Department of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy.
Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
Eur J Cardiothorac Surg. 2017 Dec 1;52(6):1041-1048. doi: 10.1093/ejcts/ezx272.
The European Society of Thoracic Surgeons (ESTS) registry was created 10 years ago and represents an international database collecting thoracic surgery procedures from European contributors. The purpose of the present report was to offer an overview of baseline and surgical characteristics and outcomes of patients submitted to lung resections for malignant lung disease as derived from the ESTS registry.
We retrieved data about all lung resections from 2007 to 2016 performed for primary and metastatic (secondary) lung cancer. We evaluated the baseline characteristics and the surgical management of this population. Within the subgroup of patients affected by primary lung cancer, we described the preoperative mediastinal staging management and the final pathological stage of disease. Finally, we analysed the morbidity and mortality rates for the cohort of patients submitted to anatomic lung resections for primary or secondary lung cancer. Outcomes were also evaluated in relation to several risk factors: type of resection, age, comorbidity, predicted postoperative forced expiratory volume in 1 s and surgical approach.
We selected 62 774 patients submitted to lung resections (male 66.5%, median age 64 years). For the entire population, median predicted postoperative forced expiratory volume in 1 s was 73.3% (interquartile range: 59, 87.6), 33.8% of patients had cardiac comorbidities and 17.3% had other comorbidities. Among the patients with primary lung cancer (51 931 patients), 50.8% had Stage I disease and 23.2% Stage II disease; preoperative invasive mediastinal staging was performed in 70.3% of patients with computed tomography scan nodal enlargement and positron emission tomography scan nodal uptake. After anatomical lung resection (51 756 patients), overall morbidity was 18.5% and mortality (30 days or in-hospital) was 2.6%. Extent of resection, age ≥75 years, presence of cardiac comorbidity, predicted postoperative forced expiratory volume in 1 s <70% and open approach instead of video-assisted thoracic surgery were associated with worse outcomes.
The results of the present report represent reliable European benchmarks for comparing the activities and outcomes of single institutions and surgeons at an international level.
欧洲胸外科协会（ESTS）注册成立于 10 年前，是一个收集欧洲贡献者胸外科手术的国际数据库。本报告的目的是提供一个概述，说明从 ESTS 注册中获得的接受肺切除术治疗恶性肺部疾病的患者的基线和手术特征及结果。
我们检索了 2007 年至 2016 年间因原发性和转移性（继发性）肺癌行肺切除术的数据。我们评估了该人群的基线特征和手术管理。在原发性肺癌患者亚组中，我们描述了术前纵隔分期管理和疾病的最终病理分期。最后，我们分析了接受原发性或继发性肺癌解剖性肺切除术的患者的发病率和死亡率。结果还与多个危险因素相关：切除类型、年龄、合并症、预测术后 1 秒用力呼气量和手术方法。
我们选择了 62774 例接受肺切除术的患者（男性占 66.5%，中位年龄 64 岁）。对于整个人群，预测术后 1 秒用力呼气量中位数为 73.3%（四分位距：59，87.6），33.8%的患者有心脏合并症，17.3%有其他合并症。在原发性肺癌患者中（51931 例），50.8%为Ⅰ期疾病，23.2%为Ⅱ期疾病；70.3%的患者因 CT 扫描淋巴结肿大和正电子发射断层扫描淋巴结摄取而进行了术前侵袭性纵隔分期。在接受解剖性肺切除术后（51756 例），总发病率为 18.5%，30 天死亡率（或院内死亡率）为 2.6%。切除范围、年龄≥75 岁、存在心脏合并症、预测术后 1 秒用力呼气量<70%以及开放方法而不是电视辅助胸腔镜手术与较差的结果相关。
本报告的结果代表了可靠的欧洲基准，可用于在国际水平上比较单个机构和外科医生的活动和结果。
