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Introduction: Mediastinal lymph node (MLN) removal by video-assisted mediastinoscopic lymphadenectomy (VAMLA) for preoperative cancer staging was reported to be associated with increased survival. The aim of this study was to evaluate the immunologic effects of complete MLN removal by VAMLA on cytotoxic T lymphocyte (CTL) phenotype and function. Methods: Seventeen patients with non-small cell lung cancer (NSCLC) (stage cT1-4N0-3M0-1A) and 20 healthy participants were included in this study. Blood samples were collected before and 4 weeks after the procedure. Lymphocytes were isolated from the removed MLNs. CTL phenotypes and functions were evaluated by flow cytometry. Plasma levels of soluble programmed cell death protein 1 (sPD-1), soluble programmed cell death protein 1 ligand, and soluble CTL antigen 4 (sCTLA-4) were measured with enzyme-linked immunosorbent assay. Results: The ratio of the immunosenescent CTLs (CD3+CD8+CD28−) was increased in peripheral blood and MLNs of the patients with NSCLC compared to controls ( p = 0.037), and MLN removal did not change this ratio. PD-1 and CTL antigen 4 expressions were significantly reduced in peripheral blood CTLs after MLN removal by VAMLA ( p = 0.01 and p = 0.01, respectively). Granzyme A expression was significantly reduced in the peripheral blood CTLs of the patients compared to controls ( p = 0.006) and MLN removal by VAMLA significantly improved Granzyme A expression in CTLs ( p = 0.003). Plasma concentrations of sPD-1 and sCTLA-4 remained unchanged after VAMLA. Conclusion: CTLs in the MLNs and peripheral blood of the patients with NSCLC had an immunosenescent phenotype, increased immune checkpoint receptor expression, and impaired cytotoxicity. MLN removal by VAMLA improved these phenotypic and functional characteristics of CTLs. These changes may explain the potential contribution of VAMLA to improved survival.

Background The management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis. Objective We tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis. Methods We made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis. Results We had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p < 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy. Conclusion Age, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.

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, were retrospectively collected. Operative strategies, duration of postoperative drainage, postoperative hospital stay, complications and follow-up data were recorded. Simple bronchoplasty or angioplasty without any sleeve resection was excluded in this study. Result: 14 of the 69 patients received neoadjuvant chemotherapy because of N2 disease. Nine underwent bronchial and arterial sleeve lobectomy (double sleeve resection), 6 bronchial sleeve resection and partial resection of pulmonary arterial wall (angioplasty), 2 arterial sleeve resection and partial resection of bronchial wall (bronchoplasty), 2 arterial sleeve resection only, 50 bronchial sleeve resection only., Simple sleeve resection was achieved in 57 cases, and extended sleeve resection in 12 cases. Of the extended cases, two were classified as Okada type B, 2 Okada type C, 5 Okada type D, 2 with complex anastomosis between left main stem bronchus with superior and basal bronchus, 1 with anastomosis between trachea and right middle lobe bronchus. There was 1 perioperative death (1.4%), which was highly suspected of myocardial infarction. There was neither anastomotic fistula nor symptomatic stricture, which needed treatment thereof. Surgical margin status was R0 in 50 patients (72.5%), R1 in 18 patients (26.1%), and R2 in 1 patient (1.5%). The median time of postoperative drainage was 7 days (3-33 days), median time of postoperative hospital stay was 11 days (6-39 days). Major complications occurred in 14 patients (21.5%), including 2 with chylothorax, 7 pneumonia, 3 pleural effusion, 1 air leak, 1 heart failure. Atelectasis necessitated endoscopic sputum clearance in 16 patients. Pathology showed squamous cell carcinoma in 50 patients, adenocarcinoma in 16, adenosquamous carcinoma in 2, and large cell carcinoma in 1 patient. Two patients were in stage IA2, 2 in stage IA3, 12 stage IB, 2 stage IIA, 34 stage IIB, 12 stage IIIA，and 5 stage IIIB. The median follow-up duration was 14 months (0-25months), with the follow-up rate of 97.1%. All patients are alive except for one death. The localrecurrent rate was 1.4% (1/69), and the distant metastasis rate was 7.2% (5/69). Conclusion: Sleeve lobectomy is a safe and reasonable procedure for surgical treatment of centrally located non-small-cell lung cancer. It has the advantages of expanding operation indication, avoiding pneumonectomy, preserving more pulmonary function, and improving postoperative quality of life.