Nakamura H, Taniguchi Y, Miwa K, Adachi Y, Fujioka S, Haruki T, Takagi Y, Yurugi Y
Department of General Thoracic Surgery, Tottori University Hospital, Yonago, Japan.
Thorac Cardiovasc Surg. 2011 Apr;59(3):137-41. doi: 10.1055/s-0030-1250377. Epub 2011 Apr 8.
Video-assisted thoracoscopic surgery (VATS) for clinical stage I non-small cell lung cancer (NSCLC) has been widely used as a less invasive surgical procedure, but the resection method is still controversial. We retrospectively compared the surgical outcomes of lobectomy, segmentectomy and wedge resection.
A total of 411 patients with clinical stage I NSCLC who underwent VATS (218 males and 193 females, aged 69.3 years; 345 adenocarcinomas, 57 squamous cell carcinomas, and 9 others) were investigated. The surgical procedure was lobectomy in 289, segmentectomy in 38, and wedge resection in 84. Surgical outcomes were compared among these 3 groups.
Demographic characteristics showed that the rate of elderly and male patients was higher in the wedge resection group. The 5-year survival rates for the lobectomy, segmentectomy, and wedge resection groups were 82.1, 87.2, and 55.4%, respectively. In the wedge resection group, the 5-year survival rate was 83.3% in patients undergoing intentional low-risk operations for small tumors with ground glass opacity, and 41.1% in those undergoing conservative high-risk operations because of comorbidities. Using Cox's proportional multivariate analysis and sex differences, histology, and tumor size as co-influential factors, the surgical procedure was found to be a significantly poor prognostic factor, and the hazard ratio of wedge resection relative to lobectomy was 4.30.
The outcomes of VATS lobectomy and segmentectomy procedures for clinical stage I NSCLC were equivalent, while the outcome for VATS wedge resection was inferior. VATS wedge resection for clinical stage I NSCLC should be carefully indicated and requires adequate patient selection.
电视辅助胸腔镜手术（VATS）治疗临床I期非小细胞肺癌（NSCLC）已作为一种侵入性较小的手术方法被广泛应用，但切除方法仍存在争议。我们回顾性比较了肺叶切除术、肺段切除术和楔形切除术的手术效果。
共调查了411例行VATS的临床I期NSCLC患者（男性218例，女性193例，年龄69.3岁；腺癌345例，鳞癌57例，其他9例）。手术方式为肺叶切除术289例，肺段切除术38例，楔形切除术84例。比较这三组的手术效果。
人口统计学特征显示，楔形切除术组老年患者和男性患者的比例较高。肺叶切除术、肺段切除术和楔形切除术组的5年生存率分别为82.1%、87.2%和55.4%。在楔形切除术组中，对磨玻璃影小肿瘤行有意低风险手术的患者5年生存率为83.3%，因合并症行保守高风险手术的患者5年生存率为41.1%。将手术方式作为协变量，采用Cox比例多因素分析并纳入性别差异、组织学类型和肿瘤大小作为共同影响因素，发现手术方式是一个显著的不良预后因素，楔形切除术相对于肺叶切除术的风险比为4.30。
VATS肺叶切除术和肺段切除术治疗临床I期NSCLC的效果相当，而VATS楔形切除术的效果较差。VATS楔形切除术治疗临床I期NSCLC应谨慎选择，需要对患者进行充分筛选。
