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Potdar A, Chen KC, Kuo SW, Lin MW, Liao HC, Huang PM, Lee YH, Wang HP, Han ML, Cheng CH, Hsu CH, Huang TC, Hsu FM, Lu SL, Lee JM. Prognostication and optimal criteria of circumferential margin involvement for esophageal cancer after chemoradiation and esophagectomy. Front Oncol 2023; 13:1111998. [PMID: 37503328 PMCID: PMC10369182 DOI: 10.3389/fonc.2023.1111998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/09/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose Circumferential radial margin (CRM) involvement by tumor after resection for esophageal cancer has been suggested as a significant prognostic factor. However, the prognostic value of CRM involvement after surgery with neoadjuvant concurrent chemoradiotherapy (CCRT) is unclear. This study aimed to evaluate the prognostic value of and survival outcomes in CRM involvement as defined by the Royal College of Pathologists (RCP) and the College of American Pathologists (CAP) for patients with esophageal cancer undergoing neoadjuvant CCRT and esophagectomy. Methods A total of 299 patients with esophageal cancer who underwent neoadjuvant CCRT followed by esophagectomy between 2006 and 2016 were enrolled in our study. The CRM status of the specimens obtained was determined pathologically according to both the CAP and RCP criteria. Survival analyses were performed and compared according to the two criteria. Results Positive CRM was found in 102 (34.1%) and 40 (13.3%) patients according to RCP and CAP criteria, respectively. The overall and progression-free survival rates were significantly lower in the CRM-positive group than in the CRM-negative group according to both the RCP and CAP criteria. However, under multivariate analysis, in addition to pathological T and N staging of the tumor, only CAP-defined CRM positivity was a significant prognostic factor with adjusted hazard ratios of 2.64 (1.56-4.46) and 2.25 (1.34-3.78) for overall and progression-free survival, respectively (P < 0.001). Conclusion In patients with esophageal cancer undergoing neoadjuvant CRT followed by esophagectomy, CAP-defined CRM positivity is an independent predictor of survival. Adjuvant therapy should be offered to patients with positive CRM.
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Affiliation(s)
- Ankit Potdar
- Department of Gastroenterology, Global Hospital, Mumbai, India
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shuenn-Wen Kuo
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Lun Han
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hsien Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hung Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Chen Huang
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Ming Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Lun Lu
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chen KC, Wu IH, Chang CY, Huang PM, Lin MW, Lee JM. The Long-Term Clinical Impact of Thoracic Endovascular Aortic Repair (TEVAR) for Advanced Esophageal Cancer Invading Aorta. Ann Surg Oncol 2021; 28:8374-8384. [PMID: 34085143 PMCID: PMC8591004 DOI: 10.1245/s10434-021-10081-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/10/2021] [Indexed: 12/29/2022]
Abstract
Background Advanced esophageal cancer invading the aorta is considered unsuitable for surgery with definitive chemotherapy or chemoradiation as the treatments of choice. In the current study, we evaluated the long-term clinical impact of combining thoracic endovascular aortic repair (TEVAR) with multimodality treatment in caring for such patients. Methods We evaluated 48 patients who had advanced esophageal cancer with aortic invasion. The oncological outcome, including overall survival (OS) and progression-free survival (PFS), after multimodality treatment with or without TEVAR is evaluated for these patients. Results Overall, 25/48 patients (52.1%) received a TEVAR procedure. There was no significant difference in OS (p = 0.223) between patients who did or did not receive TEVAR; however, patients who received TEVAR had significantly less local tumor recurrence (p = 0.020) and longer PFS (p = 0.019). This impact was most evident in patients who received both TEVAR and esophagectomy, with an incremental increase in hazard ratio (HR) for disease progression of 2.89 (95% confidence interval [CI] 0.86–9.96) and 4.37 (95% CI 1.33–14.33) observed under multivariable analysis, respectively, in comparison with patients who underwent only one or neither of these procedures (p = 0.005 for trend test). Conclusion TEVAR is a feasible procedure for esophageal cancers invading the aorta and can be used for curative-intent resection to improve local tumor control and PFS. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10081-3.
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Affiliation(s)
- Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Hui Wu
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chih-Yang Chang
- Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mong-Wei Lin
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Huang YH, Chen KC, Lin SH, Huang PM, Yang PW, Lee JM. Robotic-assisted single-incision gastric mobilization for minimally invasive oesophagectomy for oesophageal cancer: preliminary results. Eur J Cardiothorac Surg 2020; 58:i65-i69. [PMID: 32617584 PMCID: PMC7594190 DOI: 10.1093/ejcts/ezaa212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES With the gradual acceptance of robotic-assisted surgery to treat oesophageal cancer and the application of a single-port approach in several abdominal procedures, we adopted a single-port technique in robotic-assisted minimally invasive oesophagectomy during the abdominal phase for gastric mobilization and abdominal lymph node dissection. METHODS Robotic-assisted oesophagectomy and mediastinal lymph node dissection in the chest were followed by robotic-assisted gastric mobilization and conduit creation with abdominal lymph node dissection, which were performed via a periumbilicus single incision. The oesophagogastrostomy was accomplished either in the chest (Ivor Lewis procedure) or neck (McKeown procedure) depending on the status of the proximal resection margin. RESULTS The procedure was successfully performed on 11 patients with oesophageal cancer from January 2017 to December 2018 in our institute. No surgical or in-hospital deaths occurred, though we had one case each of anastomotic leakage, pneumonia and hiatal hernia (9%). CONCLUSIONS Robotic single-incision gastric mobilization for minimally invasive oesophagectomy for treating oesophageal cancer seems feasible. Its value in terms of perioperative outcome and long-term survival results awaits future evaluation.
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Affiliation(s)
- Yu-Han Huang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ke-Cheng Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sian-Han Lin
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Ming Huang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pei-Wen Yang
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jang-Ming Lee
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Zhang Z, Rong B, Guo M. Uniportal Thoracoscopic McKeown Esophagectomy. Indian J Surg 2020; 82:669-671. [PMID: 32419746 PMCID: PMC7223588 DOI: 10.1007/s12262-020-02096-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 02/07/2020] [Indexed: 10/26/2022] Open
Abstract
We performed the technique of uniportal thoracoscopic McKeown esophagectomy. The incision was located in the fourth intercostal space on the right axillary midline. The right recurrent laryngeal nerve lymph nodes were dissected. Four hemlocks were applied to clamp the proximal and distal ends of the aortic arch. The esophagus was suspended with purse-string at the level of the azygos vein arch to assist the dissection of the left recurrent laryngeal nerve lymph nodes. A silk thread was drawn out from the incision in order to remove the subcarinal lymph nodes. A thoracic drainage tube was placed at the back of the incision at the end.
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Affiliation(s)
- Zhenghua Zhang
- 1Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, Anhui 230001 People's Republic of China
| | - Baolin Rong
- 1Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, Anhui 230001 People's Republic of China
| | - Mingfa Guo
- 1Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Heifei, Anhui 230001 People's Republic of China.,Heifei, People's Republic of China
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van Boxel GI, Kingma BF, Voskens FJ, Ruurda JP, van Hillegersberg R. Robotic-assisted minimally invasive esophagectomy: past, present and future. J Thorac Dis 2020; 12:54-62. [PMID: 32190354 DOI: 10.21037/jtd.2019.06.75] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Esophagectomy for cancer of the esophagus is increasingly performed using minimally invasive techniques. After the introduction of minimally invasive esophagectomy (MIE) in the early 1990's, robotic-assisted techniques followed after the turn of the millennium. The advent of robotic platforms has allowed the development of robotic-assisted minimally invasive esophagectomy (RAMIE) over the past 15 years. Although recent trials have shown superior peri-operative morbidity and quality of life compared to open esophagectomy, no randomized trials have compared RAMIE to conventional MIE. This paper summarizes the current literature on RAMIE and provides an overview of expected future developments in robotic surgery.
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Affiliation(s)
- Gijsbert I van Boxel
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B Feike Kingma
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frank J Voskens
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jelle P Ruurda
- Department of Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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Hu W, Yuan Y, Chen L. Single-Port Thoracoscopic Minimally Invasive Esophagectomy for Esophageal Cancer. World J Surg 2018; 43:567-570. [PMID: 30264338 DOI: 10.1007/s00268-018-4811-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study was to explore the safety and feasibility of single-port thoracoscopic esophagectomy for esophageal cancer. METHODS The patients were placed in left lateral prone position, and a 4-cm incision through the 4th-5th intercostal space was taken on the post-axillary line. Except for a surgical wound protector, no other special instruments were used for single-port technique. The 10-mm camera and two or three thoracoscopic instruments were used for the thoracic phase. Mobilization of stomach with celiac lymph node dissection was performed via multiple-port laparoscopic approach. Cervical double-layered anastomosis was completed by hand-sewn technique. RESULTS A total of twenty-eight patients with esophageal squamous cell carcinoma underwent the single-port thoracoscopic surgery. All of the patients underwent R0 resection. The median time taken for thoracic phase and total operation time were 126 min (range, 121-153) and the 253 min (range, 197-309), respectively. The median number of resected thoracic lymph nodes was 16 (range, 12-24). There were no deaths or severe postoperative complications in this study, with no conversion of minimally invasive surgery to open procedure. CONCLUSIONS Our preliminary results demonstrate that this technique is safe and feasible for treating esophageal cancer within an acceptable length of operation time, which does not compromise the surgical radicality.
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Affiliation(s)
- Weipeng Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China.
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, China
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Lv W, Zeng G, Wu W, Wei W, Li X, Yang W. Application of single-port video-assisted thoracoscope in treating thoracic oesophageal squamous cell carcinoma using McKeown approach. J Minim Access Surg 2017; 14:105-110. [PMID: 28782745 PMCID: PMC5869968 DOI: 10.4103/jmas.jmas_36_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective: This study aims to investigate the feasibility of single-port video-assisted thoracoscope (SPVATS) in treating thoracic oesophageal squamous cell carcinoma (TESCC) using McKeown approach. Materials and Methods: Totally 10 McKeown approach-based SPVATS surgeries (8 males and 2 females, aged 42–68 years) were carried out from January 2015 to December 2015 to treat TESCC, including one case in upper thoracic segment, 5 cases in median thoracic segment and 4 cases in inferior thoracic segment. All the cases were pathologically diagnosed as SCC pre-operatively. SPVATS was performed to free thoracic oesophagus and dissect the lymph nodes, and laparoscopy was performed to free stomach and to perform oesophagus-left gastric collum anastomosis. Results: All the patients were successfully completed SPVATS, with average thoracic surgery time as 150 min, intra-operative blood loss as 30–260 ml (average 90 ml), and post-operative hospital stay as 9–16 days (average 12 days). Conclusions: SPVATS was technically feasible and safe in treating TESCC using McKeown approach, with less trauma and rapid post-operative recovery, and hence, it could be used as a new surgical option for McKeown approach-based TESCC treatment.
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Affiliation(s)
- Wenqiang Lv
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Guiqing Zeng
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Weibin Wu
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Wuzhi Wei
- Department of Thoracic and Cardiovascular Surgery, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
| | - Xiaodong Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, People's Republic of China
| | - Wenke Yang
- Department of Anesthesiology, People's Hospital of Jieyang, Jieyang 522000, People's Republic of China
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Lee JM, Chen SC, Yang SM, Tseng YF, Yang PW, Huang PM. Comparison of single- and multi-incision minimally invasive esophagectomy (MIE) for treating esophageal cancer: a propensity-matched study. Surg Endosc 2016; 31:2925-2931. [PMID: 27826778 DOI: 10.1007/s00464-016-5308-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the perioperative outcome of minimally invasive (MIE) esophagectomy performed with a single- or a multi-incision in treating esophageal cancer. METHOD Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3-4-cm incision was created in both the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients. RESULTS We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006-2015. There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (p < 0.05). There was no surgical mortality in the single-incision MIE group. CONCLUSION Minimally invasive esophagectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE.
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Affiliation(s)
- Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan.
| | - Shang-Chi Chen
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan
| | - Shun-Mao Yang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan
| | - Ying-Fan Tseng
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan
| | - Pei-Wen Yang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan
| | - Pei-Ming Huang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, 7, Chung-Shan South Road, Taipei, Taiwan
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Abstract
In the era of video-assisted thoracoscopic surgery (VATS), uniportal and single incision thoracoscopic surgeries are gaining popularity. The spectrum of uniportal VATS indications is now almost equal to that of conventional VATS. For example, successful uniportal sleeve lobectomy, rib segmental resection, and management of intraoperative bleeding have all been reported. According to published data in the English-language literature, more than 9,545 uniportal VATS have been performed to date, including 1,293 lobectomies, 1,024 procedures for pneumothorax, and 6,845 sympathectomies. Of the 192 articles discussing this topic, 35 were conducted in Spain, and there were an increasing number of publications from China, Korea, and other Asian countries. There were 41 technical and review articles, all of which provided an excellent foundation of surgical concept and skill learning. The benefits of uniportal VATS include better surgical geometry and cosmetics. Regarding postoperative outcomes, thirteen out of the 15 articles reviewed showed that uniportal VATS has similar or superior outcomes to conventional VATS. Most studies demonstrated that uniportal VATS produced less postoperative pain and paresthesia. In conclusion, uniportal VATS can produce excellent operative outcome, which is becoming a mature surgical approach in thoracic disease, supported by fast-accumulating and abundant experience.
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Affiliation(s)
- Cheng-Che Tu
- 1 Division of Thoracic Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan ; 2 Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan ; 3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Po-Kuei Hsu
- 1 Division of Thoracic Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan ; 2 Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan ; 3 School of Medicine, National Yang-Ming University, Taipei, Taiwan
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