Yamashita Shin-Ichi, Tokuishi Keita, Moroga Toshihiko, Nagata Asahi, Imamura Naoko, Miyahara So, Yoshida Yasuhiro, Waseda Ryuichi, Sato Toshihiko, Shiraishi Takeshi, Nabeshima Kazuki, Kawahara Katsunobu, Iwasaki Akinori
Department of General Thoracic, Breast, and Pediatric Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
General Thoracic and Breast Surgery Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
J Thorac Dis. 2020 Nov;12(11):6523-6532. doi: 10.21037/jtd-20-2259.
Early stage non-small cell lung cancer (NSCLC) is good candidate for video-assisted thoracoscopic surgery (VATS). Long-term outcome compared between VATS and open surgery remains unclear. The aim of this study was to assess the long-term outcome of VATS in early stage adenocarcinoma.
A retrospective study was performed in 546 patients which were operated between January 2006 and December 2010 in our institute and of those, 240 (220 lobectomies, and 20 segmentectomies) were clinical N0 adenocarcinoma. One hundred and thirty-five patients underwent VATS and 105 patients for open surgery. Long-term oncological outcomes were compared in both groups.
There were significant differences in age, gender, Blinkman index, clinical T factor and tumor size between two groups. VATS group showed statistically longer operation time (P=0.01), less blood loss (P=0.005), shorter length of stay (P=0.001), and less dissected number of lymph nodes (P<0.001) compared with open surgery. Disease-free survival in VATS was significantly better than open surgery (5- and 10-year survival; VATS, 91.4%, 79.0%; open, 85.1%, 73.6%; respectively, P=0.04). Overall survival in VATS was not different from open (P=0.58). Propensity matched disease-free and overall survival was not significantly different between two groups. Multivariate Cox regression analysis showed that age [P=0.04, 95% confidence interval (CI): (1.02-6.81)] in overall and T factor [P=0.01, 95% CI: (1.41-17.3)] in disease-free survival was prognostic significant after propensity matching.
Our study demonstrated that long-term outcome in VATS for early stage adenocarcinoma was equivalent to open surgery. VATS may be a treatment of choice for promising long-term prognosis.
早期非小细胞肺癌（NSCLC）是电视辅助胸腔镜手术（VATS）的良好适应证。VATS与开放手术的长期疗效对比仍不明确。本研究旨在评估VATS治疗早期腺癌的长期疗效。
对2006年1月至2010年12月在我院接受手术的546例患者进行回顾性研究，其中240例（220例行肺叶切除术，20例行肺段切除术）为临床N0期腺癌。135例患者接受VATS手术，105例患者接受开放手术。对比两组的长期肿瘤学疗效。
两组在年龄、性别、体重指数、临床T分期和肿瘤大小方面存在显著差异。与开放手术相比，VATS组手术时间更长（P=0.01），术中失血更少（P=0.005），住院时间更短（P=0.001），清扫淋巴结数量更少（P<0.001）。VATS组的无病生存率显著优于开放手术组（5年和10年生存率；VATS组分别为91.4%、79.0%；开放手术组分别为85.1%、73.6%；P=0.04）。VATS组的总生存率与开放手术组无差异（P=0.58）。倾向评分匹配后的无病生存率和总生存率在两组间无显著差异。多因素Cox回归分析显示，倾向评分匹配后，总生存中的年龄[P=0.04，95%置信区间（CI）：（1.02-6.81）]和无病生存中的T分期[P=0.01，95%CI：（1.41-17.3）]具有预后意义。
我们的研究表明，VATS治疗早期腺癌的长期疗效与开放手术相当。VATS可能是具有良好长期预后的一种治疗选择。
