Farjah Farhood, Wood Douglas E, Mulligan Michael S, Krishnadasan Bahirathan, Heagerty Patrick J, Symons Rebecca Gaston, Flum David R
Department of Surgery, Surgical Outcomes Research Center, University of Washington, Seattle, Wash 98195-6310, USA.
J Thorac Cardiovasc Surg. 2009 Jun;137(6):1415-21. doi: 10.1016/j.jtcvs.2008.11.035. Epub 2009 Mar 9.
We sought to evaluate the use of video-assisted thoracoscopy among patients with lung cancer and its safety and effectiveness relative to conventional resection.
A cohort study (1994-2002) was conducted by using the Surveillance, Epidemiology, and End-Results Medicare database. Video-assisted thoracoscopy and conventional resection were hypothesized to be equivalent in terms of risks of death. Equivalency was defined by a confidence interval of 0.72 to 1.28 for the odds of 30-day death and 0.89 to 1.11 for the hazard of death, corresponding to a difference of no more than 1% for 30-day mortality and 5% for 5-year survival, respectively.
Among 12,958 patients who underwent segmentectomy or lobectomy (mean age, 74 +/- 5 years), 6% underwent video-assisted thoracoscopy. The use of video-assisted thoracoscopy increased from 1% to 9% between 1994 and 2002. Compared with those who underwent conventional resection, patients who underwent video-assisted thoracoscopy more frequently had smaller tumors (P < .001) and stage I disease (P = .03), underwent lymphadenectomy (P < .001), and were cared for by higher-volume surgeons (P < .001) and at higher-volume hospitals (P < .001). After adjusting for differences in patient, cancer, management, and provider characteristics, the odds of early death were not significantly different between patients undergoing video-assisted thoracoscopy and those undergoing conventional resection, although equivalency was not demonstrated (adjusted odds ratio, 0.93; 95% confidence interval, 0.57-1.50). The hazard of death was equivalent for video-assisted thoracoscopy and conventional resection (adjusted hazard ratio, 0.99; 95% confidence interval, 0.90-1.08).
Video-assisted thoracoscopy was uncommonly used to manage lung cancer, although its use has increased over time. Video-assisted thoracoscopy and conventional resection were equivalent in terms of long-term survival.
我们试图评估电视辅助胸腔镜手术在肺癌患者中的应用情况及其相对于传统切除术的安全性和有效性。
利用监测、流行病学和最终结果医疗保险数据库进行了一项队列研究（1994 - 2002年）。假设电视辅助胸腔镜手术和传统切除术在死亡风险方面相当。等效性定义为30天死亡几率的置信区间为0.72至1.28，死亡风险的置信区间为0.89至1.11，分别对应30天死亡率差异不超过1%和5年生存率差异不超过5%。
在12958例行肺段切除术或肺叶切除术的患者中（平均年龄74±5岁），6%接受了电视辅助胸腔镜手术。1994年至2002年间，电视辅助胸腔镜手术的应用率从1%上升至9%。与接受传统切除术的患者相比，接受电视辅助胸腔镜手术的患者肿瘤通常较小（P < 0.001）且为I期疾病（P = 0.03），更常接受淋巴结清扫术（P < 0.001），且由手术量较大的外科医生（P < 0.001）在手术量较大的医院（P < 0.001）进行治疗。在对患者、癌症、治疗管理和医疗服务提供者特征的差异进行调整后，接受电视辅助胸腔镜手术的患者与接受传统切除术的患者早期死亡几率无显著差异，尽管未证明等效性（调整后的优势比为0.93；95%置信区间为0.57 - 1.50）。电视辅助胸腔镜手术和传统切除术的死亡风险相当（调整后的风险比为0.99；95%置信区间为0.90 - 1.08）。
电视辅助胸腔镜手术在肺癌治疗中使用并不普遍，不过其应用率随时间有所上升。电视辅助胸腔镜手术和传统切除术在长期生存率方面相当。
