RESUMEN
BACKGROUND This study aimed to compare the application value of intraoperative fluorescence navigation technology (FNT) and intraoperative ultrasound (IOUS) in primary liver cancer surgery. MATERIAL AND METHODS Fifty consecutive patients with primary liver cancer scheduled to receive surgical treatment were divided into FNT group and IOUS group. FNT and IOUS were separately used to guide tumor resection and detect new cancerous lesions in the 2 groups. The complete tumor resection rate (R0) resection rate, length of the tumor distance from cutting edge, the diagnostic efficacy of cancerous nodules and the fluorescence imaging characteristics of different types tumors were recorded. RESULTS The R0 resection rate was 100% (25 out of 25 patients) in the FNT group and 96% (24 out of 25 patients) in the IOUS group. In the FNT group, 1 case (4%, 1 out of 25 patients) had cancer tissue that was less than 1 cm from the cutting edge, compared to 7 cases (28%, 7 out of 25 patients) in the IOUS group (P=0.049), which was a significant difference. In the remaining livers of 50 consecutive patients, FNT found 5 new cancerous nodules with a sensitivity of 71.4%, a specificity of 11.1%, and a false-positive rate of 88.9%; for IOUS the results were 42.9%, 88.9%, 11.1%. The fluorescence imaging characteristics of all well-differentiated hepatocellular carcinomas were tumor tissue imaging, but all other types of tumors were ring imaging around the tumor. CONCLUSIONS FNT can improve the R0 resection rate, ensure a safe distance between tumor and cutting edge and can identify more new cancerous nodules compared to IOUS. Thus, FNT could improve the surgical treatment effect for primary liver cancer and hopefully further improve the prognosis of patients.
Asunto(s)
Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Monitoreo Intraoperatorio/métodos , Adulto , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/cirugía , Colangiocarcinoma/diagnóstico por imagen , Colangiocarcinoma/cirugía , Medios de Contraste , Femenino , Fluorescencia , Hepatectomía/métodos , Humanos , Verde de Indocianina , Cuidados Intraoperatorios , Hígado/patología , Masculino , Persona de Mediana Edad , Ultrasonografía Intervencional/métodosRESUMEN
PURPOSE: The aim of this study was to assess the incidence of pulmonary thromboembolism (PTE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and to evaluate the efficacy and safety of low-dose urokinase (UK) thrombolysis therapy when treating hemodynamically stable AECOPD patients with acute PTE (AECOPD-PTE). METHODS: A total of 419 AECOPD patients, including 96 AECOPD-PTE, were enrolled. A total of 30 AECOPD-PTE patients were collected retrospectively, and 66 AECOPD-PTE patients were prospectively divided into anticoagulation-only, low-dose UK and standard-dose UK groups. Follow-up 1 year, we evaluated the efficacy and safety of low-dose UK therapy for hemodynamically stable AECOPD-PTE patients. RESULTS: The incidence of PTE in AECOPD patients was 22.9% (96/419), which increased with COPD severity degree ranging from 3.5% (2/57) in mild, 13.6% (19/140) in moderate and 33.8% (75/222) in severe subgroups (P < .05). In the prospective study, the total effective rate of low-dose UK group 97.2% (35/36) was higher than that in anticoagulation 75.0% (12/16) and standard-dose UK group 78.6% (11/14) respectively (P < .05). In the follow-up, the adverse events rate in low-dose UK group 8.3% (3/36) was significantly lower than that in anticoagulation group 25.0% (4/16) and standard-dose UK group 71.4% (10/14) respectively (P < .05). In addition, the mean PTE recurrence time of low-dose UK group (9.0 ± 0) months was longer than anticoagulation group (2.0 ± 1.41) months (P < .05). AECOPD relapse time in anticoagulation, low-dose UK and standard-dose UK groups corresponding to (8.5 ± 2.12), (9.0 ± 0) and (8.8 ± 3.40) months were compared with no significant difference (P > .05). CONCLUSIONS: The incidence of PTE in AECOPD patients was 22.9%, especially with higher occurrence rate in severe COPD. Compared with anticoagulation-only therapy, low-dose UK treatment (500 000 IU/day for 5-7 days) could obtain a better efficacy and safety in hemodynamically stable AECOPD patients with acute PTE, corresponding with a higher effective rate (97.2%) and lower adverse events rate (8.3%) respectively.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Embolia Pulmonar/epidemiología , Activador de Plasminógeno de Tipo Uroquinasa/farmacología , Anciano , Anticoagulantes/farmacología , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/metabolismo , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Activador de Plasminógeno de Tipo Uroquinasa/administración & dosificaciónRESUMEN
PURPOSE: Delaying adjuvant chemotherapy initiation >8 weeks after radical lobectomy for non-small cell lung cancer (NSCLC) adversely affects overall survival. The effect of video-assisted thoracoscopic lobectomy (VATS) on adjuvant chemotherapy initiation is yet unclear. This study aimed to determine if using VATS for NSCLC resection affected the timing of adjuvant chemotherapy and oncological outcomes. METHODS: Patients who underwent radical lobectomy for pathological stage II or IIIA NSCLC and received adjuvant chemotherapy between January 2009 and January 2016 were identified from a prospectively maintained lung cancer database. Patients were categorized according to surgical approach: open lobectomy or VATS. Patient demographics, clinicopathological data, postoperative complications, time from radical lobectomy to adjuvant chemotherapy initiation, and long-term survival outcomes were compared. RESULTS: Age, gender, American Society of Anesthesiologists (ASA) class, comorbidity, TNM stage, and postoperative complications were similar between VATS and open cases; however, length of stay was shorter in VATS cases. No difference was observed in the proportion of patients who received adjuvant chemotherapy >8 weeks after radical lobectomy between the two groups. In the open group, a delay in adjuvant chemotherapy after radical lobectomy was associated with decreased overall survival (OS) and disease-free survival (DFS). However, delay in chemotherapy did not affect OS or DFS in the VATS group. CONCLUSIONS: The benefits of quicker recovery after VATS did not result in earlier adjuvant chemotherapy initiation in this retrospective study. However, VATS negated the inferior oncologic outcomes associated with delayed adjuvant chemotherapy initiation.