Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Eur J Cardiothorac Surg. 2021 May 8;59(5):978-986. doi: 10.1093/ejcts/ezaa404.
This study aimed to investigate the efficacy of bronchial sleeve lobectomy with pulmonary arterioplasty by uniportal video-assisted thoracoscopic surgery (UniVATS) in centrally located non-small-cell lung cancer.
One hundred and two thoracotomy and 31 UniVATS cases were included in this retrospective, single-centre study. Baseline characteristics, perioperative performance and survival outcomes were compared between the 2 groups.
Compared with the thoracotomy group, the UniVATS group was associated with lower postoperative blood transfusion rate (P = 0.043), decreased postoperative hospital stays (P = 0.008), shorter drainage duration (P = 0.003) and less drainage volume during the first postoperative 24 h (P = 0.005). Besides, the 3-year overall survival and recurrence-free survival were comparable between the 2 groups (log-rank, P = 0.81 and P = 0.78, respectively). In addition, squamous cell carcinoma was proved to be the independent favourable predictor for overall survival [hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.24-0.80; P = 0.008], and advanced pathological stage was found to be independently associated with worse overall survival (IIIB stage: HR 3.21, 95% CI 1.13-9.12; P = 0.028) and recurrence-free survival (IIIB stage: HR 3.54, 95% CI 1.32-9.51; P = 0.012).
With appropriate patient selection, UniVATS sleeve lobectomy with pulmonary arterioplasty is feasible and safe for centrally located lung cancer in the hands of thoracic surgeons with extensive thoracoscopy experience.
本研究旨在探讨经单孔电视胸腔镜手术(UniVATS)行支气管袖式肺叶切除术联合肺动脉成形术治疗中央型非小细胞肺癌的疗效。
本回顾性单中心研究纳入了 102 例开胸手术患者和 31 例 UniVATS 患者。比较了两组患者的基线特征、围手术期表现和生存结局。
与开胸组相比,UniVATS 组术后输血率较低(P=0.043),术后住院时间较短(P=0.008),引流时间较短(P=0.003),术后 24 小时内引流量较少(P=0.005)。此外,两组患者的 3 年总生存率和无复发生存率相当(对数秩检验,P=0.81 和 P=0.78)。此外,鳞状细胞癌被证明是总生存率的独立有利预测因素[风险比(HR)0.44,95%置信区间(CI)0.24-0.80;P=0.008],而较高的病理分期与总生存率较差独立相关(III B 期:HR 3.21,95%CI 1.13-9.12;P=0.028)和无复发生存率较差(III B 期:HR 3.54,95%CI 1.32-9.51;P=0.012)。
在有丰富胸腔镜经验的胸外科医生手中,对于中央型肺癌患者,经适当的患者选择,UniVATS 支气管袖式肺叶切除术联合肺动脉成形术是可行和安全的。