Jacobson Francine L, Dezube Aaron R, Bravo-Iñiguez Carlos, Kucukak Suden, Bay Camden P, Wee Jon O, Coppolino Antonio A, Jaklitsch Michael T, Ducko Christopher T
Division of Thoracic Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
J Surg Oncol. 2021 Jul;124(1):124-134. doi: 10.1002/jso.26483. Epub 2021 Apr 12.
The aim of this study was to demonstrate whether academic thoracic surgeons could achieve morbidity and mortality rates in community hospitals equivalent to those seen in National Lung Screening Trial (NLST).
This was a retrospective review of community hospital lung cancer procedures for clinical Stage I-III non-small-cell lung cancers from 2007 through 2014. Variables include age, comorbidities, computed tomography (CT) characterization, and operative techniques.
There were 177 patients who had lung cancers removed by a minimally invasive approach (79%), including lobectomy in 127 (72%), segmentectomy in 4 (2%), and wedge-resections in 46 (26%). The median patient age was 71 years (interquartile range [IQR], 63-76). The cohort was primarily female (58%), clinical Stage I (82%), with a median tumor size of 2.3 cm (IQR, 1.5-3.3). The median length of stay was 6 days (range: 1-35). Complications were experienced by 78 (44.1%) patients, most commonly atrial fibrillation in 20 (11.3%) followed by air-leak in 19 (10.7%). There were no in-hospital deaths. Tumor location and extent of resection were associated with complications, while larger tumor size, margin contour, and resection method were associated with air-leak (all p < 0.05). Higher clinical stage and larger tumor size were associated with occult Stage III disease (both p < 0.05).
The low morbidity and mortality rates from the NLST were achievable in a community setting for early-stage lung cancer. Characterization of cancers using CT imaging identified factors most commonly associated with postoperative complications and the presence of occult Stage III disease.
本研究旨在证明胸外科专科医生在社区医院能否实现与国家肺癌筛查试验（NLST）相当的发病率和死亡率。
这是一项对2007年至2014年社区医院临床I - III期非小细胞肺癌手术的回顾性研究。变量包括年龄、合并症、计算机断层扫描（CT）特征和手术技术。
177例患者通过微创方法切除肺癌（79%），其中肺叶切除术127例（72%），肺段切除术4例（2%），楔形切除术46例（26%）。患者中位年龄为71岁（四分位间距[IQR]，63 - 76岁）。该队列主要为女性（58%），临床I期（82%），肿瘤中位大小为2.3厘米（IQR，1.5 - 3.3厘米）。中位住院时间为6天（范围：1 - 35天）。78例（44.1%）患者出现并发症，最常见的是房颤20例（11.3%），其次是漏气19例（10.7%）。无院内死亡病例。肿瘤位置和切除范围与并发症相关，而肿瘤较大、切缘轮廓和切除方法与漏气相关（均p < 0.05）。较高的临床分期和较大的肿瘤大小与隐匿性III期疾病相关（均p < 0.05）。
在社区环境中，早期肺癌可实现NLST的低发病率和死亡率。利用CT成像对癌症进行特征分析可确定与术后并发症和隐匿性III期疾病存在最常见相关的因素。
