Tuminello Stephanie, Liu Bian, Wolf Andrea, Alpert Naomi, Taioli Emanuela, Flores Raja M
Department of Population Health Science and Policy, Institute for Translational Epidemiology.
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Am J Clin Oncol. 2018 Dec;41(12):1149-1153. doi: 10.1097/COC.0000000000000440.
Sublobar resection is often used as an alternative surgical approach in lung cancer patients who are unlikely to tolerate a full lobe resection. This study aims to assess outcomes of video-assisted thoracoscopic surgeries (VATS) sublobar resection as a surgical technique.
The SEER-Medicare database was queried to identify patients with primary lung cancer who had VATS or open sublobar resection. Baseline clinical differences between VATS and open patients were adjusted for in logistic regression and by propensity score matching to investigate surgical outcomes.
Patients undergoing VATS had a greater number of comorbidities (adjusted odds ratio [ORadj], 0.90; 95% confidence interval [CI], 0.85-0.96) and were less likely to have later stage cancer (ORadj, 0.80; 95% CI, 0.67-0.95), squamous compared with adenocarcinoma (ORadj, 0.82; 95% CI, 0.68-0.99), large (>30 mm) tumor size (ORadj, 0.56; 95% CI, 0.0.41-0.75). VATS patients were less likely to have nodes removed for examination during surgery (ORadj, 0.76; 95% CI, 0.64-0.90). After propensity matching (n=2148), patients who underwent VATS were less likely to experience in-hospital complications, blood transfusions, and a prolonged length of hospital stay than those who had open surgery. There was no statistically significant difference in in-hospital or long-term mortality between patients with VATS and open surgery.
In the most compromised lung cancer patients, VATS sublobar resection might be the best option.
对于不太可能耐受全肺叶切除术的肺癌患者，肺段切除术常作为一种替代手术方法。本研究旨在评估电视辅助胸腔镜手术（VATS）肺段切除术作为一种手术技术的疗效。
查询SEER - 医疗保险数据库，以识别接受VATS或开放性肺段切除术的原发性肺癌患者。通过逻辑回归和倾向得分匹配对VATS组和开放手术组患者的基线临床差异进行校正，以研究手术疗效。
接受VATS的患者合并症更多（校正比值比[ORadj]，0.90；95%置信区间[CI]，0.85 - 0.96），患晚期癌症的可能性较小（ORadj，0.80；95% CI，0.67 - 0.95），与腺癌相比，鳞状细胞癌的比例较低（ORadj，0.82；95% CI，0.68 - 0.99），肿瘤较大（>30 mm）的比例较低（ORadj，0.56；95% CI，0.41 - 0.75）。VATS组患者在手术期间切除淋巴结进行检查的可能性较小（ORadj，0.76；95% CI，0.64 - 0.90）。倾向得分匹配后（n = 2148），接受VATS的患者比接受开放手术的患者发生院内并发症、输血和住院时间延长的可能性更小。VATS组和开放手术组患者的院内或长期死亡率无统计学显著差异。
在病情最严重的肺癌患者中，VATS肺段切除术可能是最佳选择。
