支气管袖状肺叶切除术与肺动脉成形术与肺切除术的比较。
Comparison of Bronchial Sleeve Lobectomy With Pulmonary Arterioplasty Versus Pneumonectomy.
机构信息
Department of Thoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, Zhejiang, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
Ann Thorac Surg. 2022 Mar;113(3):934-941. doi: 10.1016/j.athoracsur.2021.04.007. Epub 2021 Apr 16.
BACKGROUND
This study evaluated the efficacy of bronchial sleeve lobectomy with pulmonary arterioplasty compared with pneumonectomy in centrally located non-small cell lung cancer with bronchovascular invasion.
METHODS
The cohort consisted of 212 patients receiving pneumonectomy and 156 patients undergoing bronchial sleeve lobectomy with pulmonary arterioplasty. Propensity score matching was used to create a fully balanced cohort, after which, baseline characteristics, perioperative performance, and oncologic results were compared between the 2 groups.
RESULTS
A total of 139 pneumonectomy patients were matched with 139 sleeve lobectomy patients. In the matched cohort, bronchial sleeve lobectomy with pulmonary arterioplasty was associated with longer operative time (P < .001), decreased perioperative transfusion rate (P = .002), shorter postoperative hospital stays (P < .001), shorter intensive care unit stays (P = .040), and lower Clavien-Dindo Classification (P = .016). In respect to survival outcomes, a log-rank test revealed no significant difference in overall survival (P = .381) and recurrence-free survival (P = .619) between the 2 surgical procedures.
CONCLUSIONS
Bronchial sleeve lobectomy with pulmonary arterioplasty could achieve superior perioperative outcomes and equivalent oncologic efficacy compared with pneumonectomy, indicating that this complex procedure is safe and reliable for centrally located non-small cell lung cancer concurrently involving the pulmonary artery and bronchus.
背景
本研究评估了支气管袖状肺叶切除术联合肺动脉成形术与全肺切除术治疗中央型非小细胞肺癌伴支气管血管侵犯的疗效。
方法
该队列纳入了 212 例行全肺切除术的患者和 156 例行支气管袖状肺叶切除术联合肺动脉成形术的患者。采用倾向评分匹配法创建完全均衡的队列，然后比较两组患者的基线特征、围手术期表现和肿瘤学结果。
结果
共匹配了 139 例全肺切除术患者和 139 例支气管袖状肺叶切除术患者。在匹配队列中，支气管袖状肺叶切除术联合肺动脉成形术的手术时间更长（P<0.001），围手术期输血率更低（P=0.002），术后住院时间更短（P<0.001），重症监护病房住院时间更短（P=0.040），Clavien-Dindo 分级更低（P=0.016）。在生存结果方面，对数秩检验显示两种手术方式在总生存（P=0.381）和无复发生存（P=0.619）方面无显著差异。
结论
支气管袖状肺叶切除术联合肺动脉成形术与全肺切除术相比，可获得更好的围手术期效果和相当的肿瘤学疗效，表明对于同时累及肺动脉和支气管的中央型非小细胞肺癌，这种复杂的手术是安全可靠的。
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