Duke University Medical Center, Durham, NC.
Roswell Park Cancer Institute, Buffalo, NY.
J Thorac Cardiovasc Surg. 2019 Jul;158(1):252-264.e2. doi: 10.1016/j.jtcvs.2018.12.001. Epub 2018 Dec 18.
The objective of this study was to evaluate the impact of the video-assisted thoracoscopic (VATS) approach on the outcomes of patients who underwent pneumonectomy.
The effect of the surgical approach on perioperative complications and survival in patients who underwent pneumonectomy for nonmetastatic non-small cell lung cancer across 3 institutions (2000-2016) was assessed using multivariable logistic regression, Cox proportional hazards analysis, and propensity-score matching. Completion pneumonectomies were excluded from this study, and an "intent-to-treat" analysis was performed.
During the study period, 359 patients met inclusion criteria and underwent pneumonectomy for nonmetastatic non-small cell lung cancer; 124 (35%) underwent pneumonectomy via VATS and 235 (65%) via thoracotomy. Perioperative mortality (VATS, 7% [n = 9] vs open, 8% [n = 19]; P = .75) and morbidity (VATS, 28% [n = 35] vs open, 28% [n = 65]; P = .91) were similar between the groups, even after multivariable adjustment. VATS showed similar 5-year survival when compared with thoracotomy in unadjusted analysis (47% [95% confidence interval (CI), 36-56] vs 33% [95% CI, 27-40]; P = .19), even after multivariable adjustment (hazard ratio, 0.76 [95% CI, 0.50-1.18]; P = .23). In a propensity score-matched analysis that balanced patient characteristics, there were no significant differences found in overall survival between the 2 groups (P = .69).
Although the role of VATS pneumonectomy will likely become clearer as more surgeons report results, this multicenter study suggests that the VATS approach for pneumonectomy can be performed safely, with at least equivalent oncologic outcomes when compared with thoracotomy.
本研究旨在评估电视辅助胸腔镜（VATS）手术入路对非转移性非小细胞肺癌患者肺切除术结果的影响。
通过多变量逻辑回归、Cox 比例风险分析和倾向评分匹配，评估了手术入路对 3 家机构（2000-2016 年）接受非转移性非小细胞肺癌肺切除术患者围手术期并发症和生存的影响。本研究排除了完成性肺切除术，进行了“意向治疗”分析。
在研究期间，359 名符合纳入标准的患者接受了非转移性非小细胞肺癌肺切除术；124 例（35%）通过 VATS 进行肺切除术，235 例（65%）通过开胸手术进行。围手术期死亡率（VATS，7%[n=9]比开胸，8%[n=19]；P=0.75）和发病率（VATS，28%[n=35]比开胸，28%[n=65]；P=0.91）在两组之间相似，即使在多变量调整后也是如此。在未调整分析中，VATS 与开胸术相比，5 年生存率相似（47%[95%置信区间（CI），36-56]比 33%[95% CI，27-40]；P=0.19），即使在多变量调整后也是如此（风险比，0.76[95% CI，0.50-1.18]；P=0.23）。在平衡患者特征的倾向评分匹配分析中，两组之间的总生存率无显著差异（P=0.69）。
尽管随着越来越多的外科医生报告结果，VATS 肺切除术的作用可能会更加明确，但这项多中心研究表明，与开胸术相比，VATS 入路进行肺切除术是安全的，并且至少具有相当的肿瘤学结果。
