Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France.
Eur J Cardiothorac Surg. 2012 Jun;41(6):1342-8; discussion 1348. doi: 10.1093/ejcts/ezr220. Epub 2012 Jan 6.
Although major pulmonary resections for early-stage non-small cell lung cancer (NSCLC) are more and more frequently performed through thoracoscopy, the adequacy of lymphadenectomy achieved via this approach is still questioned. The aim of this study was to evaluate the results of lymph node dissection (LND) during totally thoracoscopic (TT) major pulmonary resections.
Clinical and pathological data of consecutive patients who underwent lobectomy or segmentectomy for clinical-N0 NSCLC between 1 January 2007 and 31 December 2009 were reviewed. The main evaluation criterion was the number of mediastinal lymph nodes (LNs) and mediastinal stations dissected through a TT approach when compared with the classical posterolateral thoracotomy (PLT) approach.
A total of 296 major pulmonary resections (278 lobectomies and 18 anatomic segmentectomies) for clinical stages I-II NSCLC were performed, 96 via a TT approach and 200 through PLT. Patients' clinical characteristics were similar in both groups. The overall-i.e mediastinal and lobar-number of dissected mediastinal LNs and of dissected mediastinal stations were similar in both groups (TT: mean ± SD = 17.7 ± 8.2; PLT: 18.2 ± 9.3(P < 0.937) and 3.2 ± 0.9 vs 3.4 ± 0.9, respectively). The overall numbers of stations (TT: mean ± SD 5.1 ± 1.1; PLT: 4.5 ± 1.2) and LNs (TT: 22.6 ± 9.4, PLT: 25.4 ± 10.8) were slightly but significantly different between the two groups (P < 0.001 and P = 0.033, respectively); there was no difference in terms of post-operative complications, although patients from the TT group had significantly fewer days with the chest tube (mean ± SD = 4.0 ± 1.8 vs 5.7 ± 3.9, P < 0.001) and shorter length of stay (7.0 ± 2.5 days vs 10.3 ± 7.4, P < 0.001).
For patients undergoing thoracoscopic lobectomy or segmentectomy for clinical early-stage NSCLC, the quality of mediastinal LND is equivalent to that performed by thoracotomy.
尽管越来越多的早期非小细胞肺癌（NSCLC）患者通过胸腔镜进行了大肺切除术，但这种方法的淋巴结清扫术（LND）的充分性仍存在疑问。本研究旨在评估完全胸腔镜（TT）大肺切除术中淋巴结清扫术（LND）的结果。
回顾了 2007 年 1 月 1 日至 2009 年 12 月 31 日期间接受临床 N0 NSCLC 肺叶切除术或节段切除术的连续患者的临床和病理数据。主要评估标准是通过 TT 方法与经典后外侧开胸术（PLT）方法相比，纵隔淋巴结（LNs）的数量和纵隔站的数量。
共对 296 例临床 I-II 期 NSCLC 患者进行了大肺切除术（278 例肺叶切除术和 18 例解剖性节段切除术），96 例通过 TT 方法进行，200 例通过 PLT 方法进行。两组患者的临床特征相似。两组纵隔和肺叶淋巴结清扫总数和纵隔站数均相似（TT：均数±标准差=17.7±8.2；PLT：18.2±9.3（P＜0.937）和 3.2±0.9 与 3.4±0.9 相比）。两组纵隔站总数（TT：均数±标准差 5.1±1.1；PLT：4.5±1.2）和淋巴结总数（TT：22.6±9.4，PLT：25.4±10.8）均略有但有统计学意义（P＜0.001 和 P=0.033）；两组术后并发症无差异，尽管 TT 组患者的胸腔引流管放置时间（均数±标准差=4.0±1.8 与 5.7±3.9，P＜0.001）和住院时间（7.0±2.5 天与 10.3±7.4 天，P＜0.001）明显缩短。
对于接受胸腔镜肺叶切除术或节段切除术治疗临床早期 NSCLC 的患者，纵隔淋巴结清扫术的质量与开胸手术相当。
