Bédat Benoît, Abdelnour-Berchtold Etienne, Krueger Thortsen, Perentes Jean Yannis, Zellweger Matthieu, Triponez Frédéric, Karenovics Wolfram, Gonzalez Michel
Division of Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Service of Thoracic Surgery, University Hospital of Lausanne, Lausanne, Switzerland.
J Thorac Dis. 2019 Oct;11(10):4109-4118. doi: 10.21037/jtd.2019.10.07.
Pulmonary segmentectomies are generally classified into simple (tri-segmentectomy or lingulectomy as well as apical or basilar segmentectomy) and complex (individual or bi-segmentectomy of the upper, middle and lower lobes). Complex segmentectomies are technically feasible by video-assisted thoracic surgery (VATS) but remain challenging, and reports on post-operative outcomes are scarce. This study analyzes the differences between simple and complex VATS segmentectomy in terms of peri- and post-operative outcomes.
We retrospectively reviewed records of all patients who underwent anatomical pulmonary segmentectomy by VATS from 2014 to 2018 in two university hospitals.
A total of 232 patients (114 men; median age 67 years; range, 29-87 years) underwent VATS segmentectomy for primary lung cancer (n=177), metastases (n=26) and benign lesions (n=29). The overall 30-day mortality and morbidity rates were 0.8% and 29.7%, respectively. The re-operation rate was 4.7%. Complex segmentectomy was realized in 111 patients including 86 (77.5%) upper lobe segmentectomies and 44 (39.6%) bi-segmentectomies. There was no statistical difference between complex and simple segmentectomy in terms of operative time (145 143 min, respectively; P=0.79) and chest tube duration [median: 1 (range, 0-33) 2 (range, 1-19) days, respectively; P=0.95]. Post-operative overall complication rates were similar for both groups (30% 30%, respectively; P=0.99) and were not correlated with the type of segmentectomy. However, complex segmentectomy patients had a shorter length of hospitalization compared to simple segmentectomy patients [median: 5 (range, 1-36) 7 (range, 2-31) days; P=0.026]. Interestingly, complex segmentectomies were realized most frequently 2 years after implementation of VATS segmentectomy (23% 77%; P=0.01).
In comparison with simple segmentectomy, complex segmentectomy by VATS seems to present similar post-operative complication rates. Learning curve and progressive increase in acceptance by surgeons seem to be key elements for successful implementation of complex segmentectomies and could explain the shorter length of stay we observed.
肺段切除术一般分为简单肺段切除术（三叶段切除术、舌段切除术以及尖段或基底段切除术）和复杂肺段切除术（上叶、中叶和下叶的单个或双段切除术）。复杂肺段切除术通过电视辅助胸腔镜手术（VATS）在技术上是可行的，但仍然具有挑战性，且关于术后结果的报道较少。本研究分析了简单和复杂VATS肺段切除术在围手术期和术后结果方面的差异。
我们回顾性分析了2014年至2018年在两家大学医院接受VATS解剖性肺段切除术的所有患者的记录。
共有232例患者（114例男性；中位年龄67岁；范围29 - 87岁）接受了VATS肺段切除术，其中原发性肺癌患者177例，转移瘤患者26例，良性病变患者29例。30天总体死亡率和发病率分别为0.8%和29.7%。再次手术率为4.7%。111例患者实施了复杂肺段切除术，其中包括86例（77.5%）上叶段切除术和44例（39.6%）双段切除术。复杂肺段切除术和简单肺段切除术在手术时间（分别为145±143分钟；P = 0.79）和胸管留置时间方面[中位数：分别为1（范围0 - 33）天和2（范围1 - 19）天；P = 0.95]无统计学差异。两组术后总体并发症发生率相似（分别为30%和30%；P = 0.99），且与肺段切除术类型无关。然而，与简单肺段切除术患者相比，复杂肺段切除术患者住院时间更短[中位数：分别为5（范围1 - 36）天和7（范围2 - 31）天；P = 0.026]。有趣的是，复杂肺段切除术在VATS肺段切除术实施2年后最为常见（23%对77%；P = 0.01）。
与简单肺段切除术相比，VATS复杂肺段切除术术后并发症发生率似乎相似。学习曲线以及外科医生接受度的逐渐提高似乎是成功实施复杂肺段切除术的关键因素，这也可以解释我们观察到的住院时间缩短的现象。
