视频辅助胸腔镜手术与开胸手术治疗中央型非小细胞肺癌支气管袖状肺叶切除术的比较。
Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer.
机构信息
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China; Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain.
出版信息
J Thorac Cardiovasc Surg. 2021 Feb;161(2):403-413.e2. doi: 10.1016/j.jtcvs.2020.01.105. Epub 2020 Mar 25.
OBJECTIVES
The aim of this study was to investigate the adequacy of bronchial sleeve lobectomy by video-assisted thoracoscopic surgery in perioperative outcomes and its oncological efficacy by comparing with thoracotomy in a balanced population.
METHODS
A total of 363 patients who received bronchial sleeve lobectomy for non-small cell lung cancer from January 2013 to December 2017 were included and placed in the thoracotomy (n = 251) and video-assisted thoracoscopic surgery (n = 112) groups. Statistical analyses were performed to compare patients' demographics, perioperative outcomes, and survival between the 2 groups.
RESULTS
A total of 116 thoracotomy cases were matched with 72 video-assisted thoracoscopic surgery cases by propensity score. Compared with thoracotomy, patients in the video-assisted thoracoscopic surgery group after matching had less intraoperative blood loss (P < .01) and length of postoperative hospital stay (P < .01), duration of chest tube drainage (P < .01), and intensive care unit stay (P = .03) despite comparable operative time, complication rate, and 30- to 90-day mortality rate. The overall survival and recurrence-free survival were similar in patients who received sleeve lobectomy by thoracotomy and video-assisted thoracoscopic surgery (log-rank, P = .24 and .20, respectively) at 3 years. Although advanced TNM stage was independently associated with worse overall survival and recurrence-free survival in multivariable analysis, older age was only predictive for worse overall survival (hazard ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .02). Body mass index was also found be a predictive factor (overall survival: hazard ratio, 0.93; 95% confidence interval, 0.86-0.99, P = .03; recurrence-free survival: hazard ratio, 0.93; 95% confidence interval, 0.87-0.99, P = .02).
CONCLUSIONS
With appropriate patient selection and continued experience, video-assisted thoracoscopic surgery appears to be safe in the short-term perioperative period and does not appear to comprise oncologic outcomes in performing sleeve lobectomy.
目的
本研究旨在通过比较非小细胞肺癌支气管袖状切除术的开胸手术（thoracotomy）和电视辅助胸腔镜手术（video-assisted thoracoscopic surgery，VATS）的围手术期结果和肿瘤学疗效，评估 VATS 支气管袖状切除术的可行性。
方法
纳入 2013 年 1 月至 2017 年 12 月期间行支气管袖状切除术治疗非小细胞肺癌的 363 例患者，将患者分为开胸手术组（n=251）和电视辅助胸腔镜手术组（n=112）。通过倾向性评分匹配（propensity score matching，PSM）将 116 例开胸手术病例与 72 例电视辅助胸腔镜手术病例进行匹配。比较两组患者的人口统计学特征、围手术期结果和生存情况。
结果
PSM 后，共匹配 116 例开胸手术病例和 72 例电视辅助胸腔镜手术病例。与开胸手术组相比，电视辅助胸腔镜手术组患者术中出血量更少（P<0.01），术后住院时间（P<0.01）、胸腔引流管留置时间（P<0.01）和重症监护病房停留时间（P=0.03）更短，而手术时间、并发症发生率和 30-90 天死亡率相似。3 年时，接受开胸手术和电视辅助胸腔镜手术的袖状肺叶切除术患者的总生存率和无复发生存率相似（log-rank，P=0.24 和 P=0.20）。多变量分析显示，晚期 TNM 分期是总生存率和无复发生存率的独立影响因素，但年龄较大仅与总生存率相关（风险比，1.04；95%置信区间，1.01-1.07；P=0.02）。体质指数（body mass index，BMI）也是一个预测因素（总生存率：风险比，0.93；95%置信区间，0.86-0.99，P=0.03；无复发生存率：风险比，0.93；95%置信区间，0.87-0.99，P=0.02）。
结论
在适当的患者选择和不断积累经验的基础上，VATS 支气管袖状切除术在短期围手术期内是安全的，且不会影响袖状肺叶切除术的肿瘤学疗效。
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