Wu Xianning, Li Tian, Zhang Chuankai, Wu Gao, Xiong Ran, Xu Meiqing, Su Dan, Xie Mingran
Department of Thoracic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
School of Nursing, Anhui Medical University, Hefei, China.
Front Oncol. 2021 Apr 27;11:661821. doi: 10.3389/fonc.2021.661821. eCollection 2021.
Segmentectomy is widely used for early-stage lung cancer presenting as single or multiple ground-glass opacities (GGOs). Precise segmentectomy is the recommended procedure in China. However, clinically, most routine segmentectomies are performed using only high-resolution computed tomography (CT). The aim of this study was to evaluate the effect of two segmentectomy approaches for GGOs in the lung.
From January 2020 to September 2020, 55 precise segmentectomies performed with real-time guidance using 3D reconstruction and 343 routine segmentectomies for patients with single or multiple GGOs were performed as uniportal procedures. To reduce bias related to outcomes, preoperative clinical factors were used for propensity score matching (1:1); 55 precision and 55 routine segmentectomies were selected and further analyzed. Perioperative outcomes, namely operation time, blood loss, resection margins, number of removed lymph nodes, postoperative pulmonary function (1 month after surgery), length of postoperative stay, and postoperative complications were compared between the two groups.
Patients constituted 43 men and 67 women, with an age range of 25-68 years (median: 53 years). No significant differences were seen between the groups regarding blood loss, complications, histological type, and postoperative pulmonary function, and there were no 30-day postoperative deaths in either group. The median operation time for the Precision group (74 min) was longer than in the Routine group (55 min) (0.01), and the number of removed lymph nodes in the Precision group (5 ± 1.1) was higher than in the Routine group (3 ± 0.8) (0.01). Chest tube duration days and postoperative stay days were similar in both groups; however, the rate of air leakage on postoperative day 1 was higher in the Precision group ( = 0.020). All patients in the Precision group had adequate resection margins. Four patients (7.3%) undergoing complex segmentectomy in the Routine group had inadequate resection margins and required resection of additional lung tissue.
Routine segmentectomy can significantly shorten the operation time and might prevent postoperative air leakage in uniportal segmentectomy for lung GGOs. However, precision segmentectomy may be more precise for complex cases, ensuring adequate resection margins and lymph node dissection.
肺段切除术广泛应用于表现为单个或多个磨玻璃影（GGO）的早期肺癌。在中国，推荐进行精准肺段切除术。然而，在临床上，大多数常规肺段切除术仅使用高分辨率计算机断层扫描（CT）。本研究的目的是评估两种肺段切除术方法对肺部GGO的效果。
2020年1月至2020年9月，对55例使用三维重建实时引导进行的精准肺段切除术以及343例针对单个或多个GGO患者进行的常规肺段切除术采用单孔手术方式。为减少与结果相关的偏差，术前临床因素用于倾向评分匹配（1:1）；选择55例精准肺段切除术和55例常规肺段切除术并进一步分析。比较两组的围手术期结果，即手术时间、失血量、切缘、切除淋巴结数量、术后肺功能（术后1个月）、术后住院时间和术后并发症。
患者包括43名男性和67名女性，年龄范围为25 - 68岁（中位数：53岁）。两组在失血量、并发症、组织学类型和术后肺功能方面无显著差异，两组均无术后30天死亡病例。精准组的中位手术时间（74分钟）比常规组（55分钟）长（P<0.01），精准组切除的淋巴结数量（5±1.1）高于常规组（3±0.8）（P<0.01）。两组的胸管留置天数和术后住院天数相似；然而，精准组术后第1天的漏气率更高（P = 0.020）。精准组所有患者的切缘均足够。常规组中4例（7.3%）接受复杂肺段切除术的患者切缘不足，需要切除额外的肺组织。
对于肺部GGO的单孔肺段切除术，常规肺段切除术可显著缩短手术时间并可能预防术后漏气。然而，精准肺段切除术对于复杂病例可能更精准，可确保足够的切缘和淋巴结清扫。
