在预计术后第 1 秒用力呼气量或一氧化碳弥散量低于正常的 40%的患者中，胸腔镜肺叶切除术与可接受的发病率和死亡率相关。
Thoracoscopic lobectomy is associated with acceptable morbidity and mortality in patients with predicted postoperative forced expiratory volume in 1 second or diffusing capacity for carbon monoxide less than 40% of normal.
机构信息
Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
出版信息
J Thorac Cardiovasc Surg. 2014 Jul;148(1):19-28, dicussion 28-29.e1. doi: 10.1016/j.jtcvs.2014.03.007. Epub 2014 Mar 13.
OBJECTIVE
A predicted postoperative (ppo) forced expiratory volume in 1 second (FEV1%) or diffusing capacity of the lung for carbon monoxide (DLCO%) of <40% has traditionally been considered to convey a high risk of lobectomy owing to elevated postoperative morbidity and mortality. These recommendations, however, were largely derived from the pre-video-assisted thoracoscopic surgical (VATS) era. We hypothesized that VATS lobectomy would be associated with acceptable morbidity and mortality at ppoFEV1% and ppoDLCO% values < 40%.
METHODS
PpoFEV1% and ppoDLCO% were calculated for patients undergoing open or VATS lobectomy for lung cancer in the Society of Thoracic Surgeons General Thoracic database from 2009 to 2011. Univariate comparisons, multivariate analyses, and 1:1 propensity matching were performed.
RESULTS
A total of 13,376 patients underwent lobectomy (50.9% open, 49.1% VATS). A decreased ppoFEV1% and ppoDLCO% were each independent predictors for both cardiopulmonary complications and mortality in the open group (all P ≤ .008). In the VATS group, ppoFEV1% was an independent predictor of complications (P = .001) but not mortality (P = .77), and ppoDLCO% was an independent predictor of complications (P = .046) and mortality (P = .008). With decreasing ppoFEV1% or ppoDLCO%, complications and mortality increased at a greater rate in the open lobectomy than in a propensity-matched VATS group (n = 4215 each). For patients with ppoFEV1% < 40%, mortality was greater in the open (4.8%) than in the matched VATS group (0.7%, P = .003). Similar results were seen for ppoDLCO% < 40% (5.2% open, 2.0% VATS, P = .003). The rate of complications was significantly greater at ppoFEV1% < 40% in the open (21.9%) than in the matched VATS (12.8%, P = .005) group and similar results were seen with ppoDLCO% < 40% (14.9% open, 10.4% VATS, P = .016).
CONCLUSIONS
VATS lobectomy can be performed with acceptable rates of morbidity and mortality in patients with reduced ppoFEV1% or ppoDLCO%.
目的
传统上认为，术后（ppo）用力呼气 1 秒量（FEV1%）或一氧化碳弥散量（DLCO%）预测值＜40%提示行肺叶切除术的风险较高，因为术后发病率和死亡率较高。然而，这些建议主要来自于电视辅助胸腔镜手术（VATS）之前的时代。我们假设 VATS 肺叶切除术在 ppoFEV1%和 ppoDLCO%值＜40%时，其发病率和死亡率可以接受。
方法
从 2009 年至 2011 年，胸外科医师学会胸外科数据库中对接受开胸或 VATS 肺叶切除术治疗肺癌的患者计算 ppoFEV1%和 ppoDLCO%。进行单变量比较、多变量分析和 1:1 倾向评分匹配。
结果
共 13376 例患者接受了肺叶切除术（50.9%开胸，49.1%VATS）。ppoFEV1%和 ppoDLCO%均为开胸组心肺并发症和死亡率的独立预测因素（均 P≤.008）。在 VATS 组中，ppoFEV1%是并发症的独立预测因素（P=.001），但不是死亡率（P=.77），ppoDLCO%是并发症（P=.046）和死亡率（P=.008）的独立预测因素。随着 ppoFEV1%或 ppoDLCO%的降低，开胸肺叶切除术患者的并发症和死亡率的增长率大于经倾向评分匹配的 VATS 组（每组 n=4215）。对于 ppoFEV1%＜40%的患者，开胸组死亡率（4.8%）高于匹配的 VATS 组（0.7%，P=.003）。ppoDLCO%＜40%的患者也出现了类似的结果（开胸组 5.2%，VATS 组 2.0%，P=.003）。ppoFEV1%＜40%的开胸组并发症发生率显著高于匹配的 VATS 组（21.9%比 12.8%，P=.005），ppoDLCO%＜40%的开胸组并发症发生率也显著高于匹配的 VATS 组（14.9%比 10.4%，P=.016）。
结论
ppoFEV1%或 ppoDLCO%降低的患者行 VATS 肺叶切除术，其发病率和死亡率可接受。
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