Shaw Jason P, Dembitzer Francine R, Wisnivesky Juan P, Litle Virginia R, Weiser Todd S, Yun Jaime, Chin Cynthia, Swanson Scott J
Division of Thoracic Surgery, The Mount Sinai Medical Center, New York, New York 10029, USA.
Ann Thorac Surg. 2008 Feb;85(2):S705-9. doi: 10.1016/j.athoracsur.2007.11.048.
Thoracoscopic lobectomy is performed with increasing frequency for early-stage lung cancer. Several published reports suggest thoracoscopic resection is safe, with the potential advantage of shorter hospital stay, quicker recovery, and comparable oncologic results.
Data on 180 video-assisted thoracoscopic surgery (VATS) patients who underwent thoracoscopic lobectomy or sublobar anatomic resection at our institution between January 2002 and December 2006 were reviewed. The conversion rate to thoracotomy, complications, length of stay, and duration of chest tube drainage were determined. Similar variables were evaluated for patients aged older than 80 years, those with a forced expiratory volume in 1 second (FEV1) that was less than 50% predicted, those who had undergone preoperative neoadjuvant therapy, and those who had undergone lung-sparing anatomic resections.
Thoracoscopic anatomic lung resection was performed successfully in 166 patients. One of 180 patients (0.6%) died, and 14 patients (9.2%) underwent conversions. Overall median length of stay was 4 days (range, 1 to 98; interquartile range [IQR], 3), and median duration of chest tube drainage was 3 days (range, 0 to 35 days; IQR, 2). The median length of hospital stay and median chest tube duration for the group aged 80 years and older was 5 and 3 days; for the segmental resection group, 4 and 3 days; for the chemotherapy or radiotherapy induction group, 3.5 and 3 days; and for the FEV1 less than 50% group, 5.5 and 4 days, respectively. No patients died in any of these groups.
Thoracoscopic lung resection can be performed safely in selected patients aged 80 years and older, in those with marginal pulmonary function, and in those with pathologic response to neoadjuvant therapy.
胸腔镜肺叶切除术用于早期肺癌的频率日益增加。多篇已发表的报告表明，胸腔镜切除术是安全的，具有住院时间短、恢复快以及肿瘤学结果相当的潜在优势。
回顾了2002年1月至2006年12月期间在本机构接受胸腔镜肺叶切除术或肺段解剖性切除术的180例电视辅助胸腔镜手术（VATS）患者的数据。确定了开胸手术的转换率、并发症、住院时间和胸管引流持续时间。对年龄大于80岁的患者、第1秒用力呼气量（FEV1）低于预测值50%的患者、接受术前新辅助治疗的患者以及接受肺保留解剖性切除术的患者的类似变量进行了评估。
166例患者成功进行了胸腔镜解剖性肺切除术。180例患者中有1例（0.6%）死亡，14例（9.2%）进行了手术转换。总体中位住院时间为4天（范围1至98天；四分位间距[IQR]，3天），中位胸管引流持续时间为3天（范围0至35天；IQR，2天）。80岁及以上组的中位住院时间和中位胸管引流持续时间分别为5天和3天；肺段切除组分别为4天和3天；化疗或放疗诱导组分别为3.5天和3天；FEV1低于50%组分别为5.5天和4天。这些组中均无患者死亡。
胸腔镜肺切除术可以在80岁及以上的特定患者、肺功能临界患者以及对新辅助治疗有病理反应的患者中安全进行。
