Kamel Mohamed K, Nasar Abu, Stiles Brendon M, Altorki Nasser K, Port Jeffrey L
Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York Presbyterian Hospital , New York, New York.
J Laparoendosc Adv Surg Tech A. 2017 May;27(5):495-500. doi: 10.1089/lap.2016.0540. Epub 2016 Dec 20.
A video-assisted thoracoscopic surgical (VATS) resection, after induction chemotherapy, has long been considered a relative contraindication. We report our experience with VATS lobectomy after induction chemotherapy for patients with nonsmall cell lung cancer (NSCLC), with propensity-matched group of patients, who underwent an open approach, to determine safety and oncological outcome.
A retrospective review of a prospective database (2002-2014) was performed to identify patients undergoing potentially curative lobectomy for NSCLC after induction therapy. Propensity score matching (age, gender, and clinical stage) was performed (1:2) to obtain a balanced cohort of patients undergoing VATS resection and thoracotomy.
A total of 285 patients underwent lobectomy after induction therapy, 114 were propensity matched (VATS, n = 40, thoracotomy, n = 74). There were no differences in the clinicopathological factors or type of induction therapy (conventional versus targeted) between VATS and thoracotomy groups. Similarly, no differences were found in the number of lymph nodes resected (12 versus 15, P = .94), the number of stations sampled (4 for each, P = .68), or in the rate of R0 resection (95% versus 96%, P = .81) between VATS and thoracotomy groups. Five VATS cases were converted to an open approach because of adhesions. VATS resection was associated with less estimated blood loss (EBL), shorter length of stay (LOS), and a trend toward fewer postoperative complications. There was no difference in 5 years disease-free survival (DFS) between VATS and thoracotomy groups (73% versus 48%, P = .09). Similarly, for patients who presented with cN2, there were no differences between thoracotomy and VATS groups in DFS (P = .37). On multi-variable analysis (MVA), only the clinical N1/2 status [Hazard ratio (HR): 4.86, P < .001] independently predicted poor DFS.
A VATS lobectomy is a feasible, safe, and oncologically sound approach after induction therapy for NSCLC. When compared with thoracotomy, VATS lobectomy is associated with lower EBL, shorter LOS, and a trend toward fewer postoperative complications.
诱导化疗后行电视辅助胸腔镜手术（VATS）切除长期以来被视为相对禁忌证。我们报告了对非小细胞肺癌（NSCLC）患者诱导化疗后行VATS肺叶切除术的经验，并与倾向匹配的接受开放手术的患者组进行比较，以确定其安全性和肿瘤学结局。
对前瞻性数据库（2002 - 2014年）进行回顾性分析，以确定诱导治疗后接受潜在根治性肺叶切除术的NSCLC患者。进行倾向评分匹配（年龄、性别和临床分期）（1:2），以获得接受VATS切除和开胸手术的平衡患者队列。
共有285例患者在诱导治疗后接受了肺叶切除术，114例进行了倾向匹配（VATS组，n = 40；开胸手术组，n = 74）。VATS组和开胸手术组在临床病理因素或诱导治疗类型（传统与靶向）方面无差异。同样，VATS组和开胸手术组在切除的淋巴结数量（12个对15个，P = 0.94）、采样站数量（每组4个，P = 0.68）或R0切除率（95%对96%，P = 0.81）方面也无差异。5例VATS病例因粘连改为开放手术。VATS切除与估计失血量（EBL）较少、住院时间（LOS）较短以及术后并发症较少的趋势相关。VATS组和开胸手术组的5年无病生存率（DFS）无差异（73%对48%，P = 0.09）。同样，对于cN2期患者，开胸手术组和VATS组的DFS无差异（P = 0.37）。在多变量分析（MVA）中，只有临床N1/2状态[风险比（HR）：4.86，P < 0.001]独立预测DFS较差。
VATS肺叶切除术是NSCLC诱导治疗后一种可行、安全且肿瘤学合理的方法。与开胸手术相比，VATS肺叶切除术与较低的EBL、较短的LOS以及术后并发症较少的趋势相关。
