Abstract: Cardiovascular involvement by advanced thoracic malignancies direct extension or metastasis is a group of fatal diseases with urgent conditions. Recently the technique of cardiopulmonary bypass(CPB) has been widely used in the management of advanced thoracic malignancies. The application of this technique not only extended operation indications of these diseases, but also decreased mortality, improved the quality of life and overall survival time. This paper reviewed the history, present status, indications of operation, methods of operation, postoperative complications, efficacy, evaluation and prospect of surgical management requiring CPB for advanced thoracic malignancies.
ObjectiveTo explore the necessity of routine X-ray examination after lung surgery based on patient symptom burden. MethodsA retrospective study was conducted on the patients who underwent thoracoscopic lung resection at the Department of Thoracic Surgery of Guangdong Provincial People's Hospital from March 2020 to April 2023. The routine chest X-ray examination results and symptom burden of postoperative patients were analyzed. Symptom burden was evaluated using the Perioperative Symptom Assessment Lung inventory. Results A total of 2 101 patients were collected, including 915 males and 1 100 femals, with a median age of 56 years. Among patients who underwent routine postoperative chest X-ray, only 1.0% patients accepted intervention. Among patients who had chest X-ray after chest tube removal, only 0.5% of them needed intervention. Among patients who had chest X-ray one month after discharge, only 1.3% of them required intervention. The intervention group had significantly worse shortness of breath (3 points vs. 2 points, P=0.015), pain (2 points vs. 1 point, P=0.039), and disturbed sleep (3 points vs. 2 points, P=0.036) compared with the normal group. Conclusion Very few routine postoperative chest X-ray examinations change patients’ management, and patients who need extra-intervention tended to have more severe symptom burden after surgery.
Objective To identify the potential factors for psychological burdens and to better understand how the patients’ psychological status affect their treatment preferences. Methods A questionnaire survey was conducted among 996 patients with pulmonary nodules who visited the Thoracic Surgery Clinic of Guangdong Provincial People's Hospital from January to November 2021, including 381 males and 615 females, aged 47.26±11.53 years. A self-administrated questionnaire was used to investigate the sociodemographic and clinical characteristics of the patients, and the Hospital Anxiety and Depression Scale (HADS) was used to evaluate the psychological status of the patients, with a score>7 points of each subscale indicating potential anxiety or depression. Results Among the 996 patients with pulmonary nodules, the incidence of anxiety was 42.4% and the incidence of depression was 26.4%, while the incidence of both anxiety and depression was 24.7%. There was a significant correlation between anxiety and depression (ρ=0.834, P<0.05). Age, purpose of CT examination, number of pulmonary nodules and symptoms were independent factors for anxiety, while symptoms and number of pulmonary nodules were independent factors for depression (P<0.05). For treatment preferences, there was a statistical difference in educational level, symptoms, nodule size and anxiety level (P<0.05). Conclusion Anxiety and depression are common in patients with pulmonary nodules. Symptoms are associated with anxiety and depression, which also make an impact on treatment preferences.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
ObjectiveTo explore the distribution pattern of respiratory symptoms and relevant factors in patients with pulmonary nodules. MethodsDemographic and clinical information were collected from patients who visited the Thoracic Surgery Outpatient Clinic of Guangdong Provincial People’s Hospital from January 2021 to January 2022. Hospital Anxiety and Depression Scale (HADS) was used to assess their anxiety and depression level. ResultsA total of 1173 patients were enrolled, including 449 males and 724 females, with an average age of 46.94±11.43 years. Among the patients with pulmonary nodules, 37.7% of them had at least one respiratory symptom; 24.4% had cough, 14.0% had expectoration, 1.3% had hemoptysis and 14.9% had chest pain. Old age, male, exposure to second-hand smoking or environmental smoke, hair coloring and history of tuberculosis were major risk factors for respiratory symptoms (P<0.05). Middle age, old age, male, exposure to environmental smoke were major risk factors for cough (P<0.05); old age, smoking, larger maximum nodules diameters, exposure to environmental smoke and history of pneumonia were major risk factors for expectoration (P<0.05); male, multiple nodules, hair coloring, exposure to second-hand smoking and history of tuberculosis were major risk factors for chest pain (P<0.05). Symptomatic patients showed generally higher HADS scores than asymptomatic patients (P<0.001). ConclusionCough, expectoration and chest pain are the predominant respiratory symptoms for patients with pulmonary nodules. The presentation of respiratory symptoms increases patients' anxiety and depression.
ObjectiveTo develop a symptom and function assessment scale for patients after Nuss procedure for pectus excavatum and to test its reliability and validity. MethodsFollowing the principles and procedures of patient-reported outcome (PRO) scale development stipulated by the U.S. Food and Drug Administration, an initial draft was formed through literature analysis, qualitative interviews, and Delphi expert consultation. The preliminary draft was used to conduct a pre-survey on patients who underwent Nuss procedure for pectus excavatum at Guangdong Provincial People's Hospital, and the reliability and validity of the scale were tested. ResultsA preliminary PRO-based symptom and function scale was constructed, covering two domains: symptoms and impact on daily functions. The symptom dimension includes six items: chest tightness, palpitations, pain, shortness of breath, foreign body sensation of the steel plate, and distress; while the impact on daily functions includes four items: difficulty in getting out of bed or lying down, raising arms, bending over, and standing or sitting for a long time. A total of 73 patients who underwent Nuss procedure for pectus excavatum were included in the questionnaire survey, with 70 valid questionnaires collected, including 64 males and 6 females, with 56 patients aged 12-17 years and 14 patients≥18 years. Through exploratory factor analysis, two common factors were extracted, with a cumulative variance contribution rate of 70%. The Cronbach's α coefficient of the scale is 0.917. ConclusionThe scale developed in this study has good reliability and validity, high reliability and stability, and can be used as an evaluation tool for the recovery status of patients after Nuss procedure for pectus excavatum.