Watanabe Atsushi, Koyanagi Tetsuya, Obama Takuro, Ohsawa Hisayoshi, Mawatari Tohru, Takahashi Noriyuki, Ichimiya Yasunori, Abe Tomio
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo 060-8543, Japan.
Eur J Cardiothorac Surg. 2005 May;27(5):745-52. doi: 10.1016/j.ejcts.2005.02.007.
The feasibility of systematic node dissection (SND) for stage I primary lung cancer by video-assisted thoracic surgery (VATS) remains controversial. The aim of this study was to assess the feasibility of SND by VATS.
Four hundred and eleven patients with clinical stage I primary lung cancer were enrolled in this study. Two hundred and twenty-one patients, VATS group, underwent a major pulmonary resection with SND by VATS through a minithoracotomy (30-70mm) and two access ports; 190 patients, open thoracotomy (OT) group, did so through anterolateral thoracotomy. The two groups were compared regarding clinical data including number of dissected nodes in each nodal station for evaluating the feasibility of SND by VATS.
In the right side, the total number (N) of nodes dissected (VATS 31 vs OT 31, P=0.899), N of mediastinal nodes dissected (20 vs 21, P=0.553), and N of dissected nodes in each nodal station were similar between the two groups. In the left side, total N of nodes dissected (28 vs 27, P=0.714), N of mediastinal nodes dissected (16 vs 17, P=0.333), and N of dissected nodes in each nodal station were similar between the two groups. There were three (1.4%) and five (2.6%) operation related deaths in the VATS group and OT group, respectively (P=0.48). Chest tube duration was shorter in the VATS group than the OT group (5.8 vs 7.6 days, P=0.001). The incidences of chylothorax, recurrent laryngeal nerve injury and pleural effusion requiring thoracentesis after surgery were similar between the two groups (3 vs 4, P=0.709; 5 vs 3, P=0.480, 3 vs 8, P=0.122). The 5-year actuarial recurrence-free survival rate and cumulative survival rate of pathological stage IA cases were similar between the two groups (88.6 vs 92.4%, P=0.698; 92.9 vs 86.5%, P=0.358).
The SND by VATS was as technically feasible as SND through OT regarding number of dissected nodes and morbidity. It seems acceptable as an oncological treatment for clinical stage I lung cancer.
电视辅助胸腔镜手术（VATS）用于Ⅰ期原发性肺癌系统性淋巴结清扫（SND）的可行性仍存在争议。本研究旨在评估VATS进行SND的可行性。
411例临床Ⅰ期原发性肺癌患者纳入本研究。221例患者为VATS组，通过小切口开胸（30 - 70mm）及两个操作孔，采用VATS行肺叶切除并系统性淋巴结清扫；190例患者为开胸手术（OT）组，通过前外侧开胸完成手术。比较两组的临床资料，包括各淋巴结站清扫的淋巴结数量，以评估VATS进行SND的可行性。
右侧，两组清扫淋巴结总数（VATS组31枚 vs OT组31枚，P = 0.899）、纵隔淋巴结清扫数（20枚 vs 21枚，P = 0.553）及各淋巴结站清扫的淋巴结数相似。左侧，两组清扫淋巴结总数（28枚 vs 27枚，P = 0.714）、纵隔淋巴结清扫数（16枚 vs 17枚，P = 0.333）及各淋巴结站清扫的淋巴结数相似。VATS组和OT组分别有3例（1.4%）和5例（2.6%）手术相关死亡（P = 0.48）。VATS组胸管留置时间短于OT组（5.8天 vs 7.6天，P = 0.001）。两组术后乳糜胸、喉返神经损伤及需要胸腔穿刺引流的胸腔积液发生率相似（3例 vs 4例，P = 0.709；5例 vs 3例，P = 0.480；3例 vs 8例，P = 0.122）。两组病理ⅠA期病例的5年无病生存率和累积生存率相似（88.6% vs 92.4%，P = 0.698；92.9% vs 86.5%，P = 0.358）。
就清扫淋巴结数量和并发症而言，VATS行SND在技术上与OT行SND同样可行。作为临床Ⅰ期肺癌的肿瘤治疗方法似乎是可以接受的。
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