Yun Jae Kwang, Park Ilkun, Kim Hyeong Ryul, Choi Yong Soo, Lee Geun Dong, Choi Sehoon, Kim Yong-Hee, Kim Dong Kwan, Park Seung-Il, Cho Jong Ho, Shin Sumin, Kim Hong Kwan, Kim Jhingook, Zo Jae Il, Kim Kwhanmien, Shim Young Mog
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Lung Cancer. 2020 Dec;150:201-208. doi: 10.1016/j.lungcan.2020.10.014. Epub 2020 Oct 29.
Although the video-assisted thoracic surgery (VATS) approach has been accepted as a safe and effective alternative to lobectomy, its advantage remains unclear in advanced-stage lung cancer. This study is aimed to evaluate the feasibility and long-term outcomes of VATS in lung cancer with clinical N1 (cN1) disease.
We retrospectively reviewed the records of 1149 consecutive patients who underwent lobectomy for cN1 disease from 2006 to 2016. Perioperative outcomes and long-term survival rates were compared using a propensity score-based inverse probability of treatment weighting (IPTW) technique.
We performed VATS and open thoracotomy for 500 and 649 patients, respectively. All preoperative characteristics became similar between the two groups after IPTW adjustment. Compared to thoracotomy, VATS was associated with shorter hospitalization (7.7 days vs. 9.2 days, p < 0.001), earlier adjuvant chemotherapy (41.7 days vs. 46.6 days, p = 0.028), similar complete resection rates (95.2 % vs. 94.0 %, p = 0.583), and equivalent dissected lymph nodes (27.5 vs. 27.8, p = 0.704). On IPTW-adjusted analysis, overall survival (OS) (59.4 % vs. 60.3 %, p = 0.588) and recurrence-free survival (RFS) (59.2 % vs. 56.9 %, p = 0.651) at 5 years were also similar between the two groups. Multivariable Cox analysis revealed that VATS was not a significant prognostic factor for cN1 disease (p = 0.764 for OS and p = 0.879 for RFS).
VATS lobectomy is feasible for patients with cN1 disease, providing comparable perioperative outcomes, oncologic efficacy, and long-term outcomes as open thoracotomy.
尽管电视辅助胸腔镜手术（VATS）已被公认为是肺叶切除术的一种安全有效的替代方法，但其在晚期肺癌中的优势仍不明确。本研究旨在评估VATS在临床N1（cN1）期肺癌中的可行性和长期疗效。
我们回顾性分析了2006年至2016年间1149例因cN1期疾病接受肺叶切除术的连续患者的记录。采用基于倾向评分的治疗权重逆概率（IPTW）技术比较围手术期结局和长期生存率。
我们分别对500例和649例患者进行了VATS和开胸手术。IPTW调整后，两组所有术前特征均相似。与开胸手术相比，VATS的住院时间更短（7.7天对9.2天，p<0.001），辅助化疗更早（41.7天对46.6天，p=0.028），完全切除率相似（95.2%对94.0%，p=0.583），清扫淋巴结数量相当（27.5对27.8，p=0.704）。在IPTW调整分析中，两组5年总生存率（OS）（59.4%对60.3%，p=0.588）和无复发生存率（RFS）（59.2%对56.9%，p=0.651）也相似。多变量Cox分析显示，VATS不是cN1期疾病的显著预后因素（OS的p=0.764，RFS的p=0.879）。
VATS肺叶切除术对cN1期患者可行，其围手术期结局、肿瘤学疗效和长期疗效与开胸手术相当。
