Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA.
Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Ann Surg. 2021 Mar 1;273(3):595-605. doi: 10.1097/SLA.0000000000003231.
To compare outcomes after open versus thoracoscopic (VATS) lobectomy for clinical stage II (cN1) non-small-cell lung cancer (NSCLC).
There have been no published studies evaluating the impact of a VATS approach to lobectomy for N1 NSCLC on short-term outcomes and survival.
Outcomes of patients with clinical T1-2, N1, M0 NSCLC who underwent lobectomy without induction therapy in the National Cancer Data Base (2010-2012) were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.
Median follow-up of 1559 lobectomies (1204 open and 355 VATS) was 43.2 months. The VATS approach was associated with a shorter median hospitalization (5 vs 6 d, P < 0.001) than the open approach. There were no significant differences between the VATS and open approach with regard to nodal upstaging (12.0% vs 10.5%, P = 0.41), 30-day mortality (2.3% vs 3.1%, P = 0.31), and overall survival (5-yr survival: 48.6% vs 48.7%, P = 0.76; multivariable-adjusted HR for VATS approach: 1.08, 95% CI: 0.90-1.30, P = 0.39). A propensity score-matched analysis of 334 open and 334 VATS patients who were well matched by 14 common prognostic covariates, including tumor size, and comorbidities, continued to show no significant differences in nodal upstaging, 30-day mortality, and 5-year survival between the VATS and open groups.
In this national analysis, VATS lobectomy was used in the minority of N1 NSCLC cases but was associated with shorter hospitalization and similar nodal upstaging rates, 30-day mortality, and long-term survival when compared to open lobectomy. These findings suggest thoracoscopic techniques are feasible for the treatment of stage II (cN1) NSCLC.
比较临床 II 期（cN1）非小细胞肺癌（NSCLC）患者行开胸肺叶切除术与电视辅助胸腔镜手术（VATS）肺叶切除术的治疗效果。
目前尚无研究评估 VATS 肺叶切除术治疗 N1 NSCLC 对短期结局和生存的影响。
利用多变量 Cox 比例风险模型和倾向评分匹配分析，评估了国家癌症数据库（2010-2012 年）中接受无诱导治疗的临床 T1-2、N1、M0 NSCLC 患者行肺叶切除术的患者结局。
1204 例开胸肺叶切除术和 355 例 VATS 肺叶切除术的中位随访时间为 1559 例（43.2 个月）。与开胸肺叶切除术相比，VATS 肺叶切除术的中位住院时间更短（5 天 vs. 6 天，P＜0.001）。VATS 肺叶切除术与开胸肺叶切除术在淋巴结分期升级（12.0% vs. 10.5%，P=0.41）、30 天死亡率（2.3% vs. 3.1%，P=0.31）和总生存率（5 年生存率：48.6% vs. 48.7%，P=0.76；VATS 组多变量调整 HR：1.08，95%CI：0.90-1.30，P=0.39）方面无显著差异。对 334 例 VATS 患者和 334 例开胸肺叶切除术患者进行倾向评分匹配分析，14 个常见预后协变量（包括肿瘤大小和合并症）匹配良好，结果仍显示 VATS 组和开胸组在淋巴结分期升级、30 天死亡率和 5 年生存率方面无显著差异。
在这项全国性分析中，VATS 肺叶切除术仅用于少数 N1 NSCLC 病例，但与开胸肺叶切除术相比，其具有较短的住院时间和相似的淋巴结分期升级率、30 天死亡率和长期生存率。这些发现表明，胸腔镜技术可用于治疗 II 期（cN1）NSCLC。
