Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
J Formos Med Assoc. 2021 Nov;120(11):1949-1956. doi: 10.1016/j.jfma.2021.04.018. Epub 2021 May 13.
Nonintubated thoracoscopic lobectomy has been described as a feasible surgical treatment for early-stage lung cancer since 2011. Despite promising perioperative results, studies on tumor recurrence and long-term survival are very limited. This study was aimed to compare outcomes after thoracoscopic lobectomy with versus without intubation for stage I non-small cell lung cancer.
A retrospective data set including 115 and 155 patients who underwent nonintubated and intubated thoracoscopic lobectomy, respectively, between January 2011 and December 2013 was used to identify matched nonintubated and intubated cohorts (n = 97 per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed using Cox regression analysis and Kaplan-Meier survival estimates.
No perioperative mortality occurred in both groups. At an average follow-up of 74 months, comparing nonintubated thoracoscopic lobectomy with intubated procedure, no differences were observed in recurrence rates (14.4% vs. 25.8%, respectively; p = .057). Furthermore, no significant differences were noted in overall survival (97.9% vs. 93.8%, respectively; p = .144). Nonintubated thoracoscopic lobectomy was not found to be an independent predictor of recurrence (hazard ratio, .53; 95% confidence interval [CI], .28-1.02) or overall survival (hazard ratio, .33; 95% CI, .07-1.61).
In this propensity-matched comparison, nonintubated thoracoscopic lobectomy was not associated with an increased risk for recurrence and overall survival during the 5-year follow-up. However, more randomized trials should be conducted for further validation of these results.
自 2011 年以来，非插管胸腔镜肺叶切除术已被描述为早期肺癌的一种可行的手术治疗方法。尽管围手术期结果令人鼓舞，但关于肿瘤复发和长期生存的研究非常有限。本研究旨在比较非插管和插管胸腔镜肺叶切除治疗 I 期非小细胞肺癌的结果。
使用回顾性数据集，包括 2011 年 1 月至 2013 年 12 月期间分别接受非插管和插管胸腔镜肺叶切除术的 115 例和 155 例患者，使用倾向评分匹配算法识别非插管和插管队列（每组 97 例），该算法考虑了术前患者变量的混杂影响。主要结局变量包括无复发率和总生存率。使用 Cox 回归分析和 Kaplan-Meier 生存估计评估影响生存的因素。
两组均未发生围手术期死亡。在平均 74 个月的随访中，与插管手术相比，非插管胸腔镜肺叶切除术的复发率无差异（分别为 14.4%和 25.8%，p=0.057）。此外，总生存率也无显著差异（分别为 97.9%和 93.8%，p=0.144）。非插管胸腔镜肺叶切除术不是复发的独立预测因素（风险比，0.53；95%置信区间[CI]，0.28-1.02）或总生存率（风险比，0.33；95%CI，0.07-1.61）。
在这项倾向评分匹配比较中，非插管胸腔镜肺叶切除术在 5 年随访期间并未增加复发和总生存率的风险。然而，应该进行更多的随机试验来进一步验证这些结果。
