Li Shuang-Jiang, Zhou Kun, Wu Yan-Ming, Wang Ming-Ming, Shen Cheng, Wang Zhi-Qiang, Che Guo-Wei, Liu Lun-Xu
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Thoracic Surgery, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing 400030, China.
J Thorac Dis. 2018 Jan;10(1):416-431. doi: 10.21037/jtd.2017.12.70.
The purpose of our cohort study was to investigate the effects of pleural adhesions on perioperative outcomes in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for non-small-cell lung cancer (NSCLC).
We performed a single-center retrospective analysis on the prospectively-maintained dataset at our unit from February 2014 to November 2015. Patients were divided into two groups (Group A: presence of pleural adhesions; Group B: absence of pleural adhesions) according to our grading system of pleural adhesions when entering the chest cavity. Demographic differences in perioperative outcomes between these two groups were initially estimated. A multivariate logistic-regression analysis was then performed to confirm the predictive value of the presence of pleural adhesions.
A total of 593 NSCLC patients undergoing VATS lobectomy were enrolled. The conversion and postoperative morbidity rates were 3.2% and 29.2%, respectively. There were 154 patients with pleural adhesions (Group A) and 439 patients without pleural adhesions (Group B). Group A patients had significantly higher rates of conversion to thoracotomy (9.1% 1.1%; P<0.001) and surgical complications (24.0% 14.4%; P=0.006) than those of Group B patients. No significant difference was found in the overall morbidity and cardiopulmonary complication rates between these two groups. The presence of pleural adhesions was also significantly associated with the prolonged length of chest tube drainage (log-rank P<0.001) and length of stay (log-rank P=0.032). Finally, the presence of pleural adhesions was identified as an independent risk factor for conversion to thoracotomy [odds ratio (OR) =5.49; P=0.003] and surgical complications (OR =1.94; P=0.033) by multivariate logistic-regression analyses.
Presence of pleural adhesions can predict conversion to thoracotomy and postoperative surgical complications in patients undergoing VATS lobectomy for NSCLC. Our study calls for an internationally accepted grading system for the presence of pleural adhesions to stratify the surgical risk.
我们这项队列研究的目的是调查胸膜粘连对接受非小细胞肺癌（NSCLC）电视辅助胸腔镜手术（VATS）肺叶切除术患者围手术期结局的影响。
我们对2014年2月至2015年11月在本单位前瞻性维护的数据集中进行了单中心回顾性分析。根据进入胸腔时我们的胸膜粘连分级系统，将患者分为两组（A组：存在胸膜粘连；B组：不存在胸膜粘连）。初步评估这两组患者围手术期结局的人口统计学差异。然后进行多因素逻辑回归分析以确认胸膜粘连存在的预测价值。
共有593例接受VATS肺叶切除术的NSCLC患者入组。中转开胸率和术后发病率分别为3.2%和29.2%。有154例患者存在胸膜粘连（A组），439例患者不存在胸膜粘连（B组）。A组患者中转开胸率（9.1%对1.1%；P<0.001）和手术并发症发生率（24.0%对14.4%；P=0.006）显著高于B组患者。两组患者的总体发病率和心肺并发症发生率无显著差异。胸膜粘连的存在也与胸腔引流管留置时间延长（对数秩检验P<0.001）和住院时间延长（对数秩检验P=0.032）显著相关。最后，通过多因素逻辑回归分析，胸膜粘连的存在被确定为中转开胸（比值比[OR]=5.49；P=0.003）和手术并发症（OR=1.94；P=0.033）的独立危险因素。
胸膜粘连的存在可预测接受NSCLC的VATS肺叶切除术患者中转开胸和术后手术并发症。我们的研究呼吁建立一个国际认可的胸膜粘连存在分级系统，以对手术风险进行分层。
