Background:The management of esophageal anastomotic fistula continues to be a significant clinical challenge in the field of esophageal surgery. With rapid advances in material science, selecting appropriate biomaterials to enhance anastomotic healing and reduce the incidence of anastomotic fistula has emerged as a promising strategy to address the issues. The aim of this study was to investigate the prevention of anastomotic fistula by reinforcing the anastomosis with suitable biomaterial patches. Methods:Forty large, healthy adult New Zealand white rabbits were randomized into the experimental group (n=20) and the control group (n=20). An animal model of cervical esophageal anastomosis was established using the esophagectomy anastomosis method. The esophageal anastomoses of the rabbits in the experimental group were completely covered with hydrogel biomaterial patches loaded with basic fibroblast growth factor (bFGF) intraoperatively. Four weeks after surgery, the incidence of anastomotic fistula was observed, and tissue samples were obtained from the esophageal anastomosis site for histologic and immunofluorescent detection. Results:An animal model of cervical esophageal incision and anastomosis was successfully established in rabbits, and the incidence of anastomotic fistula in the experimental group was lower than that in the control group at the end of the experiment (1/18 versus 7/19; P<0.05). The esophageal anastomosis tensile test showed that the anastomosis in the experimental group had higher mechanical strength than that in the control group (6.49±0.17 versus 6.33±0.12 N; P<0.05). Histological examination of the anastomotic specimens showed that the tissue layers of the esophageal anastomoses in the experimental group were clear, and fibroblast proliferation and collagen fiber secretion were greater than those in the control group. Immunofluorescence showed that fibroblast proliferation was significantly increased in the perianastomotic tissues of the experimental group compared to that of the control group. Conclusions:The application of hyaluronic acid methacrylate (HAMA) hydrogel biomaterial patches loaded with bFGF in esophageal surgery improved the mechanical strength of the esophageal anastomosis, facilitated fibroblast proliferation and collagen secretion, and could promote the growth of the tissues around the esophageal anastomosis. It may thus serve as a novel therapeutic approach for reducing the incidence of anastomotic fistula in esophageal cancer.

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.

Esophagus cancer (EC) is one of the most aggressive malignant digestive system tumors and has a high clinical incidence worldwide. Magnolol, a natural compound, has anticancer effects on many cancers, including esophageal carcinoma, but the underlying mechanism has not been fully elucidated. Here, we first find that magnolol inhibits the proliferation of esophageal carcinoma cells and enhances their autophagy activity in a dose- and time-dependent manner. This study demonstrates that magnolol increases the protein levels of LC3 II, accompanied by increased HACE1 protein levels in both esophageal carcinoma cells and xenograft tumors. HACE1-knockout (KO) cell lines are generated, and the ablation of HACE1 eliminates the anti-proliferative and autophagy-inducing effects of magnolol on esophageal carcinoma cells. Additionally, our results show that magnolol primarily promotes HACE1 expression at the transcriptional level. Therefore, this study shows that magnolol primarily exerts its antitumor effect by activating HACE1-OPTN axis-mediated autophagy. It can be considered a promising therapeutic drug for esophageal carcinoma.

Geographical differences are conspicuous in lung cancer, and the distinct molecular features of lung tumor between Western patients and Asian patients have been demonstrated. However, the etiology of non-small-cell lung cancer (NSCLC) and the distribution of associated molecular aberrations in China have not been fully elucidated. The mutational profiles of 12 lung cancer-related genes were investigated in 85 patients from eastern China and 88 patients from southern China who had been histologically confirmed NSCLC. Overall, 93.6% (162/173) of tumor samples harbored at least one somatic alteration. The most frequently mutated genes were TP53 (56.1%), EGFR (50.3%), and KRAS (14.5%). We found that EGFR mutated much more frequently (60.0% vs 40.9%, P = 0.012) and TP53 mutations had significantly lower incidence (47.1% vs 64.8%, P = 0.019) in eastern cohort than that in southern cohort. Mutational signature analysis revealed a region-related mutagenesis mechanism characterized by a high prevalence of C to T transitions mainly occurring at CpG dinucleotides in southern patients. This study reveals the difference in the mutational features between NSCLC patients in eastern and southern China. The distinct patterns of gene mutation could provide clues for the mechanism of carcinogenesis of lung cancer, offering opportunities to stratify patients into optimal treatment plans based on genomic profiles.

Abstract To explore the safety and feasibility of wireless thoracoscope in thoracic surgery. A retrospective analysis was made of all the clinical data of 90 patients with thoracoscope lung resection, from April to August 2021, Shanghai changzheng hospital thoracic minimally invasive center. Compared the thoracoscope preparation time, picture resolution, picture delay, surgeon comfort level, assistant comfort level between the wireless thoracoscope group and wired thoracoscope group. The thoracoscopic preparation time of the wireless thoracoscope group was significantly shorter than that of the wired group (26.66 ± 6.04 vs 62.14 ± 10.07, p < 0.0001). Comfort level of the surgeon (4.64 ± 0.48 vs 3.77 ± 0.42, p < 0.001) and the comfort level of the assistant (4.85 ± 0.36 vs 3.88 ± 0.32, p < 0.001) of the wireless thoracoscope group were higher than that of the wired thoracoscope group. There were no statistically significant differences in video sharpness (4.64 ± 0.48 vs 4.74 ± 0.44, p = 0.31). Although there was one case picture delay in wireless group, it was caused by low power which could be dealt with by a good charge before surgery. The wireless thoracoscope has the advantages of short preparation time, high comfort for the surgeon and the assistant, no less than the wired thoracoscope in picture resolution and picture delay. Wireless connection is more convenient and portability, which is worthy of further application in clinical practice.

Background:With the popularity of high-resolution computed tomography (HRCT), more and more pulmonary nodules are being discovered. Video-assisted thoracoscopic surgery (VATS) has become the first choice for surgical treatment of pulmonary nodules. The use of accurate preoperative localization is crucial for successful resection in VATS. At present, there are many kinds of preoperative localization methods, but there are certain disadvantages. This study aimed to evaluate the feasibility and safety of mixed reality (MR)-guided pulmonary nodules localization, which is a new method that can benefit patients to a greater extent.Methods:By constructing an animal model of pulmonary nodules localization, 28 cases of pulmonary nodules were located by MR-guided localization. We recorded the localization accuracy, localization time, insertion attempts, and incidence of complications related to localization under MR-guidance.Results:All 28 nodules were successfully located: the deviation of MR-guided localization was 5.71±2.59 mm, localization time was 8.07±1.44 min, and insertion attempts was 1. A pneumothorax and localizer dislodgement occurred in 1 case, respectively.Conclusions:Since preoperative localization is critical for VATS resection of pulmonary nodules, we investigated a new localization method. As indicated by our study, MR-guided localization of pulmonary nodules is feasible and safe, which is worthy of further research and promotion. We have also registered corresponding clinical trials to further investigate and help to improve our understanding of this technique.

Objective To investigate the safety and efficacy of glasses-free three-dimensional (3D) thoracoscopic surgery in minimally invasive esophagectomy (MIE). Methods The clinical data of 98 patients, including 81 men and 17 women aged 45–77 years, with esophageal squamous cell carcinoma who underwent minimally invasive thoracoscopic esophagectomy from January 2017 to December 2019 [3 years, with clinical follow-up time: 1 year~4 years (2017.01–2020.12)] were retrospectively analyzed. Patients were divided into two groups according to different surgical methods including a glasses-free 3D thoracoscopic group (G-3D group: 38 patients) and a two-dimesional (2D) thoracoscopic group (2D group: 60 patients). The clinical outcome of the two groups were compared. Results The operation time of the thoracoscopic part in the G-3D group was significantly shorter than that in the 2D group (P<0.05). The total number of lymph node dissection in the G-3D group was more than that in the 2D group (P<0.05). The thoracic indwelling time, postoperative hospital stay, severe pulmonary infection, arrhythmia, anastomotic leakage, chylothorax, and recurrent laryngeal nerve injury were not significantly different between the two groups (P>0.05). There was also no significant difference between the two groups on the progression-free survival (P>0.05). Conclusion Glasses-free 3D thoracoscopic surgery for esophageal cancer is a safe and effective surgical procedure. Compared with 2D thoracoscopic MIE, glasses-free 3D thoracoscopic MIE for esophageal cancer has higher safety, more lymph node dissection, and higher operation efficiency through the optimized surgical operations. We believe that glasses-free 3D thoracoscopy for MIE is worthy of clinical promotion.

56岁男性患者，体检发现胸骨占位3个月。2021年8月13日于上海长征医院胸外微创中心行混合现实技术胸骨肿瘤精准切除术，手术过程顺利，术后病理示(胸骨)软骨肉瘤。术后4天出院。现随访9个月余，患者胸廓及上肢活动好，未见复发及转移。

Background:With uniportal video-assisted thoracoscopic surgery (VATS) becoming mainstream, how to make the incision cosmetic has attracted much attention. This study aimed to introduce a new traceless method for cosmetic closure of the incision and a special procedure for chest tube fixation after uniportal VATS and to evaluate the feasibility, effectiveness, and safety of this new technique.Methods:In this retrospective study, a total of 258 consecutive patients who underwent uniportal VATS were included. Among them, 127 patients were treated with a conventional method, and 131 patients were treated with a new method.Results:Patients in the new method group had a significantly less incidence of subcutaneous emphysema after the chest tube was removed. The incidence of pneumothorax after the chest tube was removed and fat liquefaction of chest incision was not significantly different between the two groups. No differences in the incidence of pneumothorax after chest tube removal and fat liquefaction of postsurgical incision were found between the two groups. Additionally, there was also no significant difference in follow-up items.Conclusions:Taken together, our results showed that this new method for minimally invasive incision closure and chest tube fixation after uniportal VATS was as feasible, effective, and safe as the conventional one but more cosmetic.

BackgroundIt still remains unclear whether subxiphoid video-assisted thoracoscopic surgery (SVATS) thymectomy is safe and reasonable. This meta-analysis aims at assessing the effectiveness and safety of SVATS for thymoma in comparison with that of intercostal video-assisted thoracoscopic surgery (IVATS) thymectomy.MethodsAll the relevant data systematically analyzed in this thesis were retrieved from PubMed, the Cochrane Library, web of science, EMBASE, and ClinicalTrials.gov. The time span for data retrieval was from the date of database establishment to March 2022. The outcome indicators include operation time, intraoperative blood loss, duration of postoperative drainage, postoperative hospital days, visual analogue scale (VAS) score on the day of operation, VAS score on postoperative day 3, and VAS score on postoperative day 7; postoperative complications were analyzed in our meta-analysis.ResultsIn 13 studies of this paper, there were 1,198 cases included. Among them, 563 cases were treated by SVATS thymectomy and 635 cases by IVATS thymectomy. There was no significant difference in the operation time [113.38 vs. 119.91 min, 95% confidence interval (CI): −0.70–0.15, p = 0.20) and the incidence of intraoperative and postoperative complications (RR = 0.82, 95% CI: 0.58–1.15, p = 0.25) between SVATS thymectomy and IVATS thymectomy. However, SVATS thymectomy significantly reduced the amount of intraoperative blood loss (47.68 vs. 66.69 mL, SMD = −0.57, 95% CI: −0.95 to −0.18, p = 0.004), postoperative drainage days (2.12 vs. 2.72 days, SMD = −0.46, 95% CI: −0.74 to −0.18, p = 0.001), postoperative hospital stays (4.53 vs. 5.91 days, SMD = −0.64, 95% CI: −0.96 to −0.31, p = 0.0001), and VAS scores after the operation.DiscussionSVATS thymectomy is safe and feasible, and the perioperative effect is better than IVATS thymectomy to a certain extent, which is worthy of popularization and further research.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/

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.

混合现实(MR)技术是继虚拟现实(VR)、增强现实(AR)技术之后出现的新型数字全息影像技术,将现实世界与虚拟世界融合在一起,形成的一种新的可视化环境.目前MR技术已被应用于各种领域,但在医学领域中的应用尚处于探索阶段.随着数字时代的迅猛发展,MR技术和医学的结合前景无限,相信未来MR技术会在医学培训、疾病诊断、医患沟通、临床诊疗等方面带来颠覆性的变化.本文将MR技术在医学中的应用进行综述.

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.

BACKGROUND:It still remains unclear whether three-dimension (3D) video-assisted thoracoscopic surgery (VATS) for esophageal cancer is safe and reasonable. This meta-analysis aims at assessing the effectiveness and safety of 3D VATS for esophageal cancer in comparison with that of two-dimension (2D) VATS.METHODS:All the relevant data systematically analyzed in this thesis is from PubMed, Embase, The Cochrane Library, Web of Science and clinicaltrials.gov, and the time span for retrieval is from the date of the database establishment to February 2021. The research on the efficacy and safety of 3D VATS for esophageal cancer and 2D VATS is consistent with our meta-analysis. Continuous variables and dichotomy variables are compared using odds ratio, average or standard average differences with 95% confidence interval (95% CI), and P values, respectively.RESULTS:In five studies of this paper, there were 553 patients in total (3D VATS group, n=266 and 2D VATS group, n=287). Patients in the 3D group had shorter operation time [standardized mean difference (SMD) =-0.99, 95% CI: -1.66 to -0.32; P=0.004], and less bleeding (SMD =-0.88, 95% CI: -1.66 to -0.10; P=0.03) than those in the 2D group. The total amount of dissected lymph node and post-operative complications in the 2D group and the 3D group were nearly the same, showing no significant difference.DISCUSSION:The results of this meta-analysis showed that 3D VATS for esophageal cancer will be more applied and developed in the future.REGISTRATION NUMBER OF PROSPERO:CRD42021238863.

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.

Central precocious puberty (CPP), largely caused by germline mutations in the MKRN3 gene, has been epidemiologically linked to cancers. MKRN3 is frequently mutated in non-small cell lung cancers (NSCLCs) with five cohorts. Genomic MKRN3 aberrations are significantly enriched in NSCLC samples harboring oncogenic KRAS mutations. Low MKRN3 expression levels correlate with poor patient survival. Reconstitution of MKRN3 in MKRN3-inactivated NSCLC cells directly abrogates in vitro and in vivo tumor growth and proliferation. MKRN3 knockout mice are susceptible to urethane-induced lung cancer, and lung cell-specific knockout of endogenous MKRN3 accelerates NSCLC tumorigenesis in vivo. A mass spectrometry-based proteomics screen identified PABPC1 as a major substrate for MKRN3. The tumor suppressor function of MKRN3 is dependent on its E3 ligase activity, and MKRN3 missense mutations identified in patients substantially compromise MKRN3-mediated PABPC1 ubiquitination. Furthermore, MKRN3 modulates cell proliferation through PABPC1 nonproteolytic ubiquitination and subsequently, PABPC1-mediated global protein synthesis. Our integrated approaches demonstrate that the CPP-associated gene MKRN3 is a tumor suppressor.

目的 探讨3D单孔充气式纵隔镜联合腹腔镜食管癌根治术的安全性和有效性.方法 回顾性分析2018年6月至2019年6月我科收治的28例实施单孔充气式纵隔镜联合腹腔镜食管癌根治术的食管鳞状细胞癌患者的临床资料,其中男25例、女3例,年龄51 ～ 76岁.根据手术方法不同,将患者分为两组,即3D纵隔镜组(3D组,10例)和2D纵隔镜组(2D组,18例).比较两组近期疗效.结果 3D组手术时间明显短于2D组(P=0.017)、清扫淋巴结数目多于2D组(P=0.005)、出血量少于2D组(P=0.015),差异均有统计学意义.两组在主刀医师眩晕感及视觉重影方面差异无统计学意义(P＞0.05).两组在颈部引流管置管时问、术后住院时间、肺部感染、心律失常、吻合口瘘、喉返神经损伤等方面差异无统计学意义(P＞0.05).结论 3D充气式纵隔镜联合腹腔镜食管癌根治术优化了2D操作,实践中是安全、可行的,可以作为未来的一种术式去尝试.

BACKGROUND:To evaluate the safety and efficacy of single incision plus one (SI+1) port three-dimensional (3D) laparoscopic minimally invasive esophagectomy (MIE).METHODS:Clinical data of patients who underwent 3D thoracic laparoscopic MIE in our department from September 2020 to March 2021 were analyzed retrospectively. According to the different methods of laparoscopic surgery, the patients were divided into 2 groups: SI+1 port 3D laparoscopy group and multiportal 3D laparoscopy group. The operation time of the 3D laparoscopy component, amount of intraoperative blood loss, number of celiac lymph node dissections, postoperative abdominal drainage days, postoperative total abdominal drainage, postoperative complications, and length of hospital stay were analyzed.RESULTS:There was no significant difference between the 2 methods in laparoscopic operation time (30.11±5.86 vs. 28.45±4.72 min, P=0.49), intraoperative blood loss (34.44±9.82 vs. 35.91±6.25 mL, P=0.69), number of celiac lymph node dissections (8.44±3.13 vs. 7.09±2.12, P=0.27), postoperative abdominal drainage days (3.11±0.33 vs. 3.00±0.00 days, P=0.28), postoperative total abdominal drainage (95.00±23.33 vs. 92.27±11.26 mL, P=0.74), postoperative complications (22.2% vs. 27.3%, P=0.33), and hospital stay (9.67±0.71 vs. 10.18±0.87 days, P=0.17). None of the patients enrolled in the study had recurrence or death to date.CONCLUSIONS:The application of SI+1 port 3D laparoscopy in minimally invasive resection of esophageal carcinoma is safe and feasible.

目的 探讨裸眼3D胸腔镜在微创食管癌根治术中的安全性及有效性.方法 回顾性分析2018年10月至2019年4月于我院接受微创食管癌根治术的65例食管癌患者的临床资料,其中男50例、女15例,年龄47～72岁.根据手术方法将患者分为两组,即裸眼3D胸腔镜组(A组,30例)、传统2D胸腔镜组(B组,35例).比较两组临床效果.结果 A组手术时间明显短于B组(P＜0.05),A组清扫淋巴结数目多于B组(P＜0.05),术后第1～3 d胸腔引流量A组多于B组,差异有统计学意义(P＜0.05),术后第4～5d胸腔引流量差异无统计学意义(P＞0.05),术后胸腔引流管置管时间A组长于B组,差异有统计学意义(P＜0.05);两组在术后住院时间、肺部感染、心律失常、吻合口瘘、喉返神经损伤等方面差异无统计学意义(P＞0.05).结论 应用裸眼3D胸腔镜实施微创食管癌根治术是一种安全、有效的手术方式,与传统的2D胸腔镜微创手术相比,其在术中的安全性更高,清扫淋巴结更加彻底,手术效率更高,值得推广.