Retrospective study on the effect of intraoperative flushing treatment with nocardia rubra cell-wall skeleton on drainage after radical surgery of lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YE Guanzhi , XU Zhenyang , ZHU Xiaolei , LIU Hongming , LI Ning ,  JIANG Jie ,  GENG Guojun

Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding?author：

JIANG Jie, Email: jiangjie06@126.com; GENG Guojun, Email: ggj622@126.com

Keywords：

Nocardia rubra cell-wall skeleton; chest fluid drainage volume; radical surgery of lung cancer

DOI：

10.7507/1007-4848.202507051

Video：

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Objective To evaluate the efficacy and safety of intraoperative pleural irrigation with nocardia rubra cell-wall skeleton (N-CWS) for reducing pleural effusion drainage after radical surgery for lung cancer. Methods A retrospective analysis was conducted on the clinical data of lung cancer patients who underwent lobectomy and mediastinal lymph node dissection at the First Affiliated Hospital of Xiamen University between December 2024 and May 2025. Patients were divided into a control group and an irrigation group based on the intraoperative use of N-CWS. Patients in the irrigation group received pleural irrigation with 800 μg of N-CWS diluted in 10 mL of normal saline. The following outcomes were compared between the two groups: pleural effusion drainage volume at 0-24 h, 24-48 h, and 48-72 h postoperatively; degree of air leak; chest tube duration; postoperative length of stay; and the incidence of adverse events (fever, chest pain, and vomiting). Results A total of 245 patients were included (97 males, 148 females) with a mean age of (61.28±6.26) years, with 205 in the control group and 40 in the irrigation group. Compared to the control group, the irrigation group showed significantly lower pleural effusion drainage volumes at 0-24 h, 24-48 h, and 48-72 h, as well as shorter chest tube duration and postoperative length of stay (all P<0.05). There was no significant difference in the degree of postoperative air leak (P=0.801). No significant differences were observed between the two groups regarding the highest body temperature within 72 h post-surgery (P=0.130), fever grade (P=0.450), severity of chest pain (P=0.138), or the incidence of nausea and vomiting (P=0.376). Conclusion Intraoperative pleural irrigation with N-CWS in patients undergoing lobectomy and mediastinal lymph node dissection for lung cancer can significantly reduce postoperative pleural effusion drainage volume, shorten chest tube duration, and decrease the length of hospital stay. The procedure is safe and feasible.

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3.	倪爽, 路子蘊, 孫行, 等. 快速康復病房腔鏡下肺結節切除術患者術后肺部并發癥危險因素分析[J]. 南京醫科大學學報(自然科學版), 2025, 45(1): 48-55.Shuang Ni, Ziyun Lu, Xing Sun, et al. Analysis of risk factors for postoperative pulmonary complications in patients undergoing laparoscopic pulmonary nodule resection in the rapid recovery ward[J]. Journal of Nanjing Medical University (Natural Science Edition), 2025, 45(1): 48-55. ).
4.	Greif B, ?gajnar J, ?tupnik T. Impact of chest tube type on pain, drainage efficacy, and short-term treatment outcome following video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial comparing coaxial silicone drains and standard polyvinyl chloride drains. J Thorac Dis. 2025, 17(2): 932-943.
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7.	肖曉輝, 雷豐豐, 劉華, 等. 內科胸腔鏡下碘伏胸膜固定術治療肺癌伴惡性胸腔積液[J]. 湖北民族大學學報(醫學版), 2020, 37(1): 99-101.Xiaohui Xiao, Fengfeng Lei, Hua Liu, et al. Internal medicine thoracoscopic iodine fixation for the treatment of lung cancer with malignant pleural effusion[J]. Journal of Hubei University for Nationalities (Medical Edition), 2020, 37(1): 99-101. ).
8.	Shinno Y, Kage H, Chino H, et al. Old age and underlying interstitial abnormalities are risk factors for development of ARDS after pleurodesis using limited amount of large particle size talc. Respirology. 2018, 23(1): 55-59.
9.	魏萍, 張川林, 陳志斌. 紅色諾卡氏菌細胞壁骨架對70例肺癌惡性胸腔積液患者近遠期預后的影響[J]. 廣州醫科大學學報, 2018(6): 53-56.Ping Wei, Chuanlin Zhang, Zhibin Chen. The effect of red Nocardia cell wall skeleton on the short- and long-term prognosis of 70 patients with malignant pleural effusion caused by lung cancer[J]. Journal of Guangzhou Medical University, 2018(6): 53-56. ).
10.	Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol. 2023, 12: 961440.
11.	吳燦興, 胡樹橋, 馬駿, 等. 肺癌術后肺部并發癥的預測因素分析[J]. 中華胸部外科電子雜志, 2019, 6(4): 229-233.Canxing Wu, Shuqiao Hu, Jun Ma, et al. Predictive factors analysis of postoperative pulmonary complications in lung cancer[J]. Chinese Journal of Thoracic Surgery, 2019, 6(4): 229-233. ).
12.	Yusa J, Tanaka K, Sata Y, et al. Predictors of intraoperative and postoperative air leakage in anatomical pulmonary resection. Surg Today. 2025. doi: 10.1007/s00595-025-03004-2. Epub ahead of print.
13.	Boira I, Galán Negrillo M, Ga?án Boscá A. Acute respiratory distress syndrome secondary to talc pleurodesis. Med Clin (Barc). 2023, 161(9): 411-412.
14.	Samadi Takaldani AH, Javanshir N, Negaresh M, et al. A Case of Acute Respiratory Distress Syndrome Following Pleurodesis With Talc. Clin Med Insights Case Rep. 2023, 16: 11795476231170196.
15.	Terra RM, da Costa PB, Dela Vega AJM, et al. Adverse events after pleurodesis in patients with malignant pleural effusion. J Thorac Dis. 2020, 12(7): 3507-3513.
16.	Zhang W, Zhao YL, Li SJ, et al. Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: a meta-analysis. J Cardiothorac Surg. 2021, 16(1): 125-132.
17.	Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018, 198(7): 839-849.
18.	Stayner LT, Carreón-Valencia T, Demers PA, et al. Carcinogenicity of talc and acrylonitrile. Lancet Oncol. 2024, 25(8): 962-963.
19.	Mohammed SM, Al-Saedi HFS, Mohammed AQ, et al. Mechanisms of Bleomycin-induced Lung Fibrosis: A Review of Therapeutic Targets and Approaches. Cell Biochem Biophys. 2024, 82(3): 1845-1870.
20.	張邵丞, 高學軍. 非小細胞肺癌患者術后持續性肺漏氣的研究進展[J]. 醫藥前沿, 2022, 12(35): 37-40.Shaocheng Zhang, Xuejun Gao. Research progress on persistent postoperative lung gas leakage in non-small cell lung cancer patients[J]. Frontiers of Medicine, 2022, 12(35): 37-40. ).
21.	徐冰南, 金亞彬, 李枚格. 外用紅色諾卡氏菌細胞壁骨架制劑(Nr-CWS)治療宮頸上皮內瘤變患者人乳頭瘤病毒宮頸持續感染的臨床療效分析[J]. 婦產與遺傳(電子版), 2022, 12(01): 38-41.Bingnan Xu, Yabin Jin, Meige Li. Clinical efficacy analysis of external application of red Nocardia cell wall scaffold preparation (Nr-CWS) in the treatment of persistent human papillomavirus cervical infection in patients with cervical intraepithelial neoplasia[J]. Obstetrics and Gynecology and Genetics (Electronic Version), 2022, 12(01): 38-41. ).
22.	Li Q, Guo L, Wang J, et al. Exosomes derived from Nr-CWS pretreated MSCs facilitate diabetic wound healing by promoting angiogenesis via the circIARS1/miR-4782-5p/VEGFA axis. Chin J Nat Med. 2023, 21(3): 172-184.
23.	聞丹丹, 李強, 沈才齊, 等. 外用紅色諾卡氏菌細胞壁骨架提高脂肪間充質干細胞活性修復糖尿病創面[J]. 中國組織工程研究, 2022, 26(07): 1038-1044.Dandan Wen, Qiang Li, Caiqi Shen, et al. External application of Nocardia rubrum cell wall skeleton improves the activity of adipose derived mesenchymal stem cells to repair diabetes wounds[J]. China Tissue Engineering Research, 2022, 26(07): 1038-1044. ).
24.	Hu K, Xu Y, Li X, et al. The Nocardia Rubra Cell Wall Skeleton Regulates Macrophages and Promotes Wound Healing. Curr Issues Mol Biol. 2022, 44(12): 5995-6005.
25.	Wang Y, Hu Y, Ma B, et al. Nocardia rubra cell wall skeleton accelerates cutaneous wound healing by enhancing macrophage activation and angiogenesis. J Int Med Res. 2018, 46(6): 2398-2409.
26.	齊利, 陳巖. 紅色諾卡氏菌細胞壁骨架胸腔內注射治療惡性胸腔積液的臨床效果[J]. 中國實用醫刊, 2019, 46(20): 104-106.Li Qi, Yan Chen. Clinical effect of intrathoracic injection of red Nocardia cell wall skeleton in the treatment of malignant pleural effusion[J]. Chinese Journal of Practical Medicine, 2019, 46(20): 104-106. ).
27.	楊珊, 張文進, 曹淼, 等. 紅色諾卡菌細胞壁骨架術中沖洗創面影響乳腺癌術后引流量的前瞻性研究[J]. 中國實用外科雜志, 2022, 42(08): 932-935.Shan Yang, Wenjin Zhang, Miao Cao, et al. A prospective study on the effect of intraoperative washing of wound surface of Nocardia rubrum cell wall skeleton on postoperative drainage of breast cancer[J]. Chinese Journal of Practical Surgery, 2022, 42(08): 932-935. ).
28.	王曉楠, 郭瑞霞, 邱海峰, 等. 外用紅色諾卡氏菌細胞壁骨架治療高危型HPV持續感染伴或不伴低級別鱗狀上皮內病變臨床療效的前瞻性研究[J]. 中國婦產科臨床雜志, 2024, 25(2): 155-159.Xiaonan Wang, Ruixia Guo, Haifeng Qiu, et al. Prospective study on the clinical efficacy of topical application of red Nocardia cell wall cytoskeleton in the treatment of persistent high-risk HPV infection with or without low-grade squamous intraepithelial lesions[J]. Chinese Journal of Obstetrics and Gynecology, 2024, 25(2): 155-159. ).
29.	Shen C, Wei W, Zhang A, et al. External application of a Nocardia rubra cell wall skeleton in the treatment of diabetic foot ulcers. Chinese Journal of Plastic and Reconstructive Surgery, 2022, 4(1): 17-19.

1. Filho AM, Laversanne M, Ferlay J, et al. The GLOBOCAN 2022 cancer estimates: Data sources, methods, and a snapshot of the cancer burden worldwide. Int J Cancer. 2025, 156(7): 1336-1346.
2. 劉東東, 沈劍, 黃思遠, 等. 肺癌根治術后肺部感染的相關因素分析[J]. 中華全科醫學, 2021, 19(4): 550-553.Dongdong Liu, Jian Shen, Siyuan Huang, et al. Analysis of Related Factors of Postoperative Pulmonary Infection in Lung Cancer Patients[J]. Chinese Journal of General Practice, 2021, 19(4): 550-553. ).
3. 倪爽, 路子蘊, 孫行, 等. 快速康復病房腔鏡下肺結節切除術患者術后肺部并發癥危險因素分析[J]. 南京醫科大學學報(自然科學版), 2025, 45(1): 48-55.Shuang Ni, Ziyun Lu, Xing Sun, et al. Analysis of risk factors for postoperative pulmonary complications in patients undergoing laparoscopic pulmonary nodule resection in the rapid recovery ward[J]. Journal of Nanjing Medical University (Natural Science Edition), 2025, 45(1): 48-55. ).
4. Greif B, ?gajnar J, ?tupnik T. Impact of chest tube type on pain, drainage efficacy, and short-term treatment outcome following video-assisted thoracoscopic surgery lobectomy: a randomized controlled trial comparing coaxial silicone drains and standard polyvinyl chloride drains. J Thorac Dis. 2025, 17(2): 932-943.
5. 張慧玲, 鄭志博, 梁乃新, 等. 老年患者胸腔鏡肺切除術后并發癥的影響因素研究[J]. 協和醫學雜志, 2025.Huiling Zhang, Zhibo Zheng, Naixin Liang, et al. Study on the influencing factors of postoperative complications in elderly patients undergoing thoracoscopic lung resection[J]. Medical Journal of Peking Union Medical College Hospital, 2025.
6. Bhatnagar R, Piotrowska HEG, Laskawiec-Szkonter M, et al. Effect of Thoracoscopic Talc Poudrage vs Talc Slurry via Chest Tube on Pleurodesis Failure Rate Among Patients With Malignant Pleural Effusions: A Randomized Clinical Trial. JAMA. 2020, 323(1): 60-69.
7. 肖曉輝, 雷豐豐, 劉華, 等. 內科胸腔鏡下碘伏胸膜固定術治療肺癌伴惡性胸腔積液[J]. 湖北民族大學學報(醫學版), 2020, 37(1): 99-101.Xiaohui Xiao, Fengfeng Lei, Hua Liu, et al. Internal medicine thoracoscopic iodine fixation for the treatment of lung cancer with malignant pleural effusion[J]. Journal of Hubei University for Nationalities (Medical Edition), 2020, 37(1): 99-101. ).
8. Shinno Y, Kage H, Chino H, et al. Old age and underlying interstitial abnormalities are risk factors for development of ARDS after pleurodesis using limited amount of large particle size talc. Respirology. 2018, 23(1): 55-59.
9. 魏萍, 張川林, 陳志斌. 紅色諾卡氏菌細胞壁骨架對70例肺癌惡性胸腔積液患者近遠期預后的影響[J]. 廣州醫科大學學報, 2018(6): 53-56.Ping Wei, Chuanlin Zhang, Zhibin Chen. The effect of red Nocardia cell wall skeleton on the short- and long-term prognosis of 70 patients with malignant pleural effusion caused by lung cancer[J]. Journal of Guangzhou Medical University, 2018(6): 53-56. ).
10. Zhao Y, Yu L, Wang L, Wu Y, Chen H, Wang Q, Wu Y. Current status of and progress in the treatment of malignant pleural effusion of lung cancer. Front Oncol. 2023, 12: 961440.
11. 吳燦興, 胡樹橋, 馬駿, 等. 肺癌術后肺部并發癥的預測因素分析[J]. 中華胸部外科電子雜志, 2019, 6(4): 229-233.Canxing Wu, Shuqiao Hu, Jun Ma, et al. Predictive factors analysis of postoperative pulmonary complications in lung cancer[J]. Chinese Journal of Thoracic Surgery, 2019, 6(4): 229-233. ).
12. Yusa J, Tanaka K, Sata Y, et al. Predictors of intraoperative and postoperative air leakage in anatomical pulmonary resection. Surg Today. 2025. doi: 10.1007/s00595-025-03004-2. Epub ahead of print.
13. Boira I, Galán Negrillo M, Ga?án Boscá A. Acute respiratory distress syndrome secondary to talc pleurodesis. Med Clin (Barc). 2023, 161(9): 411-412.
14. Samadi Takaldani AH, Javanshir N, Negaresh M, et al. A Case of Acute Respiratory Distress Syndrome Following Pleurodesis With Talc. Clin Med Insights Case Rep. 2023, 16: 11795476231170196.
15. Terra RM, da Costa PB, Dela Vega AJM, et al. Adverse events after pleurodesis in patients with malignant pleural effusion. J Thorac Dis. 2020, 12(7): 3507-3513.
16. Zhang W, Zhao YL, Li SJ, et al. Complications of thoracoscopic talc insufflation for the treatment of malignant pleural effusions: a meta-analysis. J Cardiothorac Surg. 2021, 16(1): 125-132.
17. Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018, 198(7): 839-849.
18. Stayner LT, Carreón-Valencia T, Demers PA, et al. Carcinogenicity of talc and acrylonitrile. Lancet Oncol. 2024, 25(8): 962-963.
19. Mohammed SM, Al-Saedi HFS, Mohammed AQ, et al. Mechanisms of Bleomycin-induced Lung Fibrosis: A Review of Therapeutic Targets and Approaches. Cell Biochem Biophys. 2024, 82(3): 1845-1870.
20. 張邵丞, 高學軍. 非小細胞肺癌患者術后持續性肺漏氣的研究進展[J]. 醫藥前沿, 2022, 12(35): 37-40.Shaocheng Zhang, Xuejun Gao. Research progress on persistent postoperative lung gas leakage in non-small cell lung cancer patients[J]. Frontiers of Medicine, 2022, 12(35): 37-40. ).
21. 徐冰南, 金亞彬, 李枚格. 外用紅色諾卡氏菌細胞壁骨架制劑(Nr-CWS)治療宮頸上皮內瘤變患者人乳頭瘤病毒宮頸持續感染的臨床療效分析[J]. 婦產與遺傳(電子版), 2022, 12(01): 38-41.Bingnan Xu, Yabin Jin, Meige Li. Clinical efficacy analysis of external application of red Nocardia cell wall scaffold preparation (Nr-CWS) in the treatment of persistent human papillomavirus cervical infection in patients with cervical intraepithelial neoplasia[J]. Obstetrics and Gynecology and Genetics (Electronic Version), 2022, 12(01): 38-41. ).
22. Li Q, Guo L, Wang J, et al. Exosomes derived from Nr-CWS pretreated MSCs facilitate diabetic wound healing by promoting angiogenesis via the circIARS1/miR-4782-5p/VEGFA axis. Chin J Nat Med. 2023, 21(3): 172-184.
23. 聞丹丹, 李強, 沈才齊, 等. 外用紅色諾卡氏菌細胞壁骨架提高脂肪間充質干細胞活性修復糖尿病創面[J]. 中國組織工程研究, 2022, 26(07): 1038-1044.Dandan Wen, Qiang Li, Caiqi Shen, et al. External application of Nocardia rubrum cell wall skeleton improves the activity of adipose derived mesenchymal stem cells to repair diabetes wounds[J]. China Tissue Engineering Research, 2022, 26(07): 1038-1044. ).
24. Hu K, Xu Y, Li X, et al. The Nocardia Rubra Cell Wall Skeleton Regulates Macrophages and Promotes Wound Healing. Curr Issues Mol Biol. 2022, 44(12): 5995-6005.
25. Wang Y, Hu Y, Ma B, et al. Nocardia rubra cell wall skeleton accelerates cutaneous wound healing by enhancing macrophage activation and angiogenesis. J Int Med Res. 2018, 46(6): 2398-2409.
26. 齊利, 陳巖. 紅色諾卡氏菌細胞壁骨架胸腔內注射治療惡性胸腔積液的臨床效果[J]. 中國實用醫刊, 2019, 46(20): 104-106.Li Qi, Yan Chen. Clinical effect of intrathoracic injection of red Nocardia cell wall skeleton in the treatment of malignant pleural effusion[J]. Chinese Journal of Practical Medicine, 2019, 46(20): 104-106. ).
27. 楊珊, 張文進, 曹淼, 等. 紅色諾卡菌細胞壁骨架術中沖洗創面影響乳腺癌術后引流量的前瞻性研究[J]. 中國實用外科雜志, 2022, 42(08): 932-935.Shan Yang, Wenjin Zhang, Miao Cao, et al. A prospective study on the effect of intraoperative washing of wound surface of Nocardia rubrum cell wall skeleton on postoperative drainage of breast cancer[J]. Chinese Journal of Practical Surgery, 2022, 42(08): 932-935. ).
28. 王曉楠, 郭瑞霞, 邱海峰, 等. 外用紅色諾卡氏菌細胞壁骨架治療高危型HPV持續感染伴或不伴低級別鱗狀上皮內病變臨床療效的前瞻性研究[J]. 中國婦產科臨床雜志, 2024, 25(2): 155-159.Xiaonan Wang, Ruixia Guo, Haifeng Qiu, et al. Prospective study on the clinical efficacy of topical application of red Nocardia cell wall cytoskeleton in the treatment of persistent high-risk HPV infection with or without low-grade squamous intraepithelial lesions[J]. Chinese Journal of Obstetrics and Gynecology, 2024, 25(2): 155-159. ).
29. Shen C, Wei W, Zhang A, et al. External application of a Nocardia rubra cell wall skeleton in the treatment of diabetic foot ulcers. Chinese Journal of Plastic and Reconstructive Surgery, 2022, 4(1): 17-19.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesRetrospective study on the effect of intraoperative flushing treatment with nocardia rubra cell-wall skeleton on drainage after radical surgery of lung cancer

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