Ya‐Fu Cheng

Changhua Christian Hospital

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Bing‐Yen Wang

National Chung Hsing University

Wei‐Heng Hung

Changhua Christian Hospital

Chang‐Lun Huang

Changhua Christian Hospital

Ching‐Yuan Cheng

Changhua Christian Hospital

Yi‐Ling Chen

Changhua Christian Hospital

Heng‐Chung Chen

Changhua Christian Hospital

Chia‐Chi Liu

Changhua Christian Hospital

Ching‐Hsiung Lin

Changhua Christian Hospital

Jing‐Yang Huang

Chung Shan Medical University

Pei-Cing Ke

Changhua Christian Hospital

Cooperative Institutions

Changhua Christian Hospital

Chung Shan Medical University

National Chung Hsing University

National Yang Ming Chiao Tung University

Kaohsiung Medical University

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Koo Foundation Sun Yat-Sen Cancer Center

Chang Jung Christian University

National Taiwan University Hospital

National Tsing Hua University

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Role of respiratory secretion culture in surgical outcome prediction of bacterial empyema

Research Square (Research Square) (2023)

Chia‐Chi Liu Ya‐Fu Cheng Yi‐Ling Chen Ching‐Yuan Cheng Chang‐Lun Huang

Abstract Background: Thoracic empyema is a serious infectious disease worldwide. Video-assisted thoracoscopic surgery is strongly recommended as a treatment, and pleural fluid and tissue cultures can be obtained intraoperatively. The combination of a pleural peels tissue culture and a pleural fluid culture improves the positive culture rate. We aimed to investigate the role of respiratory secretion cultures to determine the optimal management for improving surgical outcome. Methods: This retrospective study identified 1197 patients with phase II or III thoracic empyema from our institution. Patients who underwent decortication of the pleura from April 2011 to May 2022 with a positive pleural culture were included. Results: There were 225 empyema patients with either a positive pleural fluid culture or a positive pleural peel tissue culture. Of these, 76 patients had positive respiratory secretion culture findings during hospitalization. The most common species of pathogens were Pseudomonas aeruginosa (44%), Klebsiella pneumoniae (16%), and Staphylococcus aureus (10%) in the respiratory secretion cultures and Streptococcus spp. (38%), Klebsiella pneumoniae (12%), and Staphylococcus aureus (11%) in the pleural cultures. There were 30 patients who had a common pathogen in a respiratory secretion culture and in the pleural fluid/tissue culture. Poor outcome measures were found in these patients, including the longer use of antibiotics preoperatively (19.03 ± 37.66 days versus 9.59 ± 27.09 days, p = 0.006) and a higher mortality rate during hospitalization (40.0% versus 17.4%, p = 0.002). Conclusions: The respiratory secretion culture plays an essential role in prediction of surgical outcome in bacterial empyema. Obtaining the respiratory secretion specimen promptly through proper methods helps to improve the survival of empyema patients.

Decortication

Microbiological culture

10.21203/rs.3.rs-3722145/v1

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Tricuspid valve infective endocarditis complicated with multiple lung abscesses and thoracic empyema as different pathogens: a case report

Journal of Cardiothoracic Surgery (2019)

Ya‐Fu Cheng Yung‐Kun Hsieh Bing‐Yen Wang Ching-Yugn Cheng Chang‐Lun Huang

Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare. We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle. The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.

Infective Endocarditis

Cardiothoracic surgery

Lung abscess

10.1186/s13019-019-0867-1

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Citations (7)

A RARE CONGENITAL PULMONARY MALFORMATION – PULMONARY SEQUESTRATION: A CASE REPORT

CHEST Journal (2019)

Ya‐Fu Cheng H.C. Chen

10.1016/j.chest.2019.02.169

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Comparison of extended segmentectomy with traditional segmentectomy for stage I lung cancer

Journal of Cardiothoracic Surgery (2022)

Ya‐Fu Cheng Yueh-Che Hsieh Yu‐Jun Chang Ching‐Yuan Cheng Chang‐Lun Huang

For stage I non-small cell lung cancer (NSCLC), lobectomy and segmentectomy are still controversial operations. Extended segmentectomy was proposed to make larger safe margins than segmentectomy. Image-guided video-assisted thoracoscopic surgery (iVATS) is useful to accomplish extended segmentectomy. We aimed to compare the effects of iVATS extended segmentectomy to the effects of traditional segmentectomy for stage I NSCLC.This study is a retrospective analysis in a single institute. Patients with stage I NSCLC who received segmentectomy between January 2017 and September 2020 were included. Patients were distributed to iVATS extended segmentectomy (group A), and traditional segmentectomy (group B). The impacts of the different surgical methods on resection margin were assessed.There were 116 patients enrolled in this study. Sixty-two patients distributed in group A, and the other 54 patients in group B. The resection margin to a staple line was 17.94 mm in group A versus 14.15 mm in group B, p = 0.037. The margin/tumor diameter ratio was 2.08 in group A versus 1.39 in group B, p = 0.003. The enough margin rate was 75.81% and 57.41%, respectively, for group A and group B. The subgroup analysis of iVATS extended segmentectomy showed that T1a lesions had larger margin distances than did T1b lesions (19.85 mm vs. 14.83 mm, p = 0.026).The iVATS extended segmentectomy can provide more resection margin than traditional segmentectomy. Segmentectomy is more suitable to perform when the nodule's diameter is less than 10 mm.

Cardiothoracic surgery

10.1186/s13019-022-01771-4

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Esophageal squamous cell carcinoma and prognosis in Taiwan

Cancer Medicine (2018)

Ya‐Fu Cheng Hui‐Shan Chen Shiao‐Chi Wu Heng‐Chung Chen Wei‐Heng Hung

Abstract The prognosis of esophageal squamous cell carcinoma is poor. In order to find out appropriate treatment for each group of patients, we aim to examine the prognostic factors influencing survival for esophageal cancer patients in Taiwan. Data were obtained from the Taiwan Society of Cancer Registry. There were 14,394 esophageal cancer patients analyzed between 2008 and 2014 in this retrospective review. The impact of the clinicopathologic factors on overall survival was assessed. The following clinic‐pathologic factors were included to analyses: age, sex, tumor location, tumor length, histologic grade, clinical T, clinical N, clinical M, clinical stage, and all therapeutic methods within 3 months after diagnosis. The 5‐year survival rate was 16.8%, with a median survival of 343 days. The distribution of patients by their clinical stage is as follows: stage 0 ( n = 162; 1.1%); stage I ( n = 964; 6.7%); stage II ( n = 2392; 16.6%); stage III ( n = 6636; 46.1%); and stage IV ( n = 3661; 25.4%). In the multivariate analysis, age, sex, tumor location, tumor length, clinical T, clinical N, clinical M, and treatment remained independent prognostic factors. Our data indicated that age, sex, tumor location, tumor length, clinical T, clinical N, clinical M, and treatment remained independent prognostic factors. Patients who could receive surgery had significantly better outcomes.

10.1002/cam4.1499

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Optimal Timing for Video-Assisted Thoracic Surgery Decortication in Chronic Empyema: A survival analysis

Research Square (Research Square) (2024)

Ching-Min Lin Yi‐Ling Chen Ya‐Fu Cheng Ching‐Yuan Cheng Chang‐Lun Huang

Abstract Background Video-assisted thoracic surgery decortication for phase 3 thoracic empyema is widely accepted, but the optimal timing for such surgical intervention has not been established. We aim to investigate and assess the optimal decortication timing, in terms of overall survival, for chronic empyema. Methods 204 patients with pneumonia-caused phase 3 empyema were treated with video-assisted thoracic surgery decortication over 10 years at Changhua Christian Hospital. The 90-day post-operative survival status was analyzed, and we compared the survivor group versus the non-survivor group. A receiver operating characteristic curve was used to identify the optimal decortication timing. Results A comparison of characteristics between survivors and non-survivors showed statistical differences among age, presence of cardiovascular disease, presence of end-stage renal disease, duration to surgery, length of intensive care unit stay, and overall length of hospital stay. Receiver operating characteristic curve analysis determined the cut-off for video-assisted thoracic surgery decortication, based on optimal 90-day post-operative survival, to be 7.5 days after hospitalization; mortality increases threefold thereafter. Multivariate analysis revealed that age, end-stage renal disease, pleural effusion pH ≦ 7.2 and duration to surgery > 7.5 days negatively impacted 90-day post-operative survival. Conclusions Patients who underwent decortication surgery within 7.5 days of hospital admission had better overall survival.

Decortication

Cardiothoracic surgery

Video-assisted thoracoscopic surgery

10.21203/rs.3.rs-4147121/v1

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Clinical Outcome of Intraoperative Recurrent Laryngeal Nerve Monitoring during Thoracoscopic Esophagectomy and Mediastinal Lymph Node Dissection for Esophageal Cancer

Journal of Clinical Medicine (2022)

Chang‐Lun Huang Chun‐Min Chen Wei‐Heng Hung Ya‐Fu Cheng Ruei-Ping Hong

Mediastinal lymph dissection in esophagectomy for patients with esophageal cancer is important. The dissection of recurrent laryngeal nerve (RLN) lymph nodes could cause RLN injury, vocal cord palsy, pneumonia, and respiratory failure. This retrospective study aimed to evaluate the effects of intraoperative RLN monitoring in esophagectomy and mediastinal lymph node dissection in preventing RLN injury and vocal cord palsy. This study included 75 patients who underwent minimally invasive esophagectomy and mediastinal lymph node dissection for esophageal cancer with (38 patients) and without (37 patients) IONM at Changhua Christian Hospital from 2015 to 2020. The surgical and clinical outcomes were reviewed. Patients in the IONM group had more advanced clinical T status, shorter operation time (570 vs. 633 min, p = 0.007), and less blood loss (100 mL vs. 150 mL, p = 0.019). The IONM group had significantly less postoperative vocal palsy (10.5% vs. 37.8%, p = 0.006) and pneumonia (13.2% vs. 37.8%, p = 0.014) than that in the non-IONM group. IONM was an independent factor for less postoperative vocal cord palsy that was related to postoperative 2-year survival. This study demonstrated that IONM could reduce the incidence of postoperative vocal cord palsy and pneumonia.

Esophagectomy

Vocal Cord Paralysis

Aspiration Pneumonia

10.3390/jcm11174949

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The perioperative outcomes of uniport versus two-port and three-port video-assisted thoracoscopic surgery in lung cancer: a systematic review and meta-analysis

Journal of Cardiothoracic Surgery (2022)

Ya‐Fu Cheng Chang‐Lun Huang Wei‐Heng Hung Ching‐Yuan Cheng Bing‐Yen Wang

Abstract Background Uniport video-assisted thoracoscopic surgery (VATS) has been applied widely for the treatment of lung cancer in recent years. Some studies have reported that uniport VATS might provide better outcomes than multiport VATS. However, the perioperative outcomes of uniport VATS compared with two-port and three-port VATS, respectively, have yet to be studied at a comprehensive scale. This meta-analysis study compares the perioperative efficacy among uniport, two-port, and three-port VATS. Methods We searched studies published before October 1, 2019, by using Web of Science databases, Ovid Medline, Embase, and PubMed. Studies that compared uniport VATS with two-port or three-port VATS for patients with lung cancer were included. Operative time, perioperative blood loss, number of lymph nodes retrieved, conversion rate, duration of postoperative chest tube drainage, length of hospital stay (LoS), visual analogue pain scores on postoperative day (POD) 1 and POD 3, and overall morbidity were evaluated. Results Sixteen studies that compared uniport VATS with two-port or three-port VATS in the treatment of lung cancer were included. Uniport VATS showed less blood loss, a shorter duration of postoperative drainage and a lower visual analogue pain score on POD 3 than two-port VATS; it showed a shorter duration of postoperative drainage, a shorter LoS, and lower visual analogue pain scores on POD 1 and POD 3 than three-port VATS. There were no significant differences in the number of lymph nodes retrieved, operative time, conversion rate, and overall morbidity rate when comparing uniport VATS with two-port VATS or three-port VATS. Conclusions Uniport VATS might provide better perioperative outcomes than either two-port or three-port VATS in lung cancer treatment.

Video-assisted thoracoscopic surgery

Port (circuit theory)

Cardiothoracic surgery

10.1186/s13019-022-02034-y

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Citations (21)

Propensity score analysis comparing survival between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy in patients with esophageal squamous cell carcinoma

PLoS ONE (2022)

Yi-Lin Chang Ya‐Fu Cheng Hui‐Shan Chen Siao-Chi Wu Wei‐Heng Hung

The purpose of the current study is to compare definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy in patients with cT1-3/N0-3 esophageal squamous cell carcinoma in survival.Records from 2008 to 2014 of 4931 patients with clinical T1-3/N0-3 esophageal squamous cell carcinoma receiving definitive chemoradiotherapy or esophagectomy with adjuvant chemoradiotherapy were obtained from the Taiwan Cancer Registry. Univariable and multivariable analyses were performed and propensity score matching was used to minimize the bias. Overall survival was compared between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy, and also in the three different clinical stages.Definitive chemoradiotherapy was performed on 4381 patients, and 550 patients received esophagectomy adjuvant chemoradiotherapy. Each group produced 456 patients for comparison after propensity score matching. The 1-year, 2-year, and 3-year overall survival rates for matched patients in with definitive chemoradiotherapy group were 57.18%, 31.92%, and 23.8%. The 1-year, 2-year, and 3-year overall survival rates for matched patients treated in the esophagectomy with adjuvant chemoradiotherapy group were 72.35%, 45.74%, and 34.04%(p<0.0001). In multivariable analysis, treatment modality was an independent prognostic factor. Esophagectomy with adjuvant chemoradiotherapy provided better survival outcome than definitive chemoradiotherapy for patients with clinical stage II/III disease. As for patients with clinical stage I disease, there was no significant survival difference between definitive chemoradiotherapy and esophagectomy with adjuvant chemoradiotherapy.Esophagectomy with adjuvant chemoradiotherapy provided better survival than definitive chemoradiotherapy in clinical II/III esophageal squamous cell carcinoma. However, more data are needed to conduct a convincing conclusion in clinical stage I patients.

Esophagectomy

Chemoradiotherapy

10.1371/journal.pone.0271338

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Culture-Positive and Culture-Negative Empyema After Thoracoscopic Decortication: A Comparison of Short-term and Long-term Outcomes

Open Forum Infectious Diseases (2023)

Ya‐Fu Cheng Yi‐Ling Chen Ching‐Yuan Cheng Chang‐Lun Huang Wei‐Heng Hung

Empyema thoracis is a serious infectious disease and is associated with high morbidity and mortality. The perioperative outcomes between culture-positive and culture-negative empyema after thoracoscopic decortication remained controversial, especially since there were no studies that reported the survival outcomes between culture-positive and culture-negative empyema.This single-institute study involved a retrospective analysis. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. Patients were grouped into a culture-positive group and a culture-negative group according to culture results obtained no later than 2 weeks after surgery.A total of 1087 patients with empyema received surgery, and 824 were enrolled after exclusion. Among these, 366 patients showed positive culture results and 458 patients showed negative results. Longer intensive care unit stays (11.69 vs 5.64 days, P < .001), longer ventilator usage (24.70 vs 14.01 days, P = .002), and longer postoperative hospital stays (40.83 vs 28.37 days, P < .001) were observed in the culture-positive group. However, there was no significant difference in 30-day mortality between the 2 groups (5.2% in culture negative vs 5.0% in culture positive, P = .913). The 2-year survival was not significantly different between the 2 groups (P = .236).Patients with culture-positive or culture-negative empyema who underwent thoracoscopic decortication showed similar short-term and long-term survival outcomes. A higher risk of death was associated with advanced age, a higher Charlson Comorbidity Index score, phase III empyema, and a cause other than pneumonia.

Decortication

Thoracoscopy

10.1093/ofid/ofad227

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