Fang Likui, Wang Luming, Wang Yiqing, Lv Wang, Hu Jian
Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
J Cardiothorac Surg. 2018 Dec 17;13(1):128. doi: 10.1186/s13019-018-0813-7.
Surgery is an important part of multidisciplinary treatment strategy for locally advanced lung squamous cell carcinoma (LSCC), but insufficient evidence supports the feasibility and safety of video assisted thoracic surgery (VATS) following neoadjuvant chemotherapy for locally advanced LSCC. This study aims to compare perioperative data and long-term survival of locally advanced LSCC patients between VATS and thoracotomy after neoadjuvant chemotherapy.
We retrospectively collected the clinical and pathological information of patients with locally advanced LSCC who underwent surgical resection after neoadjuvant chemotherapy from October 2013 to October 2017. All patients were divided into two groups (thoracotomy and VATS) and were compared the differences in perioperative, oncological and survival outcomes.
A total of 81 patients were analyzed in this study (67 thoracotomy and 14 VATS). VATS provided less postoperative pain (P = 0.005) and produced less volume of chest drainage (P = 0.019) than thoracotomy, but the number of resected lymph nodes was less in VATS group (P = 0.011). However, there was no significant difference in the number of resected lymph node stations and the rate of nodal upstaging between two groups. The mean disease free survival (DFS) was 32.7 ± 2.7 months for the thoracotomy group and 31.8 ± 3.0 months for the VATS group (P = 0.335); the corresponding overall survival (OS) was 41.7 ± 2.2 months and 36.4 ± 4.1 months (P = 0.925).
In selected patients with locally advanced LSCC, VATS played a positive role in postoperative recovery and associated similar survival outcome compared with thoracotomy after neoadjuvant chemotherapy.
手术是局部晚期肺鳞状细胞癌（LSCC）多学科治疗策略的重要组成部分，但证据不足支持新辅助化疗后行电视辅助胸腔镜手术（VATS）治疗局部晚期LSCC的可行性和安全性。本研究旨在比较新辅助化疗后VATS与开胸手术治疗局部晚期LSCC患者的围手术期数据和长期生存率。
我们回顾性收集了2013年10月至2017年10月间接受新辅助化疗后手术切除的局部晚期LSCC患者的临床和病理信息。所有患者分为两组（开胸手术组和VATS组），比较两组围手术期、肿瘤学和生存结局的差异。
本研究共分析了81例患者（67例行开胸手术，14例行VATS）。与开胸手术相比，VATS术后疼痛较轻（P = 0.005），胸腔引流量较少（P = 0.019），但VATS组切除的淋巴结数量较少（P = 0.011）。然而，两组间切除的淋巴结站数和淋巴结分期升级率无显著差异。开胸手术组的平均无病生存期（DFS）为32.7±2.7个月，VATS组为31.8±3.0个月（P = 0.335）；相应的总生存期（OS）分别为41.7±2.2个月和36.4±4.1个月（P = 0.925）。
在选定的局部晚期LSCC患者中，与新辅助化疗后开胸手术相比，VATS在术后恢复中发挥了积极作用，且生存结局相似。
