Rodgers-Fischl Peter M, Martin Jeremiah T, Saha Sibu P
From the Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington.
South Med J. 2017 Mar;110(3):229-233. doi: 10.14423/SMJ.0000000000000620.
Video-assisted thoracoscopic (VATS) lobectomy is considered a promising surgical therapy for the diagnosis and treatment of non-small-cell lung carcinoma. The issue of whether VATS is superior to open thoracotomy remains controversial, however. We sought to determine whether the use of VATS lobectomy for diagnosing and treating non-small-cell lung carcinoma would improve patient outcomes at our institution.
A retrospective review of electronic and paper medical charts identified 109 consecutive operations for all patients undergoing thoracotomy or VATS lobectomy performed at the University of Kentucky Chandler Medical Center for fiscal years 2013 and 2014. Variables of interest included operative procedure (thoracotomy vs VATS) and operative findings (pathologic stage, operative time, postoperative length of stay [LOS], time spent in the intensive care unit, postoperative complications, direct cost).
The demographic characteristics of the patients of both groups were similar in terms of sex (64.6% vs 44.3% male) and age (62.4 vs 61.6 years), but not stage, which was higher in the thoracotomy group. The overall operative procedure time (170.6 vs 196.3 minutes), postoperative LOS (5.7 vs 5.5 days), number of lymph nodes sampled (6.2 vs 7.0), and time spent in the intensive care unit (2.1 vs 2.4 days) did not vary between both groups. The average cost per procedure did not vary significantly-$14,003.61 compared with $15,588.11 for thoracotomy and VATS, respectively.
In our study, the VATS group was associated with no reduction in postoperative LOS and a nonsignificant reduction in the amount of time spent in the intensive care unit. Postoperative perception of pain did not vary between either group. Pain perception did, however, correlate strongly with time from operation. Cost did not vary significantly between both groups, with VATS being equivalent to thoracotomy in terms of cost at our institution. In our experience, VATS is an effective, minimally invasive, and safe approach for the resection of lung nodules.
电视辅助胸腔镜（VATS）肺叶切除术被认为是诊断和治疗非小细胞肺癌的一种有前景的手术治疗方法。然而，VATS是否优于开胸手术这一问题仍存在争议。我们试图确定在我们机构使用VATS肺叶切除术诊断和治疗非小细胞肺癌是否会改善患者的治疗效果。
对电子和纸质病历进行回顾性分析，确定了2013财年和2014财年在肯塔基大学钱德勒医疗中心接受开胸手术或VATS肺叶切除术的所有患者的109例连续手术。感兴趣的变量包括手术方式（开胸手术与VATS）和手术结果（病理分期、手术时间、术后住院时间[LOS]、在重症监护病房的时间、术后并发症、直接费用）。
两组患者的人口统计学特征在性别（男性分别为64.6%和44.3%）和年龄（分别为62.4岁和61.6岁）方面相似，但分期不同，开胸手术组的分期更高。两组之间的总体手术时间（170.6分钟对196.3分钟）、术后住院时间（5.7天对5.5天）、采样淋巴结数量（6.2个对7.0个）以及在重症监护病房的时间（2.1天对2.4天）没有差异。每个手术的平均费用没有显著差异——开胸手术和VATS分别为14,003.61美元和15,588.11美元。
在我们的研究中，VATS组术后住院时间没有缩短，在重症监护病房的时间减少不显著。两组之间术后疼痛感受没有差异。然而，疼痛感受与手术时间密切相关。两组之间费用没有显著差异，在我们机构VATS在费用方面与开胸手术相当。根据我们的经验，VATS是切除肺结节的一种有效、微创且安全的方法。
