Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan.
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya, 467-8602, Japan.
Gen Thorac Cardiovasc Surg. 2021 May;69(5):850-858. doi: 10.1007/s11748-020-01556-3. Epub 2021 Jan 2.
Despite the ubiquitous utilization of anatomical sublobar resection for malignant lung tumors, the effectiveness and feasibility of subsegmentectomy remains unclear. This study therefore compared the perioperative outcomes between anatomical sublobar resection including (IS) and excluding (ES) subsegmentectomy.
Patients who had undergone anatomical sublobar resection at our institution from January 2013 to March 2019 were retrospectively reviewed. Clinicopathologic characteristics and perioperative outcomes of the IS group (n = 58) were then analyzed the compared to those of the ES group (n = 203).
No statistically significant differences in age, sex, comorbidities, tumor location, preoperative pulmonary function, or tumor size on imaging were found between both groups. The IS group had significantly higher preoperative computed tomography-guided marking rates (40% vs. 18%; p < 0.01) and used significantly more staplers for intersegmental dissection than the ES group [4, interquartile range (IQR): 3-4 vs. 3, IQR: 3-4; p = 0.03]. Both groups had comparable 30-day mortality (0% vs. 0%; p > 0.99), intraoperative complications (7% vs. 10%; p = 0.61), and postoperative complications (5% vs. 8%; p = 0.58). After propensity score matching, the IS group experienced significantly lesser blood loss than the ES group (5 mL, IQR: 1-10 vs. 5 mL, IQR: 5-20; p = 0.03). Both groups experienced no local recurrence and demonstrated similar postoperative pulmonary functions after surgery.
IS may be a feasible and acceptable therapeutic option for malignant lung tumors. Nonetheless, future investigations are required to further validate the current findings.
尽管解剖性亚肺叶切除术已广泛应用于肺部恶性肿瘤，但亚段切除术的有效性和可行性仍不明确。因此，本研究比较了包括（IS）和不包括（ES）亚段切除术的解剖性亚肺叶切除术的围手术期结果。
回顾性分析了 2013 年 1 月至 2019 年 3 月在我院行解剖性亚肺叶切除术的患者。分析了 IS 组（n=58）的临床病理特征和围手术期结果，并与 ES 组（n=203）进行比较。
两组患者的年龄、性别、合并症、肿瘤位置、术前肺功能或影像学上的肿瘤大小无统计学差异。IS 组术前 CT 引导标记率明显高于 ES 组[40%（95%CI：26-53）比 18%（95%CI：12-25）；p<0.01]，IS 组用于节段间分离的吻合器也明显多于 ES 组[4 个，四分位距（IQR）：3-4 比 3 个，IQR：3-4；p=0.03]。两组 30 天死亡率[0%（95%CI：0-11）比 0%（95%CI：0-12）；p>0.99]、术中并发症[7%（95%CI：3-14）比 10%（95%CI：4-16）；p=0.61]和术后并发症[5%（95%CI：2-9）比 8%（95%CI：4-15）；p=0.58]无统计学差异。倾向性评分匹配后，IS 组术中出血量明显少于 ES 组[5 毫升，IQR：1-10 比 5 毫升，IQR：5-20；p=0.03]。两组均无局部复发，术后肺功能无差异。
IS 可能是治疗肺部恶性肿瘤的一种可行且可接受的治疗选择。然而，需要进一步的研究来验证目前的发现。
