Shigemura Norihisa, Akashi Akinori, Funaki Soichiro, Nakagiri Tomoyuki, Inoue Masayoshi, Sawabata Noriyoshi, Shiono Hiroyuki, Minami Masato, Takeuchi Yukiyasu, Okumura Meinoshin, Sawa Yoshiki
Division of General Thoracic Surgery, Takarazuka Municipal Hospital, Hyogo, Japan.
J Thorac Cardiovasc Surg. 2006 Sep;132(3):507-12. doi: 10.1016/j.jtcvs.2006.03.058.
Although video-assisted thoracic surgery (VATS) has been in use for more than a decade, its application to major lung resection for lung cancer is still not widely practiced. The success of a cancer operation is judged by the long-term survival of the treated patients. Therefore, the goal of the present study was to evaluate long-term outcomes associated with various video-assisted lobectomy techniques and conventional surgery in patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (stage IA).
A multi-institutional, retrospective review was performed in 145 consecutive patients. Patients with clinical stage IA disease, with tumor size less than or equal to 2 cm in diameter, from three institutions underwent a complete VATS (c-VATS, n = 56), an assisted VATS (a-VATS, n = 34), or a conventional open (open, n = 55) approach for pulmonary lobectomy and lymph node dissection.
Patients undergoing lobectomy and lymph node dissection with c-VATS had less blood loss, faster recovery, shorter hospitalization, and longer operating times than did patients undergoing the lobectomy with the a-VATS and open approaches. At a mean follow-up of 38.8 months, Kaplan-Meier probabilities of survival at 5 years were as follows: c-VATS, 96.7%; a-VATS, 95.2%; open, 97.2%. There was no significant difference in the rate of recurrence among the 3 different procedures.
VATS lobectomy, a safe procedure with earlier return to normal activities, can be regarded as an acceptable cancer operation for the patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (clinical stage IA) with the same long-term survivals as open surgery.
尽管电视辅助胸腔镜手术（VATS）已应用超过十年，但其在肺癌肺叶切除术中的应用仍未广泛开展。癌症手术的成功与否是通过接受治疗患者的长期生存率来判断的。因此，本研究的目的是评估直径小于或等于2cm（IA期）的周围型非小细胞肺癌患者采用不同电视辅助肺叶切除技术和传统手术的长期预后。
对145例连续患者进行了一项多机构回顾性研究。来自三个机构的临床IA期疾病、肿瘤直径小于或等于2cm的患者接受了完全电视辅助胸腔镜手术（c-VATS，n = 56）、辅助电视辅助胸腔镜手术（a-VATS，n = 34）或传统开放手术（开放手术，n = 55）进行肺叶切除和淋巴结清扫。
与接受a-VATS和开放手术的肺叶切除术患者相比，接受c-VATS进行肺叶切除和淋巴结清扫的患者失血更少、恢复更快、住院时间更短，但手术时间更长。平均随访38.8个月时，c-VATS组、a-VATS组和开放手术组的5年总生存率分别为96.7%、95.2%和97.2%。三种不同手术方式的复发率无显著差异。
VATS肺叶切除术是一种安全的手术，能使患者更早恢复正常活动，对于直径小于或等于2cm（临床IA期）的周围型非小细胞肺癌患者而言，可被视为一种可接受的癌症手术，其长期生存率与开放手术相同。
