Cattaneo Stephen M, Park Bernard J, Wilton Andrew S, Seshan Venkatraman E, Bains Manjit S, Downey Robert J, Flores Raja M, Rizk Nabil, Rusch Valerie W
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Ann Thorac Surg. 2008 Jan;85(1):231-5; discussion 235-6. doi: 10.1016/j.athoracsur.2007.07.080.
The purpose of this study was to determine if the utilization of video-assisted thoracic surgery (VATS) for lobectomy for clinical stage I non-small cell lung cancer in elderly patients results in decreased complications compared with lobectomy by thoracotomy (THOR).
A retrospective, matched case-control study was performed evaluating the perioperative outcomes after lobectomy by VATS versus THOR performed in elderly patients (age > or = 70 years) at a single institution. All complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html).
Between May 1, 2002 and December 31, 2005 333 patients (245 THOR, 88 VATS) 70 years old or greater underwent lobectomy for clinical stage I non-small cell lung cancer. After matching based on age, gender, presence of comorbid conditions, and preoperative clinical stage, there were 82 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications compared with THOR (28% vs 45%, p = 0.04) and a shorter median length of stay (5 days, range 2 to 20 vs 6 days, range 2 to 27, p < 0.001). No patients undergoing VATS lobectomy had higher than grade 2 complications, whereas 7% of complications in the THOR group were grade 3 or higher. There were no perioperative deaths in the VATS patients compared with an in-hospital mortality rate of 3.6% (3 of 82) for THOR patients.
A VATS approach to lobectomy for clinical stage I non-small cell lung cancer in the elderly was associated with fewer and overall reduced severity of complications as well as a shorter hospital stay compared with thoracotomy.
本研究的目的是确定老年临床I期非小细胞肺癌患者采用电视辅助胸腔镜手术（VATS）进行肺叶切除术与开胸肺叶切除术（THOR）相比是否能减少并发症。
进行一项回顾性配对病例对照研究，评估在单一机构中对老年患者（年龄≥70岁）采用VATS与THOR进行肺叶切除术后的围手术期结果。所有并发症均根据美国国立癌症研究所不良事件通用术语标准第3.0版（http://ctep.cancer.gov/reporting/ctc.html）进行分级。
在2002年5月1日至2005年12月31日期间，333例70岁及以上的患者（245例行THOR，88例行VATS）因临床I期非小细胞肺癌接受了肺叶切除术。在根据年龄、性别、合并症情况和术前临床分期进行配对后，每组有82例患者。两组患者术前特征相似。与THOR相比，VATS手术的并发症发生率显著更低（28%对45%，p = 0.04），中位住院时间更短（5天，范围2至20天对6天，范围2至27天，p < 0.001）。接受VATS肺叶切除术的患者中没有高于2级的并发症，而THOR组7%的并发症为3级或更高。VATS组患者无围手术期死亡，而THOR组患者的院内死亡率为3.6%（82例中有3例）。
与开胸手术相比，老年临床I期非小细胞肺癌患者采用VATS进行肺叶切除术的并发症更少，总体严重程度更低，住院时间更短。
