单孔胸腔镜手术对于非小细胞肺癌晚期患者是否可行？
Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer?
机构信息
1 Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain ; 2 Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
出版信息
J Thorac Dis. 2014 Jun;6(6):641-8. doi: 10.3978/j.issn.2072-1439.2014.05.17.
OBJECTIVES
Conventional video-assisted thoracoscopic (VATS) lobectomy for advanced lung cancer is a feasible and safe surgery in experienced centers. The aim of this study is to assess the feasibility of uniportal VATS approach in the treatment of advanced non-small cell lung cancer (NSCLC) and compare the perioperative outcomes and survival with those in early-stage tumors operated through the uniportal approach.
METHODS
From June 2010 to December 2012, we performed 163 uniportal VATS major pulmonary resections. Only NSCLC cases were included in this study (130 cases). Patients were divided into two groups: (A) early stage and (B) advanced cases (>5 cm, T3 or T4, or tumors requiring neoadjuvant treatment). A descriptive and retrospective study was performed, comparing perioperative outcomes and survival obtained in both groups. A survival analysis was performed with Kaplan-Meier curves and the log-rank test was used to compare survival between patients with early and advanced stages.
RESULTS
A total of 130 cases were included in the study: 87 (A) vs. 43 (B) patients (conversion rate 1.1 vs. 6.5%, P=0.119). Mean global age was 64.9 years and 73.8% were men. The patient demographic data was similar in both groups. Upper lobectomies (A, 52 vs. B, 21 patients) and anatomic segmentectomies (A, 4 vs. B, 0) were more frequent in group A while pneumonectomy was more frequent in B (A, 1 vs. B, 6 patients). Surgical time was longer (144.9±41.3 vs. 183.2±48.9, P<0.001), and median number of lymph nodes (14 vs. 16, P=0.004) were statistically higher in advanced cases. Median number of nodal stations (5 vs. 5, P=0.165), days of chest tube (2 vs. 2, P=0.098), HOS (3 vs. 3, P=0.072), and rate of complications (17.2% vs. 14%, P=0.075) were similar in both groups. One patient died on the 58th postoperative day. The 30-month survival rate was 90% for the early stage group and 74% for advanced cases.
CONCLUSIONS
Uniportal VATS lobectomy for advanced cases of NSCLC is a safe and reliable procedure that provides perioperative outcomes similar to those obtained in early stage tumours operated through this same technique. Further long term survival analyses are ongoing on a large number of patients.
目的
在有经验的中心，传统的电视辅助胸腔镜（VATS）肺叶切除术治疗晚期肺癌是一种可行且安全的手术。本研究旨在评估单端口 VATS 方法在治疗晚期非小细胞肺癌（NSCLC）中的可行性，并比较通过单端口方法治疗早期和晚期肿瘤的围手术期结果和生存情况。
方法
自 2010 年 6 月至 2012 年 12 月，我们进行了 163 例单端口 VATS 主要肺切除术。本研究仅纳入 NSCLC 病例（130 例）。患者分为两组：（A）早期和（B）晚期（>5cm，T3 或 T4，或需要新辅助治疗的肿瘤）。进行了描述性和回顾性研究，比较了两组的围手术期结果和生存情况。使用 Kaplan-Meier 曲线进行生存分析，并使用对数秩检验比较早期和晚期患者的生存情况。
结果
本研究共纳入 130 例患者：87 例（A 组）和 43 例（B 组）（转换率 1.1% vs. 6.5%，P=0.119）。总体平均年龄为 64.9 岁，73.8%为男性。两组患者的人口统计学数据相似。A 组中更常进行上叶切除术（A 组 52 例，B 组 21 例）和解剖性节段切除术（A 组 4 例，B 组 0 例），而 B 组中更常进行全肺切除术（A 组 1 例，B 组 6 例）。手术时间更长（144.9±41.3 vs. 183.2±48.9，P<0.001），晚期病例的中位淋巴结数量（14 枚 vs. 16 枚，P=0.004）也更高。中位淋巴结站数（5 枚 vs. 5 枚，P=0.165）、胸腔引流管放置天数（2 天 vs. 2 天，P=0.098）、住院日（3 天 vs. 3 天，P=0.072）和并发症发生率（17.2% vs. 14%，P=0.075）在两组间相似。1 例患者在术后第 58 天死亡。早期组 30 个月生存率为 90%，晚期组为 74%。
结论
对于晚期 NSCLC 患者，单端口 VATS 肺叶切除术是一种安全可靠的手术方法，其围手术期结果与采用相同技术治疗早期肿瘤相似。目前正在对大量患者进行进一步的长期生存分析。
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