[Difference of Lung Function Retention after Segmentectomy and Lobectomy]

Analysis of perioperative complications and related risk factors of thoracotomy and complete video-assisted thoracoscopic surgery lobectomy

OBJECTIVE

To evaluate the perioperative complications and related risk factors of thoracotomy and complete video-assisted thoracoscopic surgery (c-VATS) lobectomy.

METHODS

A total of 93 patients with early lung cancer (LC) treated in our hospital from Mar. 2017 to Mar. 2021 were retrospectively enrolled. Among them, 45 patients underwent conventional thoracotomy lobectomy was classified as the control group (Con group, n=45) and other 48 patients underwent c-VATS lobectomy was classified as the observation group (Obs group, n=48). Surgical indicators of the two groups were compared, and the changes of Visual Analog Scale (VAS) score, plasma levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6), and pulmonary function indexes were compared before and after operation. Additionally, postoperative complications were compared between the two groups. Multivariate logistic regression was carried out to analyse the independent risk factors for postoperative complications.

RESULTS

The Obs group showed significantly less intraoperative blood loss than the Con group and experienced significantly shorter operation time than the Con group (both P<0.001). The Obs group had significantly lower VAS scores than the Con group at 1 day and 7 days after surgery (P<0.05), and showed significantly lower levels of plasma IL-6 and VEGF than the Con group (both P<0.001). In addition, higher forced vital capacity (FVC) and maximum ventilation per minute (MVV) were found in the Obs group than in the Con group (P<0.001), and the Obs group showed a significantly lower incidence of postoperative complications than the Con group (P<0.05). Multivariate logistic regression analysis revealed that age, body mass index (BMI) and operation mode were independent risk factors for postoperative complications.

CONCLUSION

Compared with conventional thoracotomy, c-VATS lobectomy brings a lower incidence of postoperative complications, and age, BMI and operation mode were independent risk factors for postoperative complications.

[Correlation Analysis of the Lung Volume Reduction and the Lung Function Loss after the Thoracoscopic Lobectomy]

BACKGROUND

To investigate the correlation between the reduction of lung volume and the degree of lung function damage after lobectomy.

METHODS

A total of 131 patients (72 males and 59 females) who underwent thoracoscopic lobectomy in the First Affiliated Hospital of Suzhou University from January 2019 to July 2020 (including thoracoscopic resection of left upper lobe, left lower lobe, right upper lobe, right middle lobe and right lower lobe). In order to compare the difference between postoperative pulmonary function and preoperative pulmonary function, the pulmonary function measurements were recorded at 7 days before operation, and 3 months, 6 months and 1 year after operation. Forced expiratory volume in 1 second (FEV1) was used as the main evaluation parameter of pulmonary function. The original lung volume and the remaining lung volume at each stage were calculated by Mimics Research 19.0 software. The correlation between lung volume and lung function was analyzed.

RESULTS

FEV1 in postoperative patients was lower than that before operation, and the degree of decline was positively correlated with the resection volume of lung lobes (the maximum value was shown in the left lower lobe group). Significantly, there was no significant difference in the degree of pulmonary function reduction between 3 months, 6 months and 1 year after operation.

CONCLUSIONS

The decrease of lung tissue volume after lobectomy is the main reason for the decrease of lung function, especially in the left lower lobe. And 3 months after lobectomy can be selected as the evaluation node of residual lung function.

Effect of BRAF-mediated PI3K/Akt/mTOR pathway on biological characteristics and chemosensitivity of NSCLC A549/DDP cells

The present study aimed to explore the biological characteristics of non-small cell lung cancer (NSCLC) cells and the mechanism of chemosensitivity through the role of the PI3K/Akt/mTOR signaling pathway mediated by BRAF gene silencing. Following cell transfection and grouping, an MTT assay detected the activity of NSCLC cells, a scratch wound test assessed the migration ability, flow cytometry using PI staining detected the cell cycle phase, TUNEL and flow cytometry through Annexin V-PI staining assessed the apoptosis, and colony formation was used to detect the sensitivity of lung cancer cells to cisplatin chemotherapy. Furthermore, the relative expression levels of BRAF, PTEN, PI3K, mTOR mRNA were assessed by RT-qPCR, and the protein expression levels of BRAF, PTEN, PI3K, phosphorylated (p)-PI3K, Akt, p-Akt, mTOR, p-mTOR, cisplatin resistance-related enzymes ERCC1 and BRCA1, apoptotic proteins Bax and Bcl-2 were assessed by western blotting. Compared with the control group and NC group, there were differences in decreased BRAF mRNA expression levels in the small interfering (si)BRAF group and siBRAF + IGF-1 group (both P<0.05). In addition, compared with the control group, the siBRAF, NVP-BEZ235 and siBRAF + NVP-BEZ235 groups had significant decreased cell viability at 2–6 days, decreased migration ability, shortened proportion of S-phase cells, increased proportion of G₁/G₀-phase cells, increased apoptosis rate, decreased number of colony-forming cells, decreased mRNA expression of PI3K, Akt and mTOR, increased PTEN mRNA expression, decreased protein expression levels of PI3K, p-PI3K, Akt, p-Akt, mTOR, p-mTOR, ERCC1, BRCA1 and Bcl-2, and increased protein expression levels of PTEN and Bax (all P<0.05); and more obvious trends were revealed in the siBRAF + NVP-BEZ235 group (all P<0.05); whereas opposite results were detected in the siBRAF + IGF-1 group when compared with the siBRAF group and NVP-BEZ235 group (all P<0.05). Silencing of BRAF gene expression to inhibit the activation of the PI3K/Akt/mTOR signaling pathway exerted a synergistic effect decreasing cell viability, inhibiting the cell cycle and migration, increasing the apoptosis rate, decreasing the number of colony-forming cells and increasing chemosensitivity of NSCLC. Activation of the PI3K/Akt/mTOR signaling pathway may reverse the role of silencing of BRAF gene expression, providing a potential approach for improving the chemosensitivity of NSCLC. The present study for the first time, to the best of our knowledge, clarified the possible mechanism of NSCLC cell biological characteristic changes and chemosensitivity from the perspective of BRAF gene silencing and PI3K/Akt/mTOR signaling pathway activation, providing a potential reference for suppressing tumor aggravation and improving the therapeutic outcomes of NSCLC at the genetic level.