Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York 10065, USA.
J Thorac Cardiovasc Surg. 2010 Feb;139(2):366-78. doi: 10.1016/j.jtcvs.2009.08.026.
Several single-institution series have demonstrated that compared with open thoracotomy, video-assisted thoracoscopic lobectomy may be associated with fewer postoperative complications. In the absence of randomized trials, we queried the Society of Thoracic Surgeons database to compare postoperative mortality and morbidity following open and video-assisted thoracoscopic lobectomy. A propensity-matched analysis using a large national database may enable a more comprehensive comparison of postoperative outcomes.
All patients having lobectomy as the primary procedure via thoracoscopy or thoracotomy were identified in the Society of Thoracic Surgeons database from 2002 to 2007. After exclusions, 6323 patients were identified: 5042 having thoracotomy, 1281 having thoracoscopy. A propensity analysis was performed, incorporating preoperative variables, and the incidence of postoperative complications was compared.
Matching based on propensity scores produced 1281 patients in each group for analysis of postoperative outcomes. After video-assisted thoracoscopic lobectomy, 945 patients (73.8%) had no complications, compared with 847 patients (65.3%) who had lobectomy via thoracotomy (P < .0001). Compared with open lobectomy, video-assisted thoracoscopic lobectomy was associated with a lower incidence of arrhythmias [n = 93 (7.3%) vs 147 (11.5%); P = .0004], reintubation [n = 18 (1.4%) vs 40 (3.1%); P = .0046], and blood transfusion [n = 31 (2.4%) vs n = 60 (4.7%); P = .0028], as well as a shorter length of stay (4.0 vs 6.0 days; P < .0001) and chest tube duration (3.0 vs 4.0 days; P < .0001). There was no difference in operative mortality between the 2 groups.
Video-assisted thoracoscopic lobectomy is associated with a lower incidence of complications compared with lobectomy via thoracotomy. For appropriate candidates, video-assisted thoracoscopic lobectomy may be the preferred strategy for appropriately selected patients with lung cancer.
多项单中心研究表明，与开胸手术相比，电视辅助胸腔镜肺叶切除术可能与较少的术后并发症相关。在没有随机试验的情况下，我们查询了胸外科医师学会数据库，以比较开胸和电视辅助胸腔镜肺叶切除术后的术后死亡率和发病率。使用大型国家数据库进行倾向匹配分析可能会更全面地比较术后结果。
从 2002 年至 2007 年，在胸外科医师学会数据库中确定了所有通过胸腔镜或开胸手术进行肺叶切除术的患者。排除后，共确定 6323 例患者：开胸手术 5042 例，胸腔镜手术 1281 例。进行了倾向分析，纳入了术前变量，并比较了术后并发症的发生率。
基于倾向评分进行匹配后，每组各有 1281 例患者用于分析术后结果。电视辅助胸腔镜肺叶切除术后，945 例（73.8%）无并发症，而开胸肺叶切除术后 847 例（65.3%）无并发症（P<0.0001）。与开胸肺叶切除术相比，电视辅助胸腔镜肺叶切除术心律失常的发生率较低[n=93（7.3%）与 147（11.5%）；P=0.0004]、再插管[n=18（1.4%）与 40（3.1%）；P=0.0046]和输血[n=31（2.4%）与 60（4.7%）；P=0.0028]，住院时间更短[4.0 天与 6.0 天；P<0.0001]，胸腔引流管留置时间更短[3.0 天与 4.0 天；P<0.0001]。两组手术死亡率无差异。
与开胸手术相比，电视辅助胸腔镜肺叶切除术的并发症发生率较低。对于合适的患者，电视辅助胸腔镜肺叶切除术可能是适合选择的肺癌患者的首选策略。
