Linden Philip A, D'Amico Thomas A, Perry Yaron, Saha-Chaudhuri Paramita, Sheng Shubin, Kim Sunghee, Onaitis Mark
Division of Thoracic and Esophageal Surgery, University Hospitals Case Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Ann Thorac Surg. 2014 Nov;98(5):1705-11; discussion 1711-2. doi: 10.1016/j.athoracsur.2014.06.017. Epub 2014 Sep 4.
Wedge resection is often used instead of anatomic resection in an attempt to mitigate perioperative risk. In propensity-matched populations, we sought to compare the perioperative outcomes of patients undergoing wedge resection with those undergoing anatomic resection.
The Society of Thoracic Surgery database was reviewed for stage I and II non-small cell lung cancer patients undergoing wedge resection and anatomic resection to analyze postoperative morbidity and mortality. Propensity scores were estimated using a logistic model adjusted for a variety of risk factors. Patients were then matched by propensity score using a greedy 5- to 1-digit matching algorithm, and compared using McNemar's test.
Between 2009 and 2011, 3,733 wedge resection and 3,733 anatomic resection patients were matched. The operative mortality was 1.21% for wedge resection versus 1.93% for anatomic resection (p=0.0118). Major morbidity occurred in 4.53% of wedge resection patients versus 8.97% of anatomic resection patients (p<0.0001). A reduction was noted in the incidence of pulmonary complications, but not cardiovascular or neurologic complications. There was a consistent reduction in major morbidity regardless of age, lung function, or type of incision. Mortality was reduced in patients with preoperative forced expiratory volume in 1 second less than 85% predicted.
Wedge resection has a 37% lower mortality and 50% lower major morbidity rate than anatomic resection in these propensity-matched populations. The mortality benefit is most apparent in patients with forced expiratory volume in 1 second less than 85% predicted. These perioperative benefits must be carefully weighed against the increase in locoregional recurrence and possible decrease in long-term survival associated with the use of wedge resection for primary lung cancers.
楔形切除术常被用于替代解剖性切除术，以降低围手术期风险。在倾向评分匹配人群中，我们试图比较接受楔形切除术与解剖性切除术患者的围手术期结局。
回顾胸外科医师协会数据库中接受楔形切除术和解剖性切除术的Ⅰ期和Ⅱ期非小细胞肺癌患者，分析术后发病率和死亡率。使用针对多种风险因素进行调整的逻辑模型估计倾向评分。然后采用贪婪的5至1位数字匹配算法按倾向评分对患者进行匹配，并使用McNemar检验进行比较。
在2009年至2011年期间，匹配了3733例接受楔形切除术的患者和3733例接受解剖性切除术的患者。楔形切除术的手术死亡率为1.21%，而解剖性切除术为1.93%（p = 0.0118）。4.53%的楔形切除术患者发生了严重并发症，而解剖性切除术患者为8.97%（p < 0.0001）。肺部并发症的发生率有所降低，但心血管或神经系统并发症未降低。无论年龄、肺功能或切口类型如何，严重并发症均持续减少。术前第1秒用力呼气量低于预测值85%的患者死亡率降低。
在这些倾向评分匹配人群中，楔形切除术的死亡率比解剖性切除术低37%，严重并发症发生率低50%。死亡率获益在第1秒用力呼气量低于预测值85%的患者中最为明显。对于原发性肺癌使用楔形切除术所带来的围手术期获益，必须与局部区域复发增加以及可能的长期生存率下降进行仔细权衡。
