比较肌保留开胸术与电视辅助胸腔镜手术治疗 cT1N0M0 期肺癌的疗效。

Comparison of outcomes between muscle-sparing thoracotomy and video-assisted thoracic surgery in patients with cT1 N0 M0 lung cancer.

机构信息

Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.

Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China; Department of Intervention Therapy, Fudan University Shanghai Cancer Center, Shanghai, China.

出版信息

J Thorac Cardiovasc Surg. 2017 Oct;154(4):1420-1429.e1. doi: 10.1016/j.jtcvs.2017.04.071. Epub 2017 May 20.

DOI:10.1016/j.jtcvs.2017.04.071

PMID:28651940

Abstract

OBJECTIVE

To compare short-term complications and long-term survival outcomes between muscle-sparing thoracotomy (MST) and video-assisted thoracic surgery (VATS) groups using a propensity-score matching process.

METHODS

One thousand eighty-three patients with cT1 N0 M0 lung cancer from January 2009 to December 2014 who underwent lobectomy and a systematic lymph node dissection were retrospectively included, and statistical analyses including a propensity-score matching process were used to compare short-term and long-term outcomes.

RESULTS

Before propensity-score matching, for short-term surgical outcomes, the VATS group had fewer chest tube dwelling days (P < .001), less chest tube output (P < .001), shorter hospital stay, and fewer postoperative complications (P = .015). For long-term survival outcomes, the VATS group had a longer recurrence-free survival (P < .001) and overall survival (P < .001). After propensity-score matching, for short-term surgical outcomes, the VATS group had fewer chest tube dwelling days (P < .001), less chest tube output (P < .001), shorter hospital stay (P = .002), and fewer postoperative complications (P = .008). There was no difference in recurrence-free survival and overall survival between the 2 groups (P = .158 and P = .639, respectively).

CONCLUSIONS

VATS is less invasive and is associated with shorter length of hospital stay and fewer postoperative complications. The 2 surgical approaches have equivalent long-term survival outcomes.

摘要

目的

通过倾向评分匹配过程比较保留肌肉的剖胸术（MST）和电视辅助胸腔镜手术（VATS）组的短期并发症和长期生存结果。

方法

回顾性纳入了 2009 年 1 月至 2014 年 12 月期间接受肺叶切除术和系统性淋巴结清扫术的 1083 例 cT1N0M0 肺癌患者，使用倾向评分匹配过程进行统计分析，以比较短期和长期结果。

结果

在进行倾向评分匹配之前，对于短期手术结果，VATS 组的胸腔引流管留置天数（P<.001）、胸腔引流管引流量（P<.001）、住院时间较短，术后并发症较少（P=.015）。对于长期生存结果，VATS 组无复发生存率（P<.001）和总生存率（P<.001）较长。在进行倾向评分匹配后，对于短期手术结果，VATS 组的胸腔引流管留置天数（P<.001）、胸腔引流管引流量（P<.001）、住院时间（P=.002）较短，术后并发症较少（P=.008）。两组无复发生存率和总生存率无差异（P=.158 和 P=.639）。