Desai Hem, Natt Bhupinder, Kim Samuel, Bime Christian
1 Department of Medicine.
2 Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, and.
Ann Am Thorac Soc. 2017 Feb;14(2):262-266. doi: 10.1513/AnnalsATS.201606-429OC.
There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by video-assisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared with lobectomy performed by thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared with open surgical lobectomy.
We used data from the United States Healthcare Cost and Utilization Project Nationwide Inpatient Sample database from 2009 to 2012 to compare VATS with open lobectomy for in-hospital mortality and other short-term outcomes.
We used International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes to identify the patients undergoing lobectomy. We used 1:1 ratio propensity matching with the nearest neighbor method without replacement to generate matched pairs.
Over the 4-year period, 27,451 patients underwent lobectomy. The majority of these procedures were performed by thoracotomy (65%) as compared with VATS (35%). A total of 9,393 matched pairs were created. VATS lobectomy was associated with significantly lower in-hospital mortality when compared with thoracotomy (1.3% vs. 2.5%, P < 0.001). A shorter length of hospital stay was observed for those undergoing VATS lobectomy (6.21 vs. 8.75 d, P < 0.001). The overall rate of perioperative complications was low, with those undergoing VATS being less likely to have any perioperative morbidity.
In recent years, the use of VATS for lobectomy has increased relative to thoracotomy. This trend has coincided with increased survival and shorter length of stay for VATS lobectomy compared with thoracotomy. Further studies are needed to identify comorbidities that identify ideal candidates for VATS lobectomy.
关于肺叶切除术的最佳手术方式，相关数据较少。与开胸肺叶切除术相比，电视辅助胸腔镜手术（VATS）进行的肺叶切除术的发病率较低。然而，尚无多中心研究表明VATS肺叶切除术与开放性手术肺叶切除术相比能降低死亡率。
我们使用了2009年至2012年美国医疗成本和利用项目全国住院患者样本数据库中的数据，比较VATS与开放性肺叶切除术的住院死亡率及其他短期结局。
我们使用国际疾病分类第九版临床修订版手术编码来识别接受肺叶切除术的患者。我们采用1:1比例的倾向评分匹配法，使用最近邻法且不进行替换，以生成匹配对。
在这4年期间，27451例患者接受了肺叶切除术。与VATS（35%）相比，这些手术大多数是通过开胸手术进行的（65%）。共创建了9393对匹配对。与开胸手术相比，VATS肺叶切除术的住院死亡率显著更低（1.3%对2.5%，P<0.001）。接受VATS肺叶切除术的患者住院时间更短（6.21天对8.75天，P<0.001）。围手术期并发症的总体发生率较低，接受VATS手术的患者发生任何围手术期发病的可能性较小。
近年来，与开胸手术相比，VATS用于肺叶切除术的情况有所增加。这一趋势与VATS肺叶切除术相比开胸手术生存率提高和住院时间缩短相吻合。需要进一步研究以确定能识别出VATS肺叶切除术理想候选者的合并症。
