Is Traditional Closed Thoracic Drainage Necessary to Treat Pleural Tears After Posterior Approach Thoracic Spine Surgery?

Whether the infracardiac bursa protect right pleura during laparoscopic radical operation of Siewert type II adenocarcinoma of esophagogastric junction?

BACKGROUND

Transthoracic single-port assisted laparoscopic five-step maneuver inferior mediastinal lymphadenectomy for Siewert type II adenocarcinoma of esophagogastric junction (AEG) has superiority in lower mediastinal lymph nodes dissection and digestive tract reconstruction. However, the right pleura was probably ruptured in this surgical technique. The aim of this study was to explore whether the infracardiac bursa (ICB) exposed could protect right pleura.

METHODS

We retrospectively collected and evaluated the clinical and pathological data of patients who underwent five-step maneuver of transthoracic single-port assisted laparoscopic lower mediastinal lymphadenectomy for Siewert II AEG at Guangdong Provincial Hospital of Chinese Medicine between May 2017 and February 2022.

RESULTS

A total of 49 patients were eligible, including 31 patients in ICB exposed group (group A) and 18 patients in ICB unexposed group (group B). There were no statistically significant differences in baseline characteristics between the two groups. 4 patients (12.9%) had right pleura rupture in group A, while 14 patients (77.8%) in group B, and the difference was statistically significant (p < 0.001). Compared with group B, the extubation time of endotracheal intubation (10.0 (6.0 ~ 12.0) vs. 13.0 (8.0 ~ 15.0) min, p = 0.003) and thoracic drainage tube stay (6.0 (5.0 ~ 7.0) vs. 8.0 (6.0 ~ 10.5) days, p = 0.041) were significantly shorted in the group A. The drainage volume of thorax (351.61 ± 125.00 vs. 418.61 ± 207.86 mL, p = 0.146) was non-significant less and the rate of complications (3.2% vs. 11.1%, p = 0.074) was non-significant lower in group A compared with group B. The postoperative hospital stay (9.0 (8.0,13.0) vs. 9.0 (8.0,12.0) days, p = 0.983) were similar in two groups. No serious adverse event occurred in any patient.

CONCLUSIONS

The ICB exposed could protect the right pleura and may promote postoperative recovery, which may be used as an anatomical marker in inferior mediastinal lymphadenectomy.

The emergence of new prognostic scores in lung cancer patients with spinal metastasis: A 12-year single-center retrospective study

Objective: Lung cancer patients exhibit spinal metastases from a specific population, and with this study, we aimed to develop a model that can predict this particular group's survival.

Methods: Data were retrospectively collected from 83 lung cancer patients who underwent spinal metastasis surgery at our center from 2009 to 2021. After the initial assessment of treatment and scoring effects, a nomogram for survival prediction was created by identifying and integrating critical prognostic factors, followed by a consistency index (C-index) to measure consistency, and finally, a subject working characteristic curve (ROC) to compare the predictive accuracy of the three existing models.

Results: The mean postoperative survival was 14.7 months. Surgical treatment significantly improved the VAS and Frankel scores in lung cancer patients with spinal metastases. The revised Tokuhashi score underestimated the life expectancy of these patients. Six independent prognostic factors, including age, extraspinal bone metastasis foci, visceral metastasis, Frankel score, targeted therapy, and radiotherapy, were identified and incorporated into the model. Calibration curves for 3-, 6-, and 12-month overall survival showed a good concordance between predicted and actual risk. The nomogram C-index for the cohort study was 0.800 (95% confidence interval [CI]: 0.757-0.843). Model comparisons showed that the nomogram's prediction accuracy was better than revised Tokuhashi and Bauer's scoring systems.

Conclusions: Spine surgery offered patients the possibility of regaining neurological function. Having identified shortcomings in existing scoring systems, we have recreated and validated a new nomogram that can be used to predict survival outcomes in patients with spinal metastases from lung cancer, thereby assisting spinal surgeons in making surgical decisions and personalizing treatment for these patients.

Is closed thoracic drainage tube necessary for minimally invasive thoracoscopic-esophagectomy?

Background

Closed thoracic drainage tube (CTDT) is a conventional treatment after esophagectomy, even after minimally invasive esophagectomy. Here, we report a single-center, retrospective study to explore the safety and necessity of CTDT after thoracoscopic-esophagectomy.

Methods

From October 2015 and August 2016, 50 patients were enrolled and underwent thoracoscopic-esophagectomy in semi-prone position by same surgical team. Perioperative demographic and surgical parameters, and patients' satisfaction with or without CTDT after thoracoscopic-esophagectomy were collected and analyzed.

Results

All eligible patients (18 patients without CTDT and 32 patients with CTDT) were successfully underwent thoracoscopic procedures without conversion to open approach or major intraoperative complications and perioperative death. The two groups, with similar demographic parameters, had no statistically difference in thoracic operation time, blood loss, ICU stay, postoperative mobilization and oral feeding, and hospital stay. Also, the incidence of postoperative complications was similar with or without CTDT after esophagectomy. But, no-CTDT group had better post-operative satisfaction, including less pain scale scoring and better Norton scoring.

Conclusions

This study demonstrated that the treatment of no-CTDT after the minimally invasive thoracoscopic-esophagectomy is safe and feasible, might reduce the work intensity of medical stuff and lead to a better patients' experience.