Icahn School of Medicine at Mount Sinai, New York, New York.
University of California Los Angeles, Los Angeles, California.
Semin Thorac Cardiovasc Surg. 2021;33(2):535-544. doi: 10.1053/j.semtcvs.2020.09.009. Epub 2020 Sep 23.
The objective of this study was to compare long-term outcomes of open vs minimally invasive (MIS) segmentectomy for early stage non-small-cell lung cancer (NSCLC), which has not been previouslyevaluated using national studies. Outcomes of open vs MIS segmentectomy for clinical T1, N0, M0 NSCLC in the National Cancer Data Base (2010-2015) were evaluated using propensity score matching. Of the 39,351 patients who underwent surgery for stage IA NSCLC from 2010 to 2015, 770 underwent segmentectomy by thoracotomy and 1056 by MIS approach (876 thoracoscopic [VATS], 180 robotic). The MIS to open conversion rate was 6.7% (n = 71). After propensity score matching, all baseline characteristics were well-balanced between the open (n = 683) and MIS (n = 683) groups. When compared to the open group, the MIS group had shorter median length of stay (4 vs 5 days, P< 0.001) and lower 30-day mortality (0.6% vs 1.9%, P = 0.037). There were no significant differences between MIS and open groups with regard to 30-day readmission (5.0% vs 3.7%, P = 0.43), or upstaging from cN0 to pN1/N2/N3 (3.1% vs 3.6%, P = 0.89). The MIS approach was associated with similar long-term overall survival as the open approach (5-year survival: 62.3% vs 63.5%, P = 0.89; multivariable-adjusted hazard ratio: 0.99, 95% Confidence Intervial (CI): 0.82-1.21, P = 0.96). In this national analysis of open vs MIS segmentectomy for clinical stage IA NSCLC, MIS was associated with shorter length of stay and lower perioperative mortality, and similar nodal upstaging and 5-year survival when compared to segmentectomy via thoracotomy. MIS segmentectomy does not appear to compromise oncologic outcomes for clinical stage IA NSCLC.
本研究旨在比较开放与微创（MIS）解剖性肺段切除术治疗早期非小细胞肺癌（NSCLC）的长期疗效，此前尚未使用全国性研究进行评估。利用国家癌症数据库（2010-2015 年）评估了 2010 年至 2015 年接受手术治疗的 I 期 NSCLC 患者中，开胸与 MIS 解剖性肺段切除术的临床 T1N0M0 患者的结局。在 2010 年至 2015 年期间接受手术治疗的 39351 例 I 期 NSCLC 患者中，770 例行剖胸肺段切除术，1056 例行 MIS 解剖性肺段切除术（876 例为电视辅助胸腔镜手术[VATS]，180 例为机器人手术）。MIS 转开胸的转化率为 6.7%（n=71）。经倾向评分匹配后，开放组（n=683）和 MIS 组（n=683）的所有基线特征均得到很好的平衡。与开放组相比，MIS 组的中位住院时间更短（4 天 vs 5 天，P<0.001），30 天死亡率更低（0.6% vs 1.9%，P=0.037）。两组间 30 天再入院率（5.0% vs 3.7%，P=0.43）或 cN0 至 pN1/N2/N3 的分期升级率（3.1% vs 3.6%，P=0.89）无显著差异。MIS 法与开放法在长期总生存率方面相似（5 年生存率：62.3% vs 63.5%，P=0.89；多变量调整后危险比：0.99，95%置信区间[CI]：0.82-1.21，P=0.96）。在这项关于临床 I 期 NSCLC 开胸与 MIS 解剖性肺段切除术的全国性分析中，与剖胸肺段切除术相比，MIS 法与较短的住院时间和较低的围手术期死亡率相关，且淋巴结分期升级和 5 年生存率相似。MIS 解剖性肺段切除术似乎不会影响临床 I 期 NSCLC 的肿瘤学结局。
