Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California.
Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, Stanford, California; Department of Surgery, VA Palo Alto Health Care System, Stanford, California.
Ann Thorac Surg. 2013 Oct;96(4):1171-1177. doi: 10.1016/j.athoracsur.2013.05.044. Epub 2013 Jul 31.
Controversy remains regarding the adequacy of the lymph node evaluation achieved by video-assisted thoracic surgery (VATS) lobectomy for lung cancer. This study compared the completeness of the lymph node dissection or sampling for patients undergoing lobectomy by open thoracotomy vs VATS for clinical N0 lung cancer.
This study was a retrospective review of 129 patients who underwent lobectomy for clinical N0 lung carcinoma from December 2008 to January 2012.
Lobectomy was an open procedure in 69 patients (53.5%) and by VATS in 60 (46.5%). The VATS and open groups were well matched for age (p = 0.50) and forced expiratory volume in 1 second percentage predicted (p = 0.16). The mean pathologic tumor sizes were not significantly different (2.9 ± 0.26 vs 3.4 ± 0.25 cm, respectively; p = 0. 14). The mean number of nodes dissected in the open group was significantly higher (14.7 ± 1.3 vs. 9.9 ± 0.8 nodes; p = 0.003). In the open lobectomy group, 24.6% of the patients were upstaged to pathologic N1 or N2 compared with 10% in the VATS group (p = 0.05). The Kaplan-Meier 3-year survival was similar between the groups.
In our hands, significantly more lymph nodes were dissected, and a higher percentage of patients were upstaged to N1/N2, during open lobectomy compared with VATS lobectomy in patients with clinical stage N0 lung cancer. Although this did not translate into improved survival at 3 years, concern is raised about the adequacy of lymph node dissection during VATS lobectomy.
经电视辅助胸腔镜手术（VATS）肺叶切除治疗肺癌时，淋巴结评估的充分性仍存在争议。本研究比较了开放性剖胸肺叶切除术和 VATS 治疗临床 N0 肺癌患者的淋巴结清扫或采样的完整性。
本研究回顾性分析了 2008 年 12 月至 2012 年 1 月期间 129 例接受临床 N0 肺癌肺叶切除术的患者。
69 例（53.5%）患者行开放性肺叶切除术，60 例（46.5%）患者行 VATS 肺叶切除术。VATS 组和开放性组在年龄（p=0.50）和 1 秒用力呼气容积占预计值的百分比（p=0.16）方面匹配良好。两组患者的平均病理肿瘤大小无显著差异（分别为 2.9 ± 0.26 cm 和 3.4 ± 0.25 cm；p=0.14）。开放性肺叶切除组切除的淋巴结数量明显较多（14.7±1.3 个 vs. 9.9±0.8 个；p=0.003）。开放性肺叶切除组中，24.6%的患者分期升级为病理 N1 或 N2，而 VATS 组为 10%（p=0.05）。两组患者的 3 年生存率无显著差异。
在我们的手中，与 VATS 肺叶切除术相比，开放性肺叶切除术在治疗临床分期 N0 肺癌患者时，可明显更多地切除淋巴结，且更多的患者分期升级为 N1/N2。尽管这并未在 3 年时转化为生存获益的提高，但对 VATS 肺叶切除术中淋巴结清扫的充分性提出了关注。
