Background:Recently, minimally invasive surgical modalities have become the mainstream approach for the treatment of esophageal cancer, but the incidence rate of anastomotic leak (AL) has not significantly decreased. Compared to intrathoracic anastomoses, cervical anastomotic leaks (CALs) occur at a higher rate. However, there is still a lack of consensus regarding the local management for CALs. In recent years, we have innovated an irrigation and drainage technique for patients with CALs. The aim of this article is to investigate the therapeutic effect of this novel technique. Methods:The current study was designed as a retrospective study. Patients with CALs in Shanghai Changzheng Hospital were included consecutively. Data regarding healing time (HT), frequency of dressing changes (DC), post-operative hospital stay, mortality, morbidity, as well as laboratory indicators, such as white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) were recorded. Results:The current study included a total of 53 patients with CALs. Among them, 26 patients received conventional DC treatment (DC group), while 27 patients were treated with irrigation and drainage treatment (IDT) group. IDT significantly expedited the HT of CALs (45 vs. 22 days, P<0.01), reduced the frequency of DC (2.6 vs. 1.5 times/day, P<0.01), shortened the length of post-operative hospital stay (76.5 vs. 43 days, P<0.01), and decreased the mortality rate of patients (15.4% vs. 0%, P<0.05). Additionally, the incidence of sepsis (23.1% vs. 3.7%, P<0.05) and pneumonia (30.8% vs. 7.4%, P<0.05) significantly decreased in the IDT group. Laboratory tests indicated that IDT significantly reduced the CRP and IL-6 levels on the 3rd and 7th days of treatment. Conclusions:The irrigation and drainage technique is an effective treatment for CALs and merits broad implementation within clinical practice.

Background:Esophageal malignancies have a high morbidity rate worldwide, and minimally invasive surgery has emerged as the primary approach for treating esophageal cancer. In recent years, there has been increasing discussion about the potential of employing inflatable mediastinoscopic and laparoscopic approaches as an option for esophagectomy. Building on the primary modification of the inflatable mediastinoscopic technique, we introduced a secondary modification to further minimize surgical trauma.Methods:We conducted a retrospective analysis of patients who underwent inflatable mediastinoscopy combined with laparoscopic esophagectomy at the Second Affiliated Hospital of Naval Medical University from March 2020 to March 2023. The patients were allocated to the following two groups: the traditional (primary modification) group, and the secondary modification group. Operation times, intraoperative bleeding, and postoperative complications were compared between the groups.Results:The procedure was successfully performed in all patients, and conversion to open surgery was not required in any case. There were no statistically significant differences in the surgical operation time, intraoperative bleeding, number of dissected lymph nodes, and rate of postoperative anastomotic leakage between the two groups. However, a statistically significant difference was observed in the length of the mobilized esophagus between the two groups. The mobilization of esophagus to the level of diaphragmatic hiatus via the cervical incision was successfully achieved in more patients in the secondary modification group than the primary modification group.Conclusions:Inflatable mediastinoscopy combined with single-incision plus one-port laparoscopic esophagectomy is a safe and effective surgical procedure. The use of a 5-mm flexible endoscope, ultra-long five-leaf forceps, and LigaSure Maryland forceps facilitates esophageal mobilization and lymph node dissection through a single cervical incision.

Background and objective Transcervical inflatable mediastinoscopic esophagectomy (TIME) is a novel method of minimally invasive esophagectomy (MIE) for esophageal cancer. However, whether TIME is effective and feasible as conventional MIE remains unclear. This study aimed to evaluate the efficacy of TIME by comparing it with thoracoscopic esophagectomy (TE). Methods Surgical outcomes and relapse-free survival (RFS) rates of patients with local early- or intermediate-stage thoracic esophageal squamous cell carcinoma that underwent TIME or TE from January 2017 to December 2019 were analyzed in this retrospective study. Propensity score matching was used to control the confounding factors. Results The mean operation time in TIME was shorter than that in TE (p < 0.05). Patients in the TIME group achieved postoperative ambulation earlier than those in the TE group (p < 0.05). The rate of pulmonary complications was lower in TIME than in TE (p < 0.05). The number of lymph nodes harvested during surgery and the RFS rates of two groups did not have significant differences. Conclusion TIME may be a feasible and safe method to treat local early- and intermediate-stage thoracic esophageal squamous cell carcinoma effectively and it could be a supplementary surgical method of TE for patients with poor pulmonary function or cannot undergo TE.

目的 讨论充气纵隔镜联合腹腔镜在治疗食管癌的短期随访结果.方法 回顾性分析2017年1月至2019年1月于我院接受微创食管癌根治术102例食管癌患者的临床资料.根据手术方法的不同将患者分为两组,胸腔镜组[A组,59例,其中男53例、女6例,年龄45～ 75 (63.3±7.6)岁]、单孔充气纵隔镜组[B组,43例,男35例、女8例,年龄50～ 82(66.7±6.7)岁].比较两组短期随访结果.结果 A组患者肺部感染11例(18.64％),与B组(2例,4.65％)差异有统计学意义(P＜0.05).而其它吻合口瘘等术后并发症,两组差异无统计学意义(P＞0.05).A组术后6个月、1年、2年生存率分别为96.61％、89.83％、73.33％,B组术后6个月、1年、2年生存率分别为95.35％、93.02％、79.17％,两组术后短期生存率差异无统计学意义(P＞0.05).结论 在治疗食管癌方面,充气纵隔镜联合腹腔镜术后肺部感染发生率低于传统胸腔镜联合腹腔镜手术,其它术后并发症无明显区别.两组术后短期生存率无明显差异.充气纵隔镜食管癌根治术是一种比较安全的手术方式,具有不错的短期疗效,长期疗效有待进一步检验.

OBJECTIVE:To evaluate the effect of a new negative-pressure drainage system in thoracoscopic lung cancer surgery; thereby, providing a new option for postoperative drainage.METHODS:We retrospectively analyzed data for 200 patients who underwent thoracoscopic surgery between May 2018 and October 2019. According to the thoracic drainage method, the patients were divided into the thoracic tube group and the new system group. The epidemiological and clinicopathological data were compared before operation, and the clinical effect of thoracic drainage was compared after operation.RESULTS:There was no significant difference in epidemiological and clinicopathological data between the two groups. There was also no significant difference in drain removal time, hospital stay, and complication rates between the two groups. However, the incidences of pleural effusion and poor incision healing in the new system group were lower than in the thoracic tube group. Visual analog scale (VAS) scores in the new system group were lower than those in the thoracic tube group at each postoperative interval; therefore, the new system group required less analgesia.CONCLUSION:The new system was not inferior to thoracic tubes regarding the drainage effect after thoracoscopic lung cancer surgery. Hence, the system is an alternative to traditional thoracic tubes.

Background To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique. Methods Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect. Results There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed. Conclusions Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.

Background Esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy as a safe and feasible minimally invasive technique has gained attention recently. But the occurrence of Intraoperative events is inevitable. It’s necessary to investigate and discuss the intraoperative events and countermeasures during operation. Methods Intraoperative events were retrospectively reviewed in 60 patients who underwent esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy in the recent 3 years. Results There was no perioperative death and no aortic or bronchial injury. Bronchial artery injury occurred in 2 cases (3.34%), bronchial artery combined with azygos vein hemorrhage occurred in 1 case (1.67%). The pleura were injured in 3 cases (5%). Recurrent laryngeal nerve injury was noticed in 7 cases (11.67%). Thoracic duct injury occurred in 1 case (1.67%). Conclusions As a new surgical method, esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy is considered safe and feasible, but requires improvement when compared with traditional surgical methods. Due to the influence of surgical space and with experienced surgeons, the incidence of intraoperative events such as intraoperative bleeding and thoracic duct injury is not dominant when compared with the traditional surgical methods. Thoracic surgeons should continuously improve their clinical knowledge as well as skills. Careful preoperative examination and evaluation of the patients, being familiar with the anatomical structure and various methods, wise selection of energy devices and calmly dealing with all kinds of events are the key factors for successful surgeries with fewer intraoperative events.

Abstract Background Minimally invasive esophagectomy (MIE) has been an alternative treatment for esophageal cancer. The objective of this study is to evaluate the safety and feasibility of single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy for esophageal cancer. Methods Retrospective analysis of clinical data was performed on 12 patients with esophageal cancer who underwent a single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy by one surgical team in Shanghai Changzheng hospital. Recorded outcome measures included operative time, blood loss, length of hospital stay, and perioperative complications. Results No perioperative mortality, pulmonary infection, arrhythmia, recurrent laryngeal nerve (RLN) palsy and thoracic duct injury was observed in all patients. The operative time, intraoperative blood loss and pressure of CO2 was (219 ± 9.3)min, (26.3 ± 2.7)ml and (50.5 ± 4.6)mmHg. The mean number of dissected thoracic lymph nodes was 19 ± 1.5. One patient was converted to open surgery because of massive bleeding intraoperation. Two patients occurred postoperative anastomotic leakage. Conclusion A single-port CO2-inflatabled mediastinoscopic and laparoscopic esophagectomy provides safe and feasible approach to minimally invasive esophagectomy for patients with early esophageal cancer. Disclosure All authors have declared no conflicts of interest.

Bile duct hamartoma (BDH) is a rare liver disease with a rising incidence in recent years. A retrospective study on BDH patients between June 2007 and December 2015 was conducted. All the medical records, including clinical, imaging and pathological characteristics, were retrieved. Follow-up data were obtained by telephone communication. The majority of the patients had no symptoms and the laboratory tests were normal. The appearance on ultrasound examination was variable. The lesion exhibited low density on plain computed tomography and no enhancement in 4 cases, and inhomogeneous enhancement in 1 case. Magnetic resonance imaging examination revealed hypointensity on T1-weighted imaging (WI), hyperintensity on T2WI, no enhancement in 1 case, and enhancement in 4 cases. Two patients underwent magnetic resonance cholangiopancreatography due to jaundice and intrahepatic bile duct dilation. The preoperative diagnosis was liver cancer in 4 cases, hepatic hilar biliary obstruction in 1, chronic calculous cholecystitis in 1, suspected hepatic abscess in 1, and benign liver tumor in 2 cases. All the patients underwent surgery. Nest-like cell arrangements were observed in 2 patients, and in 1 patient the lesion transformed to intrahepatic cholangiocarcinoma, resulting in the patient's death 25 months after surgery. Thus, BDH may transform into a life-threatening cholangiocarcinoma and it should be surgically removed. Furthermore, the mechanism underlying carcinogenesis in BDH requires further investigation.

Double primary liver cancer (DPLC) is a special type of clinical situation. As such, a detailed analysis of the surgical management and prognosis of patients with DPLC is lacking. The objective of the current study was to define the management and outcome of patients undergoing surgery for DPLC at a major hepatobiliary center.A total of 87 patients treated by surgical resection at the Eastern Hepatobiliary Surgery Hospital from January 1st, 2007 to October 31st, 2013 who had DPLC demonstrated by final pathological diagnosis were identified. Among these, 50 patients had complete clinical and prognostic data. Demographic and tumor characteristics as well as the prognosis were analyzed.The proportion of hepatitis B surface antigen (HBsAg) (+) and hepatitis B virus e antigen (HBeAg) (+), HBsAg (+), and HBeAg (-) hepatocirrhosis in all patients was 21.84%, 67.82%, and 63.22%, respectively. Incidental findings accounted for 58.62% of patients; among those who had symptoms, the main symptom was abdominal pain (31.03%). Nonanatomic wedge resection was the main operative approach (62.07%). Postoperatively, the main complications included seroperitoneum (11.49%), hypoproteinemia (10.34%), and pleural effusion (8.05%). Factors associated with disease-free survival (DFS) included intrahepatic cholangiocarcinoma (ICC) tumor size (P = 0.002) and use of postoperative prophylactic transcatheter arterial chemoembolization (TACE) treatment (P = 0.015). Meanwhile, hepatocellular carcinoma (HCC) size (P = 0.045), ICC size (P < 0.001), and liver function (including aspartate aminotransferase [P = 0.001] and r-glutamyl transferase [P< 0.001]) were associated with overall survival (OS).Hepatitis B virus (HBV)-related hepatitis or cirrhosis is also an important factor in the pathogenesis of DPLC and surgical treatment is safe for it with low complication rates. In addition, it is effective to prolong DFS that DPLC patients undergo postoperative prophylactic TACE treatment.

Objective To investigate the clinical efficacy of negative pressure drainage within the thoracic cavity through central venous catheters to treat pneumothorax .Methods A total of 87 patients who were admitted into our hos-pital due to pneumothorax were divided into two groups: an experiment group , in which 38 patients underwent negative pressure suction through central venous catheters , and a control group , in which traditional closed thoracic drainage with thick catheters was conducted in 49 patients.Then, lung recruitment time and pain index were evaluated .Results Pa-tients in the experimental group produced remarkably better lung recruitment time and pain index than those in the control (P<0.01).Conclusion Negative pressure suction through central venous catheters is superior to traditional closed thoracic drainage with thick catheters , which can be chosen as the first approach to treat pneumothorax .

INTRODUCTION:Repeat hepatic resection has previously been reported as the most effective treatment for recurrence of intrahepatic carcinoma. To the best of our knowledge, en bloc resection of recurrent hepatocellular carcinoma directly invading the abdominal wall has not been previously reported.CASE PRESENTATION:In September 2012, a 64-year-old Chinese male patient was referred to our hospital because of primary hepatocellular carcinoma located in Couinaud's segments III and V. Our patient first had a hepatectomy of the liver. Ten months later, he presented with an abdominal wall mass and upper abdominal pain. Computed tomography and magnetic resonance imaging scans demonstrated a 10cm tumor in his left liver with extrahepatic metastases in his abdominal wall. It was determined that he had recurrent hepatocellular carcinoma associated with direct invasion into his abdominal wall. He had an en bloc left hepatectomy with resection of the tumor in his abdominal wall. A pathological examination of the resected specimen confirmed the diagnosis of hepatocellular carcinoma involving the abdominal wall. Disease-free margins of resection were achieved. Our patient's postoperative course was uneventful. Eight months after the last surgery, our patient died owing to recurrence and distal metastasis.CONCLUSION:Direct invasion of hepatocellular carcinoma into the abdominal wall is rarely encountered. Complete surgical resection should be considered in patients with an appropriate hepatic functional reserve, with consideration of the technical difficulty relating to tumor involvement with surrounding tissues.

目的 探讨食管癌术中吻合口旁预置负压引流管治疗吻合口瘘的有效性及安全性.方法 回顾性分析2008年1月至2014年1月第二军医大学长征医院68例食管癌、贲门癌术后胸腔内吻合口瘘的临床资料.根据治疗方法的不同将患者分为3组,即吻合口旁预置负压引流管组(A组)、内镜下经鼻瘘口置入引流管组(B组)和传统治疗组(C组).结果 食管癌、贲门癌根治术胸内吻合1 251例,发生吻合口瘘68例(5.4％),死亡14例(20.6％);其中A组、B组患者死亡率少于C组,差异有统计学意义(14.3％、0 vs39.1％,P＜0.05).A组、B组重复置管次数均少于C组,差异有统计学意义(P＜0.05);A组吻合口旁预置负压引流管时间短于B组、C组(P＜0.05);A组、B组瘘口引流冲洗时间、恢复时间及胃肠减压时间短于C组,差异有统计学意义(P＜0.05).A组、C组鼻咽部明显不适感及导管堵塞发生率低于B组,差异有统计学意义(P＜0.05).除死亡患者外,各组吻合口瘘患者在经过积极治疗后均正常饮食,安全出院.结论 吻合口旁预置负压引流管对胸腔吻合口瘘的治疗效果好,可缩短患者恢复时间,降低患者死亡率,减轻患者痛苦.

Background: McKeown-type esophagectomy combined with retrosternal reconstruction is a common surgical treatment for esophageal cancer. Various enteral feeding options are available post-esophagectomy, but no definitive preference exists.Method: "Retrosternal Route Gastrostomy Feeding (RGF)" was developed as an alternative enteral feeding approach that requires few additional surgical interventions. RGF is based on McKeown-type esophagectomy. We retrospectively compared RGF (n = 121) to jejunostomy feeding (JF) (n = 153) in 274 patients at the Department of Cardiothoracic Surgery in Changzheng Hospital (Shanghai, China) between June 2008 and Sept. 2012. Data pertaining to efficacy and procedural complications were compared among patients.Results: RGF had a significantly shorter postoperative hospital stay (11 vs. 15 days, p<0.001) and time to removal of the feeding tube (9 vs. 14 days, p<0.001) compared to JF. Bowel obstruction (0.0% vs. 7.2% p = 0.003), abdominal distension (9.1% vs. 19% p = 0.022), and the occurrence of pneumonia (11.6% vs. 26.1% p = 0.003) were significantly lower in the RGF group. Feeding tube related complications and the associated morbidity rate were reduced in the RGF group. The two groups had similar tolerance to surgery.Conclusion: Our data suggests that RGF is a safe post-esophagectomy enteral feeding alternative to JF.

Background: Operative stabilization is frequently used in the clinical treatment of multiple rib fractures (MRF); however, no ideal material exists for use in this fixation. This study investigates a newly developed biodegradable plate system for the stabilization of MRF.Methods: Silk fiber-reinforced polycaprolactone (SF/PCL) plates were developed for rib fracture stabilization and studied using a canine flail chest model. Adult mongrel dogs were divided into three groups: one group received the SF/PCL plates, one group received standard clinical steel plates, and the final group did not undergo operative fracture stabilization (n = 6 for each group). Radiographic, mechanical, and histologic examination was performed to evaluate the effectiveness of the biodegradable material for the stabilization of the rib fractures.Results: No nonunion and no infections were found when using SF-PCL plates. The fracture sites collapsed in the untreated control group, leading to obvious chest wall deformity not encountered in the two groups that underwent operative stabilization.Conclusions: Our experimental study shows that the SF/PCL plate has the biocompatibility and mechanical strength suitable for fixation of MRF and is potentially ideal for the treatment of these injuries. (C) 2014 Elsevier Inc. All rights reserved.

OBJECTIVES:This study aimed to explore the incidence and causes of intra-abdominal haemorrhage after hepatectomy, indications for re-exploration, and factors affecting occurrence.METHODS:Clinical data for 77 patients (0.2% of 32 856 hepatectomy patients) submitted to re-exploration for haemorrhage following hepatectomy for primary liver cancer (PLC) from 2001 to 2010 were retrospectively reviewed and analysed for postoperative complications, potential site and cause of bleeding.RESULTS:The median interval between hepatectomy and re-exploration was 23 h in the 77 patients (range: 1 h to 11 days). Re-exploration occurred within 24 h after hepatectomy in 64 patients (83.1%), and within 8 h in 37 patients (48.1%). The most common anatomic site of intra-abdominal haemorrhage was the cut surface of the liver (n = 51, 66.2%), followed by the perihepatic ligaments (n = 19, 24.7%), the splenic fossa (n = 7, 9.1%), the diaphragm (n = 6, 7.8%), the retroperitonium (n = 6, 7.8%), the right adrenal gland (n = 3, 3.9%), and the gallbladder bed (n = 2, 2.6%). The most common form of bleeding was oozing. Early haemorrhage (at ≤ 24 h) was most likely to occur in the form of venous bleeding or oozing from the cut surface of the liver. Rates of 5-year overall and disease-free survival in the 77 patients were 22.1% and 3.9%, respectively.CONCLUSIONS:Re-exploration for haemorrhage following hepatectomy for PLC is a rare event. Haemorrhage occurs predominantly at the cut parenchymal surface. Early return to the operating room is vital and perioperative survival is common in this high-risk group.

OBJECTIVES:Palmar hyperhidrosis (PH) is a common dysfunctional disorder, with endoscopic thoracic sympathectomy (ETS) being the most popular treatment method. However, until now, there is little improvement to this technique. In this paper, we present a new alternative to the conventional surgical method. METHODS:We performed ETS with flexible thoracoscopy under deep sedation without intubation in 13 patients. All patients were followed up until today. RESULTS:During surgery, the vital signs of the patients remained stable and no intubation was necessary. The operative times ranged between 30 and 40 min. The symptom of PH disappeared postoperatively, and no complications occured. All patients were discharged from the hospital on the second postoperative day. CONCLUSIONS:ETS with flexible thoracoscopy under deep sedation without intubation is a safe and effective method.

AIM:To clarify whether histone deacetylase inhibitors histone deacetylase inhibitors (HDACIs) can sensitize hepatocellular carcinoma (HCC) cells to sorafenib treatment.METHODS:Bax, Bcl-2, ATG5-ATG12, p21, and p27 protein levels in Hep3B, HepG2, and PLC/PRF/5 cells were examined by Western blot. CCK8 and a fluorometric caspase-3 assay were used to examine cellular viability and apoptosis levels. The effect of Beclin-1 on sensitization of HCC cells to sorafenib was examined by transfecting Beclin-1 siRNA into Hep3B, HepG2, and PLC/PRF/5 cells.RESULTS:Autophagy inhibition enhances the inhibitory effects of vorinostat and sorafenib alone or in combination on HCC cell growth. Vorinostat and sorafenib synergistically induced apoptosis and cell cycle alterations. Western blot data indicated that HDACIs and Beclin-1 knockdown increased the p53 acetylation level. The knockdown of Beclin-1 enhanced the synergistic effect of the combination of vorinostat with sorafenib.CONCLUSION:HDACIs can sensitize HCC cells to sorafenib treatment by regulating the acetylation level of Beclin-1.

Objectives: At present there are numerous methods to solve nutrition after oesophagectomy but no definitive solution. In this study, we investigate a retrosternal gastrostomy route method. Methods: Between 2008 and 2012, 274 patients underwent oesophagectomy and received retrosternal gastric tube reconstruction. Patients underwent either retrosternal route gastrostomy feeding (RGF group, n = 121) or jejunostomy feeding (JF group, n = 153) placement for enteral nutrition. Results: Forty-two (15.3%) were female and the mean age of the patients was 61.7 (range 44 to 78) years. The median length of postoperative hospital stay, median time to removal of the feeding tube and the intubation time of the gastric tube of the RGF group were shorter than in the JF group (11 days vs 15 days, P < 0.001; 9 days vs 14 days, P < 0.001; 4.5 ± 2.3 days vs 8.0 ± 2.6 days, P < 0.001). The incidence of digestive system complications was lower in the RGF group compared with the JF group: bowel obstruction, 0 of 121 (0.0%) vs 11 of 153 (7.2%), P = 0.003; abdominal distension, 11 of 121 (9.1%) vs 29 of 153 (19%), P = 0.022. The mortality rates related to the feeding tube complications showed no statistical significance (P > 0.05) between groups. Although there were no statistically significant differences between the two groups in surgical complications, in a multivariate regression model the intubation time of the gastric tube was the strongest predictor for postoperative pneumonia (OR 3.26, 95% CI 1.59 to 6.66). Conclusions: RGF is a feasible and safe feeding method for patients undergoing oesophagectomy and receiving retrosternal gastric tube reconstruction.

BACKGROUND:The reconstruction of large bone defects, including rib defects, remains a challenge for surgeons. In this study, we used biodegradable polydioxanone (PDO) cages to tissue engineer ribs for the reconstruction of 4cm-long costal defects.METHODS:PDO sutures were used to weave 6cm long and 1cm diameter cages. Demineralized bone matrix (DBM) which is a xenograft was molded into cuboids and seeded with second passage bone marrow mesenchymal stem cells (BMSCs) that had been osteogenically induced. Two DBM cuboids seeded with BMSCs were put into the PDO cage and used to reconstruct the costal defects. Radiographic examination including 3D reconstruction, histologic examination and mechanical test was performed after 24 postoperative weeks.RESULTS:All the experimental subjects survived. In all groups, the PDO cage had completely degraded after 24 weeks and been replaced by fibrous tissue. Better shape and radian were achieved in PDO cages filled with DBM and BMSCs than in the other two groups (cages alone, or cages filled with acellular DBM cuboids). When the repaired ribs were subjected to an outer force, the ribs in the PDO cage/DBMs/BMSCs group kept their original shape while ribs in the other two groups deformed. In the PDO cage/DBMs/BMSCs groups, we also observed bony union at all the construct interfaces while there was no bony union observed in the other two groups. This result was also confirmed by radiographic and histologic examination.CONCLUSIONS:This study demonstrates that biodegradable PDO cage in combination with two short BMSCs/DBM cuboids can repair large rib defects. The satisfactory repair rate suggests that this might be a feasible approach for large bone repair.