Hwang Yoohwa, Kang Chang Hyun, Kim Hye-Seon, Jeon Jae Hyun, Park In Kyu, Kim Young Tae
Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Eur J Cardiothorac Surg. 2015 Aug;48(2):273-8. doi: 10.1093/ejcts/ezu422. Epub 2014 Nov 18.
Thoracoscopic lobectomy has been widely performed on patients with early-stage lung cancer; meanwhile indications of thoracoscopic segmentectomy have not been clearly defined due to technical difficulties and unclear oncological outcomes. The aim of this study was to compare early and late outcomes between thoracoscopic segmentectomy and thoracoscopic lobectomy.
Between January 2005 and December 2013, 100 thoracoscopic segmentectomies and 1049 thoracoscopic lobectomies were performed on patients with lung cancer in our institute. Preoperative clinical parameters including gender, age, tumour size, pathological stage, histology and forced expiratory volume in 1 s (FEV1) were used for propensity score matching. After propensity score matching, 94 thoracoscopic segmentectomies and 94 lobectomies were selected and compared.
Thoracoscopic segmentectomies were performed on patients with normal lung function (mean FEV1 = 101.6 ± 24.1%), small-sized tumour (mean diameter 1.7 ± 1.0 cm), early-stage cancer (Stage I 93.7%) and predominant adenocarcinoma (81.9%). The lobectomy group had similar clinical features with the segmentectomy group. Most commonly performed procedures were left upper lobe upper division segmentectomy (19%) and right lower lobe superior segmentectomy (17%). Segmentectomies were performed in all lobes except the right middle lobe. There were no differences between segmentectomy and lobectomy in terms of operation time (166.3 ± 54.7 min vs 181.1 ± 85.2 min, P = 0.47) and hospital stay (6.2 ± 5.2 days vs 7.1 ± 7.1 days, P = 0.31). Incidence of postoperative complications was non-significantly higher in the lobectomy group (17.2 vs 10.6%, P = 0.1), and postoperative mortality rates were also non-significantly higher in the segmentectomy group (1.1 vs 2.1%, P = 0.56). Postoperative FEV1 decrease was non-significantly lower in the segmentectomy group (8.9 ± 10.8 vs 11.0 ± 13.1, P = 0.36). The 3-year overall survival and recurrence-free survival was not different between the two groups (94 and 87% in the segmentectomy group and 96 and 94% in the lobectomy group, P = 0.62 and P = 0.69, respectively).
Thoracoscopic segmentectomy could achieve equal short-term surgical results and long-term oncological outcomes compared with thoracoscopic lobectomy.
胸腔镜肺叶切除术已广泛应用于早期肺癌患者；与此同时，由于技术难度和肿瘤学结局不明确，胸腔镜肺段切除术的适应证尚未明确界定。本研究的目的是比较胸腔镜肺段切除术和胸腔镜肺叶切除术的早期和晚期结局。
2005年1月至2013年12月期间，我院对肺癌患者实施了100例胸腔镜肺段切除术和1049例胸腔镜肺叶切除术。术前临床参数包括性别、年龄、肿瘤大小、病理分期、组织学类型和第1秒用力呼气量（FEV1）用于倾向评分匹配。倾向评分匹配后，选取94例胸腔镜肺段切除术和94例肺叶切除术进行比较。
胸腔镜肺段切除术用于肺功能正常（平均FEV1 = 101.6 ± 24.1%）、肿瘤较小（平均直径1.7 ± 1.0 cm）、早期癌症（I期93.7%）且以腺癌为主（81.9%）的患者。肺叶切除术组与肺段切除术组具有相似的临床特征。最常实施的手术是左上叶上叶段切除术（19%）和右下叶上段切除术（17%）。除右中叶外，所有肺叶均实施了肺段切除术。肺段切除术和肺叶切除术在手术时间（166.3 ± 54.7分钟对181.1 ± 85.2分钟，P = 0.47）和住院时间（6.2 ± 5.2天对7.1 ± 7.1天，P = 0.31）方面无差异。肺叶切除术组术后并发症发生率略高但无统计学意义（17.2%对10.6%，P = 0.1），肺段切除术组术后死亡率也略高但无统计学意义（1.1%对2.1%，P = 0.56）。肺段切除术组术后FEV1下降略低但无统计学意义（8.9 ± 10.8对11.0 ± 13.1，P = 0.36）。两组的3年总生存率和无复发生存率无差异（肺段切除术组分别为94%和87%，肺叶切除术组分别为96%和94%，P分别为0.62和0.69）。
与胸腔镜肺叶切除术相比，胸腔镜肺段切除术可获得同等的短期手术结果和长期肿瘤学结局。
