Thoracic Surgery

The Department of Thoracic Surgery of Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine originated from the Department of Cardiothoracic Surgery, founded in the early 1950s by renowned professors such as Liang Qichen and Wang Yishan. In the early years of the department, surgical treatment of lung cancer, esophageal cancer and thymoma was already carried out, making it one of the earliest and most famous surgical centers for esophageal and lung surgery in China. As the department continued to develop, the Department of Cardiothoracic Surgery was further divided into two independent departments: Thoracic Surgery and Cardiovascular Surgery. Since 2014, under the leadership of Director Zhao Xiaojing, with the dedicated cooperation of team members, the scale and surgical volume of the Department of Thoracic Surgery have continued to expand. It has developed into a thoracic surgery specialty with distinctive features in diagnosis and treatment and excellent comprehensive techniques: in particular, for the diagnosis and treatment of early ground-glass lesions, strict requirements are imposed on all physicians to improve the accuracy of imaging diagnosis; the concordance rate between the preoperative diagnosis of pulmonary nodules and the postoperative pathological diagnosis reaches 95%, avoiding overtreatment and preventing the physical and psychological harm that unnecessary surgery brings to patients, reaching a nationally leading level; as the Shanghai Municipal Thoracic Surgery Specialized Training Base, the department hosts national thoracic surgery training courses and participated in compiling the thoracic surgery chapters of the national unified textbooks for higher education institutions. At present, the Department of Thoracic Surgery performs more than 3,000 operations annually and more than 700 pulmonary nodule ablations, and proficiently performs various types of lobectomy, segmentectomy, esophageal and mediastinal surgeries via thoracoscopy, single-port thoracoscopy, robot-assisted thoracoscopy and other approaches; the proportion of thoracoscopic lung cancer surgeries exceeds 95%. In the treatment of esophageal cancer, lung cancer and mediastinal tumors, the department advocates standardized diagnosis and treatment criteria; the positive detection rate for early lung cancer, the comprehensive treatment of intermediate- and advanced-stage lung cancer, and the clinical application of thoracoscopic techniques have all reached a nationally leading level. The Department of Thoracic Surgery currently has 5 chief physicians, 6 associate chief physicians, 6 attending physicians and 6 resident physicians, including 15 with doctoral degrees. Over the past five years, it has obtained 10 research projects of various types (including 4 National Natural Science Foundation grants) and published more than 40 SCI papers. Surgical situation of the department: the minimally invasive thoracoscopic rate for routine lung and esophageal surgeries exceeds 90%. 1) Lung surgeries: standard radical surgery for lung cancer, lobectomy; pneumonectomy; segmentectomy; sleeve lobectomy with bronchial and pulmonary artery plasty; lung volume reduction surgery, bulla resection, pleurodesis; resection of benign lung tumors; lung resection for pulmonary tuberculosis and bronchiectasis, lung transplantation, etc. 2) Tracheal surgeries: resection of tracheal tumors, carinal resection and plasty, second carina reconstruction. 3) Esophageal surgeries: multidisciplinary comprehensive treatment of locally advanced esophageal cancer, radical surgery for esophageal cancer and cardia cancer, gastroesophageal anastomosis; esophageal cancer resection, colon interposition for esophageal replacement; surgery for cervical esophageal cancer and high intrathoracic esophageal cancer, reoperation for esophageal anastomotic stricture; Heller's procedure; enucleation of esophageal leiomyoma; esophageal antireflux surgery; repair of esophageal rupture; resection of esophageal diverticula, etc. 4) Surgeries for diaphragmatic and mediastinal diseases: repair of traumatic diaphragmatic hernia, repair of hiatal hernia, resection of giant mediastinal tumors, thymectomy, extended thymectomy for myasthenia gravis, etc. 5) Surgeries for chest wall and pleural cavity diseases: resection of benign chest wall tumors; resection of malignant chest wall tumors with chest wall repair and reconstruction; correction of pectus excavatum; empyema debridement; decortication of the fibrous cortex in chronic empyema; resection of pleural mesothelioma, etc. Thoracic duct ligation; sympathetic trunk resection for palmar hyperhidrosis. 6) Mediastinoscopic surgery: biopsy of mediastinal tumors and lymph nodes. Clinical features: 1) Popularization of minimally invasive techniques: the proportion of radical resections for lung cancer, esophageal cancer and mediastinal tumors performed thoracoscopically has exceeded 90% of the total surgical volume, most of which are single-port thoracoscopic surgeries. Lung cancer surgeries include lobectomy, sleeve lobectomy, double-sleeve resection and segmentectomy; esophageal cancer surgeries include thoracoscopic-laparoscopic combined esophagectomy with gastric (or colonic) conduit and intrathoracic (or cervical) anastomosis; mediastinal tumor surgeries include extended thoracoscopic thymectomy via a transthoracic or subxiphoid approach, etc. In recent years, the department has carried out tubeless (non-intubated, spontaneous-breathing) single-port thoracoscopic surgery, radical esophagectomy with insufflation mediastinoscopy, and microwave and cryoablation for pulmonary nodules, further reducing surgical trauma. 2) Standardization of multidisciplinary comprehensive tumor treatment: through CT three-dimensional reconstruction, AI-assisted diagnosis, percutaneous lung biopsy, mediastinoscopy, electromagnetic navigation bronchoscopy (ENB), endobronchial ultrasound (EBUS), rapid on-site evaluation (ROSE) and other technologies, the diagnostic rate of lung cancer is improved; for early lung cancer, precise assessment is performed and individualized treatment plans are formulated to prevent overtreatment. Following the latest NCCN guidelines and the frontiers of the discipline, the department has established a thoracic oncology MDT team to steadily optimize multidisciplinary treatment protocols for advanced thoracic tumors (lung cancer, esophageal cancer, thymoma, etc.), and routinely performs preoperative neoadjuvant chemotherapy, radiotherapy, targeted therapy, immunotherapy and postoperative adjuvant therapy. 3) Routinization of highly difficult surgeries: the department routinely performs various types of carinal (or second carinal) resection and reconstruction, double-sleeve lobectomy, lung transplantation, tumor resection with vascular invasion plus artificial vessel replacement/bypass, complex cervicothoracic junction tumors, etc. Relying on the strong comprehensive strength of Renji Hospital, surgical treatment is provided for patients with other severe chronic diseases (such as uremia and rheumatic diseases), and simultaneous combined surgeries are performed with other departments, such as lung cancer combined with heart valve replacement or coronary artery bypass surgery, and simultaneous combined surgery for thoracic malignancies combined with other malignancies.