Tosi Davide, Nosotti Mario, Bonitta Gianluca, Mazzucco Alessandra, Righi Ilaria, Mendogni Paolo, Rosso Lorenzo, Palleschi Alessandro, Rocco Gaetano, Crisci Roberto
Thoracic Surgery and Lung Transplant Unit, Fondazione Irccs Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Interact Cardiovasc Thorac Surg. 2019 Nov 1;29(5):714-721. doi: 10.1093/icvts/ivz153.
This study compares the uniportal with the 3-portal video-assisted thoracic surgery (VATS) by examining the data collected in the Italian VATS Group Database. The primary end point was early postoperative pain; secondary end points were intraoperative and postoperative complications, surgical time, number of dissected lymph nodes and length of stay.
This was an observational, retrospective, cohort, multicentre study on data collected by 49 Italian thoracic units. Inclusion criteria were clinical stage I-II non-small-cell lung cancer, uniportal or 3-portal VATS lobectomy and R0 resection. Exclusion criteria were cT3 disease, previous thoracic malignancy, induction therapy, significant comorbidities and conversion to other techniques. The pain parameter was dichotomized: the numeric rating scale ≤3 described mild pain, whereas the numeric rating scale score >3 described moderate/severe pain. The propensity score-adjusted generalized estimating equation was used to compare the uniportal with 3-portal lobectomy.
Among 4338 patients enrolled from January 2014 to July 2017, 1980 met the inclusion criteria; 1808 patients underwent 3-portal lobectomy and 172 uniportal surgery. The adjusted generalized estimating equation regression model using the propensity score showed that over time pain decreased in both groups (P < 0.001). There was a statistical difference on the second and third postoperative days; odds ratio (OR) 2.28 [95% confidence interval (CI) 1.62-3.21; P < 0.001] and OR 2.58 (95% CI 1.74-3.83; P < 0.001), respectively. The uniportal-VATS group had higher operative time (P < 0.001), shorter chest drain permanence (P < 0.001) and shorter length of stay (P < 0.001).
Data from the Italian VATS Group Database showed that in clinical practice uniportal lobectomy seems to entail a higher risk of moderate/severe pain on second and third postoperative days.
本研究通过分析意大利电视辅助胸腔镜手术（VATS）组数据库中收集的数据，比较单孔与三孔电视辅助胸腔镜手术（VATS）。主要终点是术后早期疼痛；次要终点是术中和术后并发症、手术时间、清扫淋巴结数量和住院时间。
这是一项对49个意大利胸外科单位收集的数据进行的观察性、回顾性、队列、多中心研究。纳入标准为临床I-II期非小细胞肺癌、单孔或三孔VATS肺叶切除术及R0切除。排除标准为cT3疾病、既往胸段恶性肿瘤、诱导治疗、严重合并症及转为其他手术技术。疼痛参数进行二分法分类：数字评分量表≤3表示轻度疼痛，而数字评分量表评分>3表示中度/重度疼痛。采用倾向评分调整的广义估计方程比较单孔与三孔肺叶切除术。
在2014年1月至2017年7月纳入的4338例患者中，1980例符合纳入标准；1808例患者接受了三孔肺叶切除术，172例接受了单孔手术。使用倾向评分的调整广义估计方程回归模型显示，随着时间推移，两组疼痛均减轻（P<0.001）。术后第二天和第三天存在统计学差异；优势比（OR）分别为2.28[95%置信区间（CI）1.62-3.21；P<0.001]和OR 2.58（95%CI 1.74-3.83；P<0.001）。单孔VATS组手术时间更长（P<0.001），胸腔引流管留置时间更短（P<0.001），住院时间更短（P<0.001）。
意大利VATS组数据库的数据显示，在临床实践中，单孔肺叶切除术在术后第二天和第三天出现中度/重度疼痛的风险似乎更高。
