Zhao Jun, Zeng Qingpeng, Li Jiagen, Tan Fengwei, Xue Qi, Mu Juwei, Gao Yushun, Wang Dali, Gao Shugeng
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Thorac Dis. 2020 Dec;12(12):7145-7155. doi: 10.21037/jtd-20-2695.
Uniportal thoracoscopic sleeve lobectomy is rarely reported owing to its high degree of difficulty. We conducted a comparative study on the safety and efficacy of uniportal versus multiportal thoracoscopic sleeve lobectomy for the treatment of centrally located lung cancer.
From January 2016 to December 2018, 30 thoracoscopic sleeve lobectomies (12 by the uniportal approach and 20 by the multiportal approach) for centrally located lung cancer at our institution were retrospectively analyzed.
The uniportal approach resulted in a significantly shorter chest drainage duration (5.3±1.9 7.1±2.8 days, P=0.028) and a smaller chest drainage volume (796.7±582.9 1,667.8±1,154.9 mL, P=0.004) than the multiportal approach. The two groups showed no significant differences in the dissection of lymph nodes, operation time, estimated blood loss, conversion rate, length of postoperative hospital stay and the proportion of patients with postoperative complications. The short-term overall survival (OS) and disease-free survival (DFS) between uniportal and multiportal groups were similar (3-year OS, 100.0% 82.5%, P=0.222; 3-year DFS, 75.8% 84.4%, P=0.641). For the eight cases of the uniportal approach conducted by the same surgeon, the cumulative sum (CUSUM) curve showed its inflection at patient number 4 and divided the series into phase I (learning phase) and phase II (experienced phase). A significant reduction in estimated blood loss (42.5±8.7 177.5±121.2 mL, P=0.037), chest drainage volume (280.0±155.8 972.5±464.5 mL, P=0.043) and chest drainage duration (3.8±1.0 6.8±2.2 days, P=0.027) was also noted in the phase II patients compared with the phase I patients.
Uniportal thoracoscopic sleeve lobectomy is technically feasible and safe for the treatment of centrally located lung cancer and may achieve superior surgical outcomes compared with the multiportal approach.
单孔胸腔镜袖式肺叶切除术因难度高而鲜有报道。我们对单孔与多孔胸腔镜袖式肺叶切除术治疗中央型肺癌的安全性和有效性进行了一项对比研究。
回顾性分析2016年1月至2018年12月在我院接受胸腔镜袖式肺叶切除术治疗中央型肺癌的30例患者（单孔入路12例，多孔入路20例）。
与多孔入路相比，单孔入路的胸腔引流时间显著缩短（5.3±1.9天对7.1±2.8天，P=0.028），胸腔引流量也显著减少（796.7±582.9毫升对1,667.8±1,154.9毫升，P=0.004）。两组在淋巴结清扫、手术时间、估计失血量、中转率、术后住院时间及术后并发症发生率方面无显著差异。单孔组与多孔组的短期总生存（OS）和无病生存（DFS）相似（3年OS，100.0%对82.5%，P=0.222；3年DFS，75.8%对84.4%，P=0.641）。对于由同一位外科医生实施的8例单孔入路手术，累积和（CUSUM）曲线在第4例患者处出现拐点，将该系列分为I期（学习期）和II期（经验期）。与I期患者相比，II期患者的估计失血量（42.5±8.7毫升对177.5±121.2毫升，P=0.037）、胸腔引流量（280.0±155.8毫升对972.5±464.5毫升，P=0.043）和胸腔引流时间（3.8±1.0天对6.8±2.2天，P=0.027）也显著减少。
单孔胸腔镜袖式肺叶切除术治疗中央型肺癌在技术上是可行且安全的，与多孔入路相比，可能取得更好的手术效果。
