Bongiolatti Stefano, Gonfiotti Alessandro, Vokrri Eduart, Borgianni Sara, Crisci Roberto, Curcio Carlo, Voltolini Luca
Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy.
Department of Thoracic Surgery, University of L'Aquila, L'Aquila, Italy.
Interact Cardiovasc Thorac Surg. 2020 Jun 1;30(6):803-811. doi: 10.1093/icvts/ivaa044.
The objective of this retrospective multi-institutional study was to evaluate the postoperative outcomes of video-assisted thoracoscopic surgery (VATS)-lobectomy (VATS-L) for non-small-cell lung cancer (NSCLC) in patients with impaired lung function. The second end point was to illustrate the effective role of forced expiratory volume in 1 s (FEV1%) and the diffusing capacity of the lung for carbon monoxide (DLCO%) in predicting complications in this population.
Data from patients who underwent VATS-L at participating centres were analysed and divided into 2 groups: group A comprised patients with FEV1% and/or DLCO% >60% and group B included patients with impaired lung function defined as FEV1% and/or DLCO% ≤60%. To define clinical predictors of death and complications, we performed univariate and multivariable regression analyses.
A total of 5562 patients underwent VATS-L, 809 (14.5%) of whom had impaired lung function. The postoperative mortality rate did not differ between the 2 groups (2.3% vs 3.2%; P = 0.77). The percentage of patients who had any complication (21.4% vs 34.2%; P ≤ 0.001), the complication rate (28% vs 49.8%; P ≤ 0.001) and the length of hospital stay (P ≤ 0.001) were higher for patients with limited pulmonary function. Impaired lung function was a strong predictor of overall and pulmonary complications at multivariable analysis.
VATS-L for NSCLC can be performed in patients with impaired lung function without increased risk of postoperative death and with an acceptable incidence of overall and respiratory complications. Our analysis suggested that FEV1% and DLCO% play a substantial role in estimating the risk of complications after VATS-L, but their role was less reliable for estimating the mortality.
本项回顾性多机构研究旨在评估肺功能受损的非小细胞肺癌（NSCLC）患者行电视辅助胸腔镜手术（VATS）肺叶切除术（VATS-L）后的结局。第二个终点是阐明一秒用力呼气容积（FEV1%）和肺一氧化碳弥散量（DLCO%）在预测该人群并发症方面的有效作用。
分析参与中心接受VATS-L的患者数据，并将其分为两组：A组包括FEV1%和/或DLCO%>60%的患者，B组包括肺功能受损（定义为FEV1%和/或DLCO%≤60%）的患者。为了确定死亡和并发症的临床预测因素，我们进行了单因素和多因素回归分析。
共有5562例患者接受了VATS-L，其中809例（14.5%）肺功能受损。两组术后死亡率无差异（2.3%对3.2%；P = 0.77）。肺功能受限患者发生任何并发症的百分比（21.4%对34.2%；P≤0.001）、并发症发生率（28%对49.8%；P≤0.001）和住院时间（P≤0.001）更高。在多因素分析中，肺功能受损是总体和肺部并发症的有力预测因素。
肺功能受损的NSCLC患者可行VATS-L，术后死亡风险不会增加，总体和呼吸并发症发生率可接受。我们的分析表明，FEV1%和DLCO%在评估VATS-L术后并发症风险方面发挥了重要作用，但在评估死亡率方面其作用不太可靠。
