Shiraishi Takeshi, Shirakusa Takayuki, Hiratsuka Masafumi, Yamamoto Satoshi, Iwasaki Akinori
Department of Surgery II, Fukuoka University School of Medicine, Fukuoka, Japan.
Ann Thorac Surg. 2006 Sep;82(3):1021-6. doi: 10.1016/j.athoracsur.2006.04.031.
The outcomes of a video-assisted thoracoscopic surgery lobectomy for lung cancer, with a special focus on its locoregional control, were compared with a conventional lobectomy.
We performed a retrospective review of 160 patients who had undergone a lobectomy either by means of thoracoscopic surgery (n = 81) or a standard thoracotomy (n = 79) for clinical T1N0M0 nonsmall-cell lung cancer. The overall, disease-free, and locoregional recurrence-free survival were compared. In a separate multivariate analysis, the ability of numerous clinical and surgical factors, including the surgical approach, to predict locoregional recurrence was investigated.
The total recurrence of the primary disease occurred in 28 cases (12 locoregional and 14 distant). In the 12 documented local recurrences, 8 belonged to the thoracoscopic surgery group and 4 were in the standard thoracotomy group, without significant differences (p = 0.229). The overall 5-year survival rates associated with the thoracoscopic and standard procedure were 89.1% and 77.7%, respectively (p = 0.149). No significant differences in the disease-free or locoregional recurrence-free survivals were observed between the groups. The results of a multivariate analysis for the incidence of total and locoregional recurrence demonstrated that two covariates, lymph node metastasis and the surgical side (right or left lung), were significant factors for both total and locoregional recurrence. No significant relationship was found between thoracoscopic surgery or standard thoracotomy, and the incidence of locoregional recurrence.
Our findings suggest that thoracoscopic surgery is not inferior regarding its ability to achieve locoregional control in comparison with the standard procedure.
比较了电视辅助胸腔镜手术肺叶切除术治疗肺癌的效果，特别关注其局部区域控制情况，并与传统肺叶切除术进行了对比。
我们对160例因临床T1N0M0非小细胞肺癌接受肺叶切除术的患者进行了回顾性研究，其中81例采用胸腔镜手术，79例采用标准开胸手术。比较了总体生存率、无病生存率和局部区域无复发生存率。在另一项多变量分析中，研究了包括手术方式在内的众多临床和手术因素预测局部区域复发的能力。
原发性疾病总复发28例（局部区域复发12例，远处复发14例）。在12例有记录的局部复发中，8例属于胸腔镜手术组，4例属于标准开胸手术组，差异无统计学意义（p = 0.229）。胸腔镜手术和标准手术的总体5年生存率分别为89.1%和77.7%（p = 0.149）。两组间无病生存率或局部区域无复发生存率无显著差异。对总复发和局部区域复发发生率的多变量分析结果表明，两个协变量，即淋巴结转移和手术侧（右肺或左肺），是总复发和局部区域复发的重要因素。未发现胸腔镜手术或标准开胸手术与局部区域复发发生率之间存在显著关系。
我们的研究结果表明，与标准手术相比，胸腔镜手术在实现局部区域控制方面的能力并不逊色。
