Yang Zhiqiang, Zhai Chunbo
Department of Thoracic Surgery, Weifang People's Hospital, Shandong Province, Weifang, 261041, China.
J Cardiothorac Surg. 2018 Apr 24;13(1):33. doi: 10.1186/s13019-018-0714-9.
Several retrospective studies have confirmed that video-assisted thoracoscopic surgery (VATS) following neoadjuvant chemotherapy is a safe and feasible treatment for advanced non-small cell lung cancer patients. As a minimally invasive technique, VATS usually leads to better clinical outcomes and better compliance with adjuvant treatment than conventional thoracotomy. Uniportal VATS (U-VATS) as an alternative option to conventional multi-port VATS has attracted much attention recently because reduced number and size of incisions may help to decrease inflammatory response and reduce postoperative pain for patients. However, rarely studies have reported the application of U-VATS following neoadjuvant chemotherapy for the treatment of advanced lung cancer patients.
A total of 29 lung cancer patients undergoing VATS following neoadjuvant chemotherapy were included in this study. The clinical data of these patients were retrospectively analyzed, including the preoperative neoadjuvant chemotherapy plan, surgical effect, postoperative complications, operation time, operative blood loss, number of lymph nodes dissected and postoperative mortality.
All patients underwent VATS following two cycles of neoadjuvant chemotherapy. Among these patients, 26 completed U-VATS, two were converted to triple-port VATS, and one was converted to open thoracotomy. The operation time ranged from 120 min to 300 min (mean: 160 ± 38.5 min); the operative blood loss was 50-500 ml (mean:167.8 ± 78.4 ml); the number of lymph nodes dissected was 16-28 (mean: 21.9 ± 3.7); the postoperative drainage time was 3-13 d (mean: 5.6 ± 1.9 d); and the postoperative hospital stay was 6-16 d (7.7 ± 1.9 d). Postoperative complications occurred in five (17.2%) patients, including three cases of respiratory infection, one case of air leakage (more than two weeks), and one case of wound infection. In addition, the 30- and 90-day postoperative mortality was zero.
U-VATS following neoadjuvant chemotherapy is feasible and safe for the treatment of advanced lung cancer patients.
多项回顾性研究证实，新辅助化疗后行电视辅助胸腔镜手术（VATS）对晚期非小细胞肺癌患者是一种安全可行的治疗方法。作为一种微创技术，与传统开胸手术相比，VATS通常能带来更好的临床效果和更高的辅助治疗依从性。单孔VATS（U-VATS）作为传统多孔VATS的替代选择，近年来备受关注，因为切口数量和尺寸的减少可能有助于减轻患者的炎症反应并减轻术后疼痛。然而，很少有研究报道新辅助化疗后应用U-VATS治疗晚期肺癌患者的情况。
本研究共纳入29例新辅助化疗后行VATS的肺癌患者。对这些患者的临床资料进行回顾性分析，包括术前新辅助化疗方案、手术效果、术后并发症、手术时间、术中出血量、清扫淋巴结数量及术后死亡率。
所有患者在接受两个周期的新辅助化疗后行VATS。其中，26例完成了U-VATS，2例转为三孔VATS，1例转为开胸手术。手术时间为120分钟至300分钟（平均：160±38.5分钟）；术中出血量为50 - 500毫升（平均：167.8±78.4毫升）；清扫淋巴结数量为16 - 28个（平均：21.9±3.7个）；术后引流时间为3 - 13天（平均：5.6±1.9天）；术后住院时间为6 - 16天（7.7±1.9天）。5例（17.2%）患者发生术后并发症，包括3例呼吸道感染、1例漏气（超过两周）和1例伤口感染。此外，术后30天和90天死亡率为零。
新辅助化疗后行U-VATS治疗晚期肺癌患者是可行且安全的。
