Helminen Olli, Valo Johanna, Andersen Heidi, Lautamäki Anna, Räsänen Jari, Sihvo Eero
Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
Department of Pulmonology, Vaasa Central Hospital, Vaasa, Finland.
J Thorac Dis. 2020 Jun;12(6):3073-3084. doi: 10.21037/jtd-20-656.
The technical concepts of thoracoscopic segmentectomy are still evolving. In this study we present a simple bronchoscopy-based intersegmental demarcation technique with short- and mid-term outcomes compared between thoracoscopic segmentectomy and lobectomy.
All 105 consecutive patients with lung cancer intended to treat with video-assisted thoracoscopic surgery (VATS) segmentectomy were compared to 110 consecutive VATS lobectomies. Short- and mid-term outcome comparison included complications, length of hospital stay, pulmonary functions, and 3-year progression-free and overall survival. Mid-term outcomes were adjusted for age, sex, comorbidities, pulmonary functions, histology, stage and adjuvant treatment.
Segmentectomy patients had more comorbidities (P=0.006), worse pulmonary functions (FEV1%, P=0.005; DLCO/va, P=0.011), poor exercise capacity (P=0.043) and were considered high-risk patients more often (41.9% 25.5%, P=0.011). Major complication rates did not differ between the groups (P=0.718). Mean length of hospital stay decreased after segmentectomy (4.7 . 5.9 days, P=0.033). Following segmentectomy, FEV1% slightly improved (1.0%). After lobectomy, the mean decline of FEV1% was 8.1% (P<0.001). Respectively, in high-risk patients, 2.1% improvement and 9.9% decline (P=0.027) were observed. Overall mortality hazard after segmentectomy was similar to that for lobectomy (unadjusted HR 0.80, 95% CI: 0.45-1.44, adjusted HR 0.87, 95% CI: 0.43-1.76). When considering only stage I non-small cell lung cancer, 3-year overall survival after segmentectomy and lobectomy were 86.8% . 79.8% (P=0.412) and 3-year recurrence-free survival 93.0% . 89.7%, P=0.450.
Following segmentectomy, regardless of worse surgical candidates, hospital stay was shorter. Furthermore, preservation of lung function also in high-risk patients, was observed without compromising mid-term oncologic outcomes.
胸腔镜肺段切除术的技术概念仍在不断发展。在本研究中，我们提出了一种基于支气管镜的简单肺段间分界技术，并比较了胸腔镜肺段切除术和肺叶切除术的短期和中期结果。
将105例连续接受电视辅助胸腔镜手术（VATS）肺段切除术的肺癌患者与110例连续接受VATS肺叶切除术的患者进行比较。短期和中期结果比较包括并发症、住院时间、肺功能以及3年无进展生存率和总生存率。中期结果根据年龄、性别、合并症、肺功能、组织学、分期和辅助治疗进行调整。
肺段切除术患者合并症更多（P = 0.006），肺功能更差（FEV1%，P = 0.005；DLCO/va，P = 0.011），运动能力较差（P = 0.043），且更多被视为高危患者（41.9%对25.5%，P = 0.011）。两组主要并发症发生率无差异（P = 0.718）。肺段切除术后平均住院时间缩短（4.7天对5.9天，P = 0.033）。肺段切除术后，FEV1%略有改善（1.0%）。肺叶切除术后，FEV1%的平均下降率为8.1%（P < 0.001）。在高危患者中，分别观察到改善2.1%和下降9.9%（P = 0.027）。肺段切除术后的总体死亡风险与肺叶切除术相似（未调整的HR为0.80，95%CI：0.45 - 1.44，调整后的HR为0.87，95%CI：0.43 - 1.76）。仅考虑I期非小细胞肺癌时，肺段切除术和肺叶切除术后的3年总生存率分别为86.8%对79.8%（P = 0.412），3年无复发生存率分别为93.0%对89.7%，P = 0.450。
肺段切除术后，尽管手术候选者情况较差，但住院时间较短。此外，在高危患者中也观察到肺功能得到保留，且不影响中期肿瘤学结果。
