Lung Cancer Res 2021 Jan;10(1):143-155

Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.

Background: Sleeve lobectomy has been reported to be a safe procedure after neoadjuvant chemotherapy. We aim to evaluate the oncological and surgical outcomes of neoadjuvant chemoimmunotherapy (IO+C) for local advanced non-small cell lung cancer (NSCLC) patients who underwent sleeve lobectomy.

Methods: NSCLC patients that underwent sleeve lobectomy between December 2016 and December 2019 were retrospectively included. Patients were divided into two groups: neoadjuvant IO+C and chemotherapy. Oncological, intraoperative and postoperative variables were compared.

Results: In total, 20 patients underwent sleeve lobectomy after neoadjuvant IO+C (n=10) or chemotherapy (n=10). In the neoadjuvant IO+C group, 8/10 (80%) patients achieved a partial response (PR), 1/10 (10%) patients had a complete pathological response (CPR), and 5/10 (50%) patients achieved a major pathological response (MPR). In the neoadjuvant chemotherapy group, only 3/10 (30%) patients had PR, and 3/10 (30%) patients achieved MPR. No complications were found in the neoadjuvant IO+C group, 1 chylothorax occurred in the neoadjuvant chemotherapy group. Other peri- and postoperative outcomes were similar: bleeding volume (365.00 347.50 mL; P=0.267), operation time (291.88 287.50 min; P=0.886), chest tube duration (5.40 5.00 day; P=0.829), total drainage volume (815.50 842.50 mL; P=0.931) and the length of hospital-stay (7.00 6.56 day; P=0.915). In addition, less N1 (average number 4.70 7.40) and N2 (average number 9.80 vs. 20.10) lymph nodes were acquired in the neoadjuvant IO+C group than the neoadjuvant chemotherapy group. The number of lymph nodes positive for tumor cells was also less in the neoadjuvant IO+C group than the neoadjuvant chemotherapy group, both in N1 (0.40 1.60) and N2 (0.10 1.30). The positive lymph node ratio (LNR) was lower in the neoadjuvant IO+C group, both in N1 (0.05 0.15) and N2 (0.01 0.09). A greater destruction on elastic fiber of the blood vessels, vascular wall degeneration, fibrinoid necrosis and fibrosis, and greater pulmonary interstitial exudation were found in neoadjuvant IO+C patients compared to the neoadjuvant chemotherapy patients.

Conclusions: Sleeve lobectomy for advanced NSCLC following IO+C is feasible, although the operations become more complex, neoadjuvant IO+C did not delay postoperative recovery.
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http://dx.doi.org/10.21037/tlcr-20-778DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867787PMC
January 2021

Expert consensus on neoadjuvant immunotherapy for non-small cell lung cancer.

Transl Lung Cancer Res 2020 Dec;9(6):2696-2715

Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, Guangzhou, China.

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http://dx.doi.org/10.21037/tlcr-2020-63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815365PMC
December 2020

Treatments for combined small cell lung cancer patients.

Transl Lung Cancer Res 2020 Oct;9(5):1785-1794

Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Background: Combined small cell lung cancer (CSCLC) is a subtype of small cell lung cancer (SCLC) which contains both components of SCLC and non-small cell lung cancer (NSCLC). The prognostic outcomes and treatment strategy of it are still unclear. A large-scale retrospective study was performed to investigate proper treatments for CSCLC.

Methods: All cases of CSCLC were identified from the SEER database during the period of 2004-2016. Clinical characteristics, first-line treatments, surgical procedures and survival data including overall survival (OS) and cancer-specific survival (CSS) were analyzed.

Results: A total of 37,639 SCLC patients were identified. CSCLC accounted for 2.1% (784/37,639). The mean age of CSCLC cohort is 67.3±9.9 years old. Male and white ethnicity patients were accounted for larger proportions (55.7% and 80.4%). The oncological characteristics of CSCLC were consistent with SCLC that most of patients were diagnosed as higher grade and advanced stages. The prognosis of CSCLC was better than SCLC but worse than NSCLC in IA-IIIA stages. No difference was observed in IIIB-IV. Surgery was beneficial in IA-IB stage CSCLC. Adjuvant chemotherapy seemed to have few effects on early stage patients. Trimodality treatment could significantly improve OS in IIA-IIIA CSCLC patients. Chemotherapy-based treatment is predominant choice in advanced stage patients.

Conclusions: CSCLC is a rare and special subtype of SCLC. It has better survival outcome than non-CSCLC in early stage. Surgical treatment is crucial in early stage of CSCLC. Prognostic improvement might be achieved from trimodality treatment in stage IIA-IIIA. Chemotherapy-based treatments should be considered in advanced stage. The effect of surgical treatments in advanced stage patients should be further investigated.
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http://dx.doi.org/10.21037/tlcr-20-437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7653110PMC
October 2020

Does size matter? -a population-based analysis of malignant pleural mesothelioma.

Transl Lung Cancer Res 2020 Aug;9(4):1041-1052

Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Background: The 8 edition staging system for malignant pleural mesothelioma (MPM) has been proposed. The size of tumor is not taken into consideration. We intend to elucidate the prognostic value of the size of MPM and evaluate the current staging system via the data of SEER database.

Methods: All cases of primary MPM were identified and extracted from the SEER database during the period of 2004-2016. The endpoints were overall survival (OS) and cancer-specific survival (CSS) which were analyzed using Kaplan-Meier method. Log-rank test and Cox regression were utilized to identify the prognostic factors.

Results: A total of 2,138 patients were included in the primary cohort. The 1-, 3- and 5-year survival rates of MPM were 39.4%, 11.8% and 3.8%. Older, male and advanced stage patients accounted for larger proportion of the cohort. Besides tumor extension, lymph node involvement and metastatic status, tumor size, pathological type and differentiation grade were significant prognostic factors. In the stratified analysis of tumor extension, size is a significant prognostic factor in T2 patients and indicates inferior survival outcomes. Surgery, chemotherapy and radiation can increase both OS and CSS in MPM patients. Triple combination treatments showed a superiority to other treatments.

Conclusions: Tumor size matters in the prognosis of MPM especially in the early stage of MPM patients. The adjusted TNM staging system incorporating tumor size has better accuracy than the 8 edition IMIG system. However, some stages had not been fully identified. More cases of early stages are warranted for essential revision.
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http://dx.doi.org/10.21037/tlcr-19-488DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481612PMC
August 2020

Uniportal video-assisted thoracic surgery for the treatment of lung cancer: a consensus report from Chinese Society for Thoracic and Cardiovascular Surgery (CSTCVS) and Chinese Association of Thoracic Surgeons (CATS).

Transl Lung Cancer Res 2020 Aug;9(4):971-987

Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Uniportal video-assisted thoracoscopic surgery (UniVATS) has been widely adopted in China, where several ultra-high volume thoracic surgical and training centers are located. The objective of this consensus from Chinese experts was to summarize the current application and give reference for the future development of UniVATS in the treatment of lung cancer. A panel of 41 experts from 21 Chinese hospitals was invited to join this project. The Delphi method was used in this consensus consisting of two rounds of voting. The questionnaire was based on the current clinical evidence. Forty (97.6%) experts completed the 2 rounds of questionnaires. The experts' experience was relatively similar. We defined the UniVATS as monitor-dependent surgery, no use of rib-spreading and single incision less than 4 cm. Tumor with stage of T1-T3 and N0-N2 is considered amenable to UniVATS. Other consensus was reached on several points outlining the safety and feasibility, surgical skills, learning curve, short-term and long-term outcomes for lung cancer, and current application of subxiphoid and nonintubated UniVATS approach. This consensus statement represents a collective agreement among Chinese experts to suggest that UniVATS is an effective alternative to multi-portal approach, although high-level evidence is expected in the future. Some agreements can be referred in the training of young surgeons.
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http://dx.doi.org/10.21037/tlcr-20-576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7481589PMC
August 2020

Tubeless video-assisted thoracic surgery for lung cancer: is it ready for prime time?

Future Oncol 2020 Jun 7;16(18):1229-1234. Epub 2020 May 7.

Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, PR China.

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http://dx.doi.org/10.2217/fon-2020-0278DOI Listing
June 2020

Perioperative chemoimmunotherapy in a patient with stage IIIB non-small cell lung cancer.

Ann Transl Med 2020 Mar;8(5):245

Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.

We present a case of a 56-year-old male patient with stage IIIB (T3N2M0) poorly differentiated squamous cell carcinoma of the lung. Four cycles of chemotherapy were first applied, and the patient had stable disease. However, the patient refused to receive radiotherapy, therefore second-line treatment chemotherapy combined with anti-PD-1 immunotherapy was applied. Partial response was reached at the 4 cycle of chemotherapy combined with anti-PD-1 immunotherapy. The neoadjuvant strategy was prolonged to 10 cycles but no significant change was observed on tumor size. The patient then underwent video-assisted thoracoscopic left lower lobectomy. Eight cycles of adjuvant PD-1 immunotherapy were applied postoperatively. Perioperative immunotherapy demonstrated good curative effect in this patient and no recurrence was observed at the clinic 40 months following surgery. Here we intend to explore the concept of immunotherapy combined with chemotherapy and surgery in neoadjuvant and adjuvant setting, and to investigate the possibility of extending this strategy in patients with stage IIIB non-small cell lung cancer (NSCLC).
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http://dx.doi.org/10.21037/atm.2020.01.118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154428PMC
March 2020

Spontaneous breathing anesthesia for cervical tracheal resection and reconstruction.

J Thorac Dis 2019 Dec;11(12):5336-5342

Department of Anesthesiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Background: Spontaneous breathing anesthesia (SBA) may have advantages over general anesthesia for cervical tracheal resection and reconstruction (TRR), avoiding the difficulties and complication caused by endotracheal intubation and surgical cross-field intubation. This prospective study evaluates SBA for cervical TRR.

Methods: Date was obtained from 35 patients who had cervical TRR under SBA from May 2015 to March 2019. Intravenous sedation and ultrasound-guided bilateral superficial cervical plexus block (CPB) were applied to maintain effective analgesia and sedation.

Results: Thirty-two patients with tracheal tumors and 3 patients with post-intubation tracheal stenosis underwent TRR. After the airway was opened, 29 patients resumed stable spontaneous breathing, 1 patient needed high-frequency jet ventilation, and 1 patient needed anesthesia conversion for surgical reasons.

Conclusions: Spontaneous breathing anesthesia is feasible for the cervical TRR. It can be an alternative anesthetic technique for certain patients.
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http://dx.doi.org/10.21037/jtd.2019.11.70DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988036PMC
December 2019

Nonintubated Anesthesia for Tracheal/Carinal Resection and Reconstruction.

Thorac Surg Clin 2020 Feb;30(1):83-90

Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, No.151 of Yanjiangxi Road, Yuexiu, Guangzhou, Guangdong, China. Electronic address:

Nonintubated anesthesia is feasible and might be associated with shorter surgery time and shorter hospitalization for tracheal/carinal resection and reconstruction. Only case reports and a few small retrospective series study were conducted to evaluate nonintubated anesthesia for tracheal/carinal resection and reconstruction; no randomized control trials exist. Further exploration should focus on selection of optimal candidates and prospective validation.
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http://dx.doi.org/10.1016/j.thorsurg.2019.08.007DOI Listing
February 2020

Electromagnetic navigation bronchoscopy fluorescence localization and VATS subxiphoid bilateral wedge resection under non-intubated anesthesia.

J Thorac Dis 2019 Jul;11(7):3186-3190

Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

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http://dx.doi.org/10.21037/jtd.2019.06.66DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687988PMC
July 2019

Postintubation Tracheal Stenosis: Management and Results 1993 to 2017.

Ann Thorac Surg 2019 11 9;108(5):1471-1477. Epub 2019 Jul 9.

Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address:

Background: To evaluate the management, complications of treatment, and outcomes of postintubation tracheal stenosis.

Methods: A retrospective review was performed of records from a prospective database of all patients undergoing tracheal or laryngotracheal resection from 1993 to 2017 for postintubation tracheal stenosis. Redo operations after failure of initial resection and reconstruction for postintubation tracheal stenosis were included.

Results: There were 392 patients whose ages ranged from 3 months to more than 84 years. A tracheostomy was performed in 275 as part of their care before surgery (present at time of resection in 123), dilations in 201, laser treatment in 82, T tubes in 66, and stents in 44 patients. Median length of resection was 3 cm. Laryngeal release was required in 15 of 392 (3.8%). Operative mortality was 0.8% (3 of 392); T tubes, tracheostomy present at resection, requirement for postoperative tracheostomy, and laryngeal involvement adversely impacted outcomes. Patients having tracheal resection and reconstruction had good or satisfactory outcomes in 96% (289 of 301) compared with 85% (77 of 91) having laryngotracheal resection. Complications within 30 days and at more than 30 days occurred in 116 patients and 14 patients, respectively. There were 96 anastomotic complications-68% minor (65 of 96), and 32% major (31 of 96). Necrosis of cartilage occurred in 12 patients and dehiscence in 14 patients.

Conclusions: Despite advances in care postintubation tracheal stenosis remains a challenging problem. Laryngotracheal resection and tracheostomy lead to worse outcomes. Excellent surgical results can be obtained for postintubation tracheal stenosis. Good results require careful evaluation, management of comorbid conditions, meticulous technique, minimizing tension, and preservation of blood supply.
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http://dx.doi.org/10.1016/j.athoracsur.2019.05.050DOI Listing
November 2019

New tubeless video-assisted thoracoscopic surgery for small pulmonary nodules.

Eur J Cardiothorac Surg 2017 04;51(4):689-693

Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

Objectives: Problems associated with intubation, chest drainage and urinary catheterization can have a negative impact on patient's recovery after thoracic surgery. We therefore evaluated the feasibility of a new tubeless (spontaneous ventilation without tracheal intubation, urinary catheterization, and no post-operative chest drain placement) approach to perform video-assisted thoracoscopic surgery (VATS) for small pulmonary nodules (SPN) less than 2cm in diameter.

Methods: From 1 January 2012 to 31 December 2014, 34 patients with SPNs were treated using tubeless VATS in our centre. To be eligible for this approach, the patient must have a body mass index (BMI) of less than 25; ASA grade of II or less; no history of prostate or renal disease and no parenchymal air leak at the end of surgery. All operations were performed via an anterior uniportal VATS under spontaneous ventilation without tracheal intubation.

Results: All patients [29 male:5 females; average age: 58 ± 19 years old] completed their operation under spontaneous ventilation, without conversion to endotracheal intubation. There was good operative exposure and definite diagnosis was obtained in all patients. The anaesthesia and operating time were 23 ± 3 min and 43 ± 10 min, respectively. No major intra-operative or post-operative complications were seen. Patients recovered from their anaesthesia (fully awake) within a mean time of 18 ± 3 min after surgery, and were eating 42 normally on an average of 5 ± 1 h post-operatively. No patients had pain on deep breathing or coughing (Bruggemann Comfort Score < 2). Within 24 h after surgery, 26 patients were discharged, while the remaining 8 patients were discharged on the second day. None of the patients needed re-invention with chest drainage or urinary catheterization even after discharge. All patients remained well at a median [interquartile range] follow-up time of 3[2-5] weeks.

Conclusions: Tubeless VATS approach for SPNs is feasible in carefully selected patients. Intubation, chest drainage, and/or urinary catheterization may not be necessary in all patients.
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http://dx.doi.org/10.1093/ejcts/ezw364DOI Listing
April 2017

Implementation of a novel enhanced recovery after surgery program in thoracoscopic bilateral bullectomy.

J Thorac Cardiovasc Surg 2017 05 12;153(5):e115-e118. Epub 2016 Nov 12.

Department of Thoracic Surgery, First Affiliated Hospital of Guangzhou Medical University; Guangzhou Research Institute of Respiratory Disease; and Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou, China. Electronic address:

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http://dx.doi.org/10.1016/j.jtcvs.2016.10.058DOI Listing
May 2017

Tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of chest tube postoperatively.

J Thorac Dis 2016 Aug;8(8):2226-32

Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; ; Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China.

Background: To assess the feasibility and safety of tubeless video-assisted thoracoscopic surgery (VATS) under non-intubated, intravenous anesthesia with spontaneous ventilation and no placement of a chest tube postoperatively compared with VATS under intubated anesthesia with single-lung mechanical ventilation.

Methods: A total of 91 patients undergoing tubeless VATS (60 sympathectomies, 22 bullae resections, and 9 mediastinal tumor resections) between December 2012 and December 2015 were included. Additionally, 82 patients were treated by VATS by the same team while under intubated general anesthesia (52 sympathectomies, 19 bullae resections, and 11 mediastinal tumor resections). Comprehensive early outcome data, including intraoperative and postoperative variables, were compared between the subgroups.

Results: In total, 89 patients in the tubeless group underwent an effective operation and exhibited good postoperative recovery, while 2 (one sympathectomy and one bullae resection) had their operation aborted for some reason. The tubeless group showed advantages in the postoperative fasting time, the mean duration of the postoperative hospital stay, and postoperative pain scores, while no significant difference was found in intraoperative blood loss, the operation time or postoperative complications between the tubeless group and the intubated group. Furthermore, 83% (49/59) of sympathectomies, 81% (17/21) of bullae resections, and 56% (5/9) of mediastinal tumor resections were achieved via day surgery.

Conclusions: In this study, our experience has shown that tubeless VATS is a safe and feasible surgery with certain advantages in selected patients with thoracic disease and that we can achieve day surgery in these cases.
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http://dx.doi.org/10.21037/jtd.2016.08.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999680PMC
August 2016

The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer: a propensity score matching analysis.

Eur J Cardiothorac Surg 2016 Nov 10;50(5):920-925. Epub 2016 May 10.

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Objectives: To comparatively assess the impact of non-intubated intravenous anaesthesia with spontaneous ventilation (NIIASV) versus intubated anaesthesia with single-lung mechanical ventilation (IASLV) on early outcomes of video-assisted thoracoscopic (VATS) anatomical resection of non-small-cell lung cancer (NSCLC).

Methods: A total of 339 patients with NSCLC undergoing VATS anatomical resection (282 lobectomies and 57 segmentectomies) between December 2011 and December 2014 were included for analysis and divided into two groups according to anaesthesia type: NIIASV (151 patients) and IASLV (188 patients). Comprehensive early outcome data including intraoperative and postoperative variables were compared between subgroups. Propensity score matching was used to control for selection bias due to non-random group assignment in a 1:1 manner, resulting in 136 pairs (20 for segmentectomy and 116 for lobectomy) with balanced baseline characteristics.

Results: The NIIASV procedure was completed uneventfully in all 32 patients undergoing segmentectomy and in 119 lobectomy patients undergoing lobectomy, whereas 9 lobectomy patients required conversion to IASLV. These 9 cases were excluded from the comparative analysis. Comparisons between NIIASV and IASLV results showed no intergroup differences in demographics, baseline data, operative time, intraoperative blood loss, number of resected lymph nodes and duration of chest tube dwell time. Conversely, significantly better results occurred in the NIIASV group in postoperative fasting time (P < 0.001), overall postoperative chest drainage volume (P < 0.04) and hospital stay (P < 0.02).

Conclusions: In this study, VATS anatomical resection for NSCLC patients is feasible under NIIASV. Perioperative data comparisons with IASLV have shown that postoperative fasting time, overall drainage volume and hospital stay were significantly better with NIIASV, suggesting a more rapid recovery. Further investigation is warranted to assess the long-term effects and survival of this promising globally less invasive surgical strategy.
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http://dx.doi.org/10.1093/ejcts/ezw160DOI Listing
November 2016

Video-assisted thoracoscopic surgery resection and reconstruction of thoracic trachea in the management of a tracheal neoplasm.

J Thorac Dis 2016 Mar;8(3):600-7

1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Intratracheal tumor is a rare tumor, accounting for only 2% of upper respiratory tract neoplasms. Its symptoms are similar to those of head and neck cancers, including coughing up blood, sore throat, and airway obstruction. The diagnosis of this disease is often based on the findings of fibrobronchoscopy or computed tomography (CT). Surgery remains the treatment of choice for tracheal tumor. In patients with benign neoplasms or if the tumors have limited involvement, fibrobronchoscopic resection of the tumor can be performed. For malignant tumors, however, radical resection is required. In the past, open incision is used during the surgery for tumors located in thoracic trachea. Along with advances in video-assisted thoracoscopic surgery (VATS) minimally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve the radical resection of the tumor and meanwhile dramatically reduce the injury to the patients. In this article we describe the application of VATS resection and reconstruction of trachea in the management of a tracheal neoplasm.
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http://dx.doi.org/10.21037/jtd.2016.01.60DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805830PMC
March 2016

Non-intubated resection and reconstruction of trachea for the treatment of a mass in the upper trachea.

J Thorac Dis 2016 Mar;8(3):594-9

1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Tumors of the upper trachea are typically treated by tracheal resection and reconstruction via neck incision under general anesthesia. In recent years, non-intubated thoracic surgery has been widely applied for the treatment of lung diseases due to its advantages including quick postoperative recovery. In this article, we describe the application of non-intubated tracheal resection and reconstruction in one patient for the treatment of a mass in upper trachea.
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http://dx.doi.org/10.21037/jtd.2016.01.56DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805817PMC
March 2016

Video-assisted transthoracic surgery resection of a tracheal mass and reconstruction of trachea under non-intubated anesthesia with spontaneous breathing.

J Thorac Dis 2016 Mar;8(3):575-85

1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Radical surgery for tracheal tumors is typically completed under basal anesthesia. Thus, endotracheal intubation and mechanical ventilation are required. However, these procedures may influence the surgical operation and meanwhile prolong the surgical duration and postoperative recovery. In this article we describe the application of video-assisted transthoracic surgery (VATS) resection of a tracheal mass and reconstruction of trachea a non-intubated patient with spontaneous breathing.
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http://dx.doi.org/10.21037/jtd.2016.01.62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805803PMC
March 2016

Complete video-assisted thoracoscopic surgery (VATS) bronchial sleeve lobectomy.

J Thorac Dis 2016 Mar;8(3):553-74

1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Guangzhou Research Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou 510120, China ; 3 National Centre for Clinical Trials on Respiratory Diseases, Guangzhou 510120, China ; 4 Department of Anesthesiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Background: To explore the effectiveness of video-assisted thoracoscopic surgery (VATS) bronchial sleeve resection and reconstruction.

Methods: The clinical data of patients who had received VATS bronchial sleeve lobectomy in our center from January 2008 to February 2015 were retrospectively analyzed.

Results: Totally 118 patients (105 men and 13 women) received the VATS bronchial sleeve lobectomy. The procedures included sleeve resection of right upper lobe (n=59), right middle lobe (n=7), right lower lobe (n=8), left upper lobe (n=34), and left lower lobe (n=10). The lesions were confirmed to be squamous cell carcinoma (n=68), adenocarcinoma (n=16), mucoepidermoid carcinoma (n=8), adenosquamous carcinoma (n=7), large cell carcinoma (n=1), carcinoids (n=5), and others (n=13; including small cell carcinoma, pleomorphic carcinoma, and inflammatory myofibroblastic tumor). Operations lasted 118-223 min [mean ± standard deviations (SD): 124.00±31.75 min]. The length of removed bronchus was 1.50-2.00 cm (mean ± SD: 1.75±0.26 cm). The duration of bronchial anastomosis (from the first puncture to the completion of knotting) was 15-42 min (mean ± SD: 30.20±7.97 min). The number of dissected lymph node stations (at least three mediastinal lymph node stations, including station 7) was 5-9 stations (mean ± SD: 6.50±1.18 min). The number of dissected lymph nodes was 10-46 (mean ± SD: 26.00±10.48). The intraoperative blood loss was 20-400 mL (mean ± SD: 71.00±43.95 mL), and no blood transfusion was performed. All patients were observed in intensive care unit (ICU) for 1 day. Postoperative drainage was performed for 3-8 days (mean ± SD: 5.00±1.49 days). Postoperative hospital stay was 3-8 days (mean ± SD: 5.10±2.07 days).

Conclusions: VATS bronchial sleeve resection and reconstruction is a safe and feasible technique.
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http://dx.doi.org/10.21037/jtd.2016.01.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4805843PMC
March 2016

Nonintubated uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax.

Chin J Cancer Res 2015 Apr;27(2):197-202

1 The First Clinical College, Southern Medical University, Guangzhou 510515, China ; 2 Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.

Objective: The objective of the current study was to evaluate the feasibility and safety of nonintubated uniportal video-assisted thoracoscopic surgery (VATS) for the management of primary spontaneous pneumothorax (PSP).

Methods: From November 2011 to June 2013, 32 consecutive patients with PSP were treated by nonintubated uniportal thoracoscopic bullectomy using epidural anaesthesia and sedation without endotracheal intubation. An incision 2 cm in length was made at the 6(th) intercostal space in the median axillary line. The pleural space was entered by blunt dissection for placement of a soft incision protector. Instruments were then inserted through the incision protector to perform thoracoscopic bullectomy. Data were collected within a minimum follow-up period of 10 months.

Results: The average time of surgery was 49.0 min (range, 33-65 min). No complications were recorded. The postoperative feeding time was 6 h. The mean postoperative chest tube drainage and hospital stay were 19.3 h and 41.6 h, respectively. The postoperative pain was mild for 30 patients (93.75%) and moderate for two patients (6.25%). No recurrences of pneumothorax were observed at follow-up.

Conclusions: The initial results indicated that nonintubated uniportal video-assisted thoracoscopic operations are not only technically feasible, but may also be a safe and less invasive alternative for select patients in the management of PSP. This is the first report to include the use of a nonintubated uniportal technique in VATS for such a large number of PSP cases. Further work and development of instruments are needed to define the applications and advantages of this technique.
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http://dx.doi.org/10.3978/j.issn.1000-9604.2015.03.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4409965PMC
April 2015

Safety and feasibility of video-assisted thoracoscopic surgery for stage IIIA lung cancer.

Chin J Cancer Res 2014 Aug;26(4):418-22

1 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.

Objective: The current study was prospectively designed to explore the application of video-assisted thoracoscopic surgery (VATS) radical treatment for patients with stage IIIA lung cancer, with the primary endpoints being the safety and feasibility of this operation and the second endpoints being the survival and complications after the surgery.

Methods: A total of 51 patients with radiologically or mediastinoscopically confirmed stage IIIA lung cancer underwent VATS radical treatment, during which the standard pulmonary lobectomy and mediastinal lymph node dissection were performed after pre-operative assessment. The operative time, intraoperative blood loss/complications, postoperative recovery, postoperative complications, and lymph node dissection were recorded and analyzed. This study was regarded as successful if the surgical success rate reached 90% or higher.

Results: A total of 51 patients with non-small cell lung cancer (NSCLC) were enrolled in this study from March 2009 to February 2010. The median post-operative follow-up duration was 50.5 months. Of these 51 patients, 41 (80.4%) had N2 lymph node metastases. All patients underwent the thoracoscopic surgeries, among whom 50 (98%) received pulmonary lobectomy and mediastinal lymph node dissection completely under the thoracoscope, 6 had their incisions extended to about 6 cm due to larger tumor sizes, and 1 had his surgery performed using a 12 cm small incision for handling the adhesions between lymph nodes and blood vessels. No patient was converted to conventional open thoracotomy. No perioperative death was noted. One patient received a second surgery on the second post-operative day due to large drainage (>1,000 mL), and the postoperative recovery was satisfactory. Up to 45 patients (88.2%) did not suffer from any perioperative complication, and 6 (11.8%) experienced one or more complications.

Conclusions: VATS radical treatment is a safe and feasible treatment for stage IIIA lung cancer.
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http://dx.doi.org/10.3978/j.issn.1000-9604.2014.08.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153931PMC
August 2014

Long-term survival outcomes of video-assisted thoracic surgery for patients with non-small cell lung cancer.

Chin J Cancer Res 2014 Aug;26(4):391-8

1 Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China ; 2 Department of Thoracic Surgery, Guangzhou Institute of Respiratory Diseases, Guangzhou 510120, China ; 3 Key cite of National Clinical Research Center for Respiratory Diseases, Guangzhou 510120, China.

Background: Video-assisted thoracic surgery (VATS) has been shown to be a safe alternative to conventional thoracotomy for patients with non-small cell lung cancer (NSCLC). However, popularization of this relatively novel technique has been slow, partly due to concerns about its long-term outcomes. The present study aimed to evaluate the long-term survival outcomes of patients with NSCLC after VATS, and to determine the significant prognostic factors on overall survival.

Methods: Consecutive patients diagnosed with NSCLC referred to one institution for VATS were identified from a central database. Patients were treated by either complete-VATS or assisted-VATS, as described in previous studies. A number of baseline patient characteristics, clinicopathologic data and treatment-related factors were analyzed as potential prognostic factors on overall survival.

Results: Between January 2000 and December 2007, 1,139 patients with NSCLC who underwent VATS and fulfilled a set of predetermined inclusion criteria were included for analysis. The median age of the entire group was 60 years, with 791 male patients (69%). The median 5-year overall survival for Stage I, II, III and IV disease according to the recently updated TNM classification system were 72.2%, 47.5%, 29.8% and 28.6%, respectively. Female gender, TNM stage, pT status, and type of resection were found to be significant prognostic factors on multivariate analysis.

Conclusions: VATS offers a viable alternative to conventional open thoracotomy for selected patients with clinically resectable NSCLC.
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http://dx.doi.org/10.3978/j.issn.1000-9604.2014.08.04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153938PMC
August 2014

Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study.

Surg Innov 2015 Apr 12;22(2):123-30. Epub 2014 May 12.

The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China

Objective: The purposes of this study were to evaluate the feasibility, safety, and advantages of nonintubated video-assisted thoracoscopic surgery (VATS) under epidural anesthesia, by comparing with the performance of conventional approaches.

Patients And Methods: A total of 354 patients (245 men and 109 women) were recruited in this study. The surgical procedures included bullae resection, pulmonary wedge resection, and lobectomy. The anesthetic technique (epidural vs general) was selected randomly. Patients who underwent nonintubated VATS under epidural anesthesia comprised the intervention group, and patients who received VATS under general anesthesia with double lumen tube comprised the control group.

Results: In total, 167 patients were included in the intervention group, and 180 patients were included in the control group. The 2 treatment groups of bullae resection showed significant differences in postoperative fasting time, duration of postoperative antibiotic use depending on the time when the white blood cells decreased to normal levels, and duration of postoperative hospital stay (P < .05). Nonintubated VATS is associated with a decreased level of inflammatory cytokines (P < .05).

Conclusion: VATS under anesthesia with nontracheal intubation is safe and feasible, and has demonstrated advantages, including shorter postoperative fasting time, shorter duration of antibiotic use, and shorter hospital stay, compared with VATS under general anesthesia with double lumen tube.
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http://dx.doi.org/10.1177/1553350614531662DOI Listing
April 2015

Modification of TiO2 with sulfate and phosphate for enhanced eosin Y-sensitized hydrogen evolution under visible light illumination.

Photochem Photobiol Sci 2013 Oct;12(10):1903-10

Department of Chemistry, Nanchang University, Nanchang 330031, China.

TiO2 was modified with sulfate and phosphate (denoted as S/TiO2 and P/TiO2) through a simple sulfuric or phosphoric acid treatment. A strong coordination bond forms between sulfate or phosphate and Ti(4+) of TiO2. Eosin Y (EY)-sensitized S/TiO2 and P/TiO2 (Pt as a co-catalyst and triethanolamine as a sacrificial electron donor) exhibit enhanced photocatalytic activity for hydrogen evolution under visible light illumination (λ > 420 nm) compared to that of EY-sensitized TiO2. The conduction band (CB) edges of S/TiO2 and P/TiO2 shift toward the negative, and the hydrogen bond interaction between the reduced radical EY˙-H and S/TiO2 or P/TiO2 is enhanced due to the inducing effect of the bound sulfate and phosphate. Thus, the photocatalytic hydrogen evolution is promoted. The effects of the concentration of the sulfuric or phosphoric acid as well as concentration of EY on the sensitization hydrogen evolution were investigated. The possible mechanism was discussed.
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http://dx.doi.org/10.1039/c3pp50167aDOI Listing
October 2013

Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection for non-small cell lung cancer.

Surg Innov 2014 Apr 21;21(2):180-6. Epub 2013 Jun 21.

1The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China.

Background: The purpose of the current study is to present the clinical and surgical results in patients who underwent hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection.

Methods: Thirty-one patients, 27 men and 4 women, underwent segmental-main bronchial sleeve anastomoses for non-small cell lung cancer between May 2004 and May 2011.

Results: Twenty-six (83.9%) patients had squamous cell carcinoma, and 5 patients had adenocarcinoma. Six patients were at stage IIB, 24 patients at stage IIIA, and 1 patient at stage IIIB. Secondary sleeve anastomosis was performed in 18 patients, and Y-shaped multiple sleeve anastomosis was performed in 8 patients. Single segmental bronchiole anastomosis was performed in 5 cases. The average time for chest tube removal was 5.6 days. The average length of hospital stay was 11.8 days. No anastomosis fistula developed in any of the patients. The 1-, 2-, and 3-year survival rates were 83.9%, 71.0%, and 41.9%, respectively.

Conclusion: Hybrid video-assisted thoracic surgery with segmental-main bronchial sleeve resection is a complex technique that requires training and experience, but it is an effective and safe operation for selected patients.
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http://dx.doi.org/10.1177/1553350613492026DOI Listing
April 2014

Eosin Y-sensitized graphitic carbon nitride fabricated by heating urea for visible light photocatalytic hydrogen evolution: the effect of the pyrolysis temperature of urea.

Phys Chem Chem Phys 2013 May 17;15(20):7657-65. Epub 2013 Apr 17.

Department of Chemistry, Nanchang University, Nanchang 330031, China.

Graphitic carbon nitride (g-C3N4) was prepared by pyrolysis of urea at different temperatures (450-650 °C), and characterized by thermogravimetric and differential thermal analysis (TG-DTA), elemental analysis (C/H/N), X-ray diffraction (XRD), UV-vis diffuse reflectance spectra (DRS), Brunauer-Emmett-Teller (BET) analysis, Fourier transform-infrared (FT-IR) spectroscopy, X-ray photoelectron spectroscopy (XPS), and photoluminescence (PL) spectra. The samples prepared at low temperatures (450 and 500 °C) are a mixture of g-C3N4 and impurities, whereas the samples prepared at high temperatures (550, 600 and 650 °C) should be g-C3N4 (polymeric carbon nitride). The polymerization degree of g-C3N4 for the prepared samples increases to a maximum at 600 °C with increasing pyrolysis temperature and then decreases, whereas the defect concentration changes conversely, that is, g-C3N4 prepared at 600 °C has the lowest defect concentration. Using Eosin Y (EY) and the prepared sample as the sensitizer and the matrix, respectively, the photocatalytic activity for hydrogen evolution from aqueous triethanolamine solution was investigated. The g-C3N4 prepared at 600 °C exhibits the highest sensitization activity. Under optimum conditions (1.25 × 10(-5) mol L(-1) EY and 7.0 wt% Pt), the maximal apparent quantum yield of EY-sensitized g-C3N4 prepared at 600 °C for hydrogen evolution is 18.8%. The highest activity can be attributed to the pure composition, the higher dye adsorption amount and the lowest defect concentration.
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http://dx.doi.org/10.1039/c3cp44687eDOI Listing
May 2013

Activated carbon nanoparticles or methylene blue as tracer during video-assisted thoracic surgery for lung cancer can help pathologist find the detected lymph nodes.

J Surg Oncol 2010 Nov;102(6):676-82

Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical College, Guangzhou, PR China.

Background: To assess whether using methylene blue (MB) or activated carbon nanoparticles as tracer can increase the detected number of lymph nodes in the systematic nodal dissected tissue during Video-Assisted Thoracic Surgery (VATS) for non-small cell lung cancer.

Methods: Three groups of 20 patients each were obtained from randomization of 60 patients with NSCLC requiring VATS with systematic nodal dissection (SND) from February 2007 and December 2008, there were 17, 16, and 17 patients in group A (injection activated carbon nanoparticles), group B (injection MB), and group C (controls), respectively.

Results: There was difference of the total number of dissected lymph nodes per patient among three groups (P < 0.001). The total number of dissected LNs and mediastinal nodes per patient in group A and group B was more than in group C (P < 0.001). There were 20, 18, and 14 metastatic LNs dissected in 6, 6, and 7 patients of group A, B, and C, respectively. There was difference of total number of dissected metastatic LNs per patient among three groups (P = 0.002).

Conclusions: MB can be as effective as activated carbon nanoparticles being tracer to increase the detected number of LNs in the systematic nodal dissected tissue during VATS for NSCLC.
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http://dx.doi.org/10.1002/jso.21684DOI Listing
November 2010

Video-assisted thoracoscopic surgery (VATS) for patients with solitary fibrous tumors of the pleura.

J Thorac Oncol 2010 Feb;5(2):240-3

Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, People's Republic of China.

Objectives: To present our experience of video-assisted thoracoscopic surgery (VATS) for patients with solitary fibrous tumors of the pleura (SFTPs) and to discuss the treatment of choice of such neoplasms.

Methods: Between June 2000 and September 2008, 21 patients with SFTPs (9 men and 12 women) underwent VATS at our department. The mean age was 52.5 years (range, 33-76 years).

Results: Surgical excision was performed in all patients. Surgical excision was performed by VATS in 15 patients (71.4%), by VATS plus a small thoracotomy (<5 cm) in 4 patients (19.0%), and by posterolateral thoracotomy accompanied by VATS in 2 patients (9.5%). Mean chest drain duration was 2.3 days (range, 1-4 days), and the mean hospital stay was 7.2 days (range, 4-15 days). There were 18 pathologically benign SFTP cases (85.7%) and 3 malignant SFTP cases (14.3%). There was no operative morbidity or mortality. No recurrence or metastasis of SFTPs developed during postoperative median follow-up period of 43 months.

Conclusions: Complete resection and close follow-up for years after operation is recommended for SFTPs. VATS may play an important role in reducing the size of the thoracotomy incision in the treatment of SFTPs, which results in less invasive surgery.
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http://dx.doi.org/10.1097/JTO.0b013e3181c6b6b2DOI Listing
February 2010

Feasibility Of Administering Adjuvant Chemotherapy Of Pemetrexed Followed By Pemetrexed/oxaliplatin Immediately Post-VATS In Patients With Completely Resected NSCLC.

J Thorac Dis 2009 Dec;1(1):55-62

Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangzhou Medical College; Guangzhou Research Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, PR China.

Non-small cell lung cancer (NSCLC) accounts for the largest number of cancer deaths annually, worldwide. It seems reasonable to test a less toxic regimen also in early stages after complete (R0) resection of the tumor, where reduced toxicities might improve the feasibility of drug delivery, compliance and the convenience of treatment for the patient and hence perhaps improve survival. The main purpose of this phase II trial is to evaluate the clinical feasibility-in terms of patients without dose limiting toxicities or premature treatment withdrawal or death-of administering adjuvant chemotherapy of pemetrexed followed by pemetrexed/oxaliplatin immediately post-VATS (video-assisted thoracic surgery) in patients with completely resected NSCLC.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256481PMC
December 2009

Surgical Management Of 3 Cases With Huge Tracheoesophageal Fistula With Esophagus Segment in situ As Replacement Of The Posterior Membranous Wall Of The Trachea.

J Thorac Dis 2009 Dec;1(1):39-45

Department of Cardiothoracic Surgery (Drs He, Shao, Li, Yin, and Wang), Department of Pathology (Dr Gu), the First Affiliated Hospital of Guangzhou Medical College, Guangzhou Research Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease (Drs He, Chen, Shao, Li, Yin, and Wang), Centro Hospital Conde De S. Januario (Dr Chen), Pacific Cancer Centre Singapore (Dr Tucker).

Objective: Tracheoesophageal fistula (TEF) is an uncommon and potentially life-threatening complication of blunt chest trauma. The objectives of this report are to describe our surgical experience in three patients with huge TEF and to evaluate the short-term results of surgical management in this potentially life-threatening complication of blunt chest trauma.

Methods: Three patients with huge TEF (5.2-7.0 cm in diameter) after blunt chest trauma were kept in supine position, then the neck was excided and esophagus was free, double breasted suture and clench and mutilation were performed successively over the same level of superior aperture of thorax. The thoracic esophagus was then located in situ at the membrane portion where the trachea was incomplete. Meanwhile, the stomach was then freed through a middle abdominal incision and pulled through the posterior tunnel of the sternum to the neck. Last, an anastomosis between esophagus and tubular stomach was performed over left neck.

Results: All three patients recovered well after the operation. They were able to take liquids and then solids beginning ten days after the procedure. One year post-operation, they were able to resume normal activity.

Conclusions: The surgical management of patients with huge TEF by esophageal exclusion (cervical gastroesophagostomy) and use of esophagus segment in situ as replacement of the posterior membranous wall of the trachea is feasible.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3256480PMC
December 2009