Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
School of Clinical Sciences, University of Bristol, Bristol, UK.
Eur J Cardiothorac Surg. 2018 Feb 1;53(2):342-347. doi: 10.1093/ejcts/ezx297.
As the practice of video-assisted thoracoscopic surgery (VATS) lobectomy gains widespread acceptance, the complexity of procedures attempted increases and the stage of tumour that may be safely approached remains controversial. We examined the impact of nodal involvement with respect to perioperative outcomes after VATS lobectomy.
All patients listed for VATS lobectomy for non-small-cell lung cancer at our institution from 2012 to 2016 were analysed. Bronchoplastic or chest wall resections and tumours over 7 cm were considered a contraindication to a thoracoscopic approach.
Of the 489 patients identified, 97 (19.8%) patients had pathological nodal involvement. The overall conversion rate was 6.1%, reoperation rate was 5.3% and readmission rate was 5.9%. Median hospital stay was 5 days, 30-day mortality was 0.6% and 90-day mortality was 1.6%. No significant difference was identified between the nodal-negative or -positive groups in terms of preoperative demographics, hospital stay, postoperative complications, conversion rate, reoperation rate or readmission rate. Univariate logistic regression identified gender, Thoracoscore, dyspnoea score, performance status, chronic obstructive pulmonary disease, previous stroke, preoperative lung function and non-adenocarcinoma as predictors of postoperative complications. A multivariate model including nodal status identified Thoracoscore (odds ratio 1.57, 95% confidence interval 1.16-2.18; P < 0.001) and preoperative transfer factor (odds ratio 0.97, 95% confidence interval 0.96-0.98; P < 0.001) as the only predictors of complications.
In non-small-cell lung cancer patients with pathological hilar or mediastinal lymph node involvement, VATS lobectomy can be safely performed, as there does not appear to be an adverse effect on the incidence of perioperative complications, length of stay or readmissions.
随着电视辅助胸腔镜手术（VATS）肺叶切除术的广泛应用，手术的复杂性增加，可安全进行的肿瘤分期仍存在争议。我们研究了淋巴结受累对 VATS 肺叶切除术后围手术期结果的影响。
对我院 2012 年至 2016 年期间所有接受 VATS 肺叶切除术治疗非小细胞肺癌的患者进行分析。支气管成形术或胸壁切除术和直径超过 7cm 的肿瘤被认为是胸腔镜入路的禁忌症。
在 489 例患者中，97 例（19.8%）患者存在病理性淋巴结受累。总体中转开胸率为 6.1%，再次手术率为 5.3%，再次入院率为 5.9%。中位住院时间为 5 天，30 天死亡率为 0.6%，90 天死亡率为 1.6%。淋巴结阴性或阳性组在术前人口统计学特征、住院时间、术后并发症、中转开胸率、再次手术率或再次入院率方面无显著差异。单因素逻辑回归分析发现，性别、胸科评分、呼吸困难评分、体力状态、慢性阻塞性肺疾病、既往卒中、术前肺功能和非腺癌是术后并发症的预测因素。包括淋巴结状态的多因素模型确定胸科评分（优势比 1.57，95%置信区间 1.16-2.18；P<0.001）和术前转移因子（优势比 0.97，95%置信区间 0.96-0.98；P<0.001）是并发症的唯一预测因素。
在存在病理性肺门或纵隔淋巴结受累的非小细胞肺癌患者中，VATS 肺叶切除术是安全可行的，因为似乎不会对围手术期并发症的发生率、住院时间或再入院率产生不利影响。
