Reichert Martin, Kerber Stefanie, Pösentrup Bernd, Bender Julia, Schneck Emmanuel, Augustin Florian, Öfner Dietmar, Padberg Winfried, Bodner Johannes
Department of General, Visceral, Thoracic, Transplant and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Giessen, Rudolf-Buchheim Strasse 7, 35392, Giessen, Germany.
Langenbecks Arch Surg. 2016 Sep;401(6):867-75. doi: 10.1007/s00423-016-1478-0. Epub 2016 Jul 25.
Based on increasing evidence of its benefits regarding perioperative and oncologic outcome, video-assisted thoracoscopic surgery (VATS) has gained increasing acceptance in the surgical treatment of early stage non-small cell lung cancer (NSCLC). However, the evidence for a VATS approach in anatomic lung resection for benign pulmonary diseases is still limited.
Between March 2011 and May 2014, data from 33 and 63 patients who received VATS anatomic lung resection for benign diseases (VATS-B) and early stage NSCLC (VATS-N), respectively, were analyzed retrospectively. For subgroup analyses, VATS-B was subdivided by operation time and underlying diseases. Subgroups were compared to VATS-N.
Three patients from VATS-B and four from VATS-N experienced conversion to open surgery. Causes of conversion in VATS-B were intraoperative complications, whereas conversions in VATS-N were elective for oncological concerns (p < 0.05). Operation time and duration of postoperative mechanical ventilation were longer by tendency; postoperative stay on intensive care unit and chest tube duration were significantly longer in VATS-B. Subgroup analyses showed a longer operation time as a predictor for worse perioperative outcome regarding postoperative mechanical ventilation, postoperative stay on intensive care unit, chest tube duration, and length of hospital stay. Patients with longer operation time suffered from more postoperative complications. Differences in perioperative outcome data were not significantly dependent on the underlying benign diseases compared to VATS-N.
VATS is feasible and safe in anatomic lung resection for benign pulmonary diseases. Not the underlying disease, but a longer operation time is a factor for worse postoperative outcome.
鉴于视频辅助胸腔镜手术（VATS）在围手术期及肿瘤学结局方面的益处的证据不断增加，其在早期非小细胞肺癌（NSCLC）手术治疗中的接受度也日益提高。然而，VATS用于良性肺部疾病的解剖性肺切除的证据仍然有限。
回顾性分析2011年3月至2014年5月期间分别接受VATS解剖性肺切除治疗良性疾病（VATS-B）和早期NSCLC（VATS-N）的33例和63例患者的数据。为进行亚组分析，VATS-B根据手术时间和基础疾病进行细分。将各亚组与VATS-N进行比较。
VATS-B组有3例患者和VATS-N组有4例患者转为开胸手术。VATS-B组中转开胸的原因是术中并发症，而VATS-N组中转开胸是出于肿瘤学考虑的选择性手术（p<0.05）。手术时间和术后机械通气时间有延长的趋势；VATS-B组在重症监护病房的术后停留时间和胸管留置时间明显更长。亚组分析显示，手术时间较长是术后机械通气、重症监护病房术后停留时间、胸管留置时间和住院时间等围手术期结局较差的预测因素。手术时间较长的患者术后并发症更多。与VATS-N组相比，围手术期结局数据的差异并不显著取决于基础良性疾病。
VATS用于良性肺部疾病的解剖性肺切除是可行且安全的。术后结局较差的因素不是基础疾病，而是手术时间较长。
