Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Thorac Cancer. 2021 Sep;12(17):2375-2381. doi: 10.1111/1759-7714.14080. Epub 2021 Jul 17.
Repeat pulmonary resection is widely accepted in clinical practice. This study aimed to compare sublobar resection (segmentectomy or wedge resection) with lobectomy in the treatment of patients who underwent a second pulmonary resection.
This study retrospectively included patients who underwent lobectomy or sublobar resection for second pulmonary resection. 1:1 propensity score matching (PSM) was performed to balance selection bias. Clinicopathological features, perioperative and survival outcomes of lobectomy and sublobar resection were compared.
A total of 308 patients who underwent second pulmonary resection were identified: 71 (23.1%) who underwent lobectomy and 237 (76.9%) who underwent sublobar resection. After PSM, 58 patients for each group were selected with well-balanced clinicopathological characteristics. In patients who underwent sublobar resection, significantly shorter chest tube duration (days) (median, 4 vs. 2, p < 0.001) and postoperative hospital stay (days) (median, 6 vs. 4, p < 0.001) were observed. There was no significant difference in overall survival between these two groups after the second and first surgery (p = 0.65, p = 0.98), respectively. Subgroup analysis according to the type of the first resection showed consistent results.
Sublobar resection may be considered as an alternative option for second pulmonary resection due to its perioperative advantages and similar survival outcomes compared with lobectomy.
肺叶切除术在临床实践中被广泛接受。本研究旨在比较亚肺叶切除术（肺段切除术或楔形切除术）与肺叶切除术在治疗接受二次肺切除术的患者中的疗效。
本研究回顾性纳入了接受肺叶切除术或亚肺叶切除术进行二次肺切除术的患者。采用 1:1 倾向评分匹配（PSM）来平衡选择偏倚。比较肺叶切除术和亚肺叶切除术的临床病理特征、围手术期和生存结局。
共确定了 308 例接受二次肺切除术的患者：71 例（23.1%）接受肺叶切除术，237 例（76.9%）接受亚肺叶切除术。经过 PSM 后，每组各选择了 58 例具有良好平衡的临床病理特征的患者。在接受亚肺叶切除术的患者中，观察到胸腔引流管留置时间（天）（中位数，4 天 vs. 2 天，p<0.001）和术后住院时间（天）（中位数，6 天 vs. 4 天，p<0.001）明显缩短。在第二次和第一次手术后，两组之间的总体生存率没有显著差异（p=0.65，p=0.98）。根据第一次手术的类型进行亚组分析，结果一致。
与肺叶切除术相比，亚肺叶切除术具有围手术期优势和相似的生存结局，可作为二次肺切除术的替代选择。
