Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Jpn J Clin Oncol. 2021 Nov 1;51(11):1649-1655. doi: 10.1093/jjco/hyab128.
Many thoracic surgeons have tried to make lung cancer surgery less invasive. Among the minimally invasive approaches that are currently available, it is controversial which is optimal. Minimally invasive open surgery, i.e. hybrid video-assisted thoracic surgery, has been adopted for lung cancer surgery at our institute. The objective of this study was to evaluate minimally invasive open surgery in terms of perioperative outcomes over the most recent 5 years.
Between 2015 and 2019, 2738 patients underwent pulmonary resection for lung cancer at National Cancer Center Hospital, Japan. Among them, 2174 patients with clinical stage I lung cancer who underwent minimally invasive open surgery were included. Several perioperative parameters were evaluated.
The patients consisted of 1092 men (50.2%) and 1082 women (49.8%). Lobectomy was performed in 1255 patients (57.7%), segmentectomy in 603 (27.7%) and wide wedge resection in 316 (14.5%). Median blood loss was 30 ml (interquartile range: 15-57 ml) for lobectomy, 17 ml (interquartile range: 10-31 ml) for segmentectomy and 5 ml (interquartile range: 2-10 ml) for wide wedge resection. Median operative time was 120 min (interquartile range: 104-139 min) for lobectomy, 109 min (interquartile range: 98-123 min) for segmentectomy and 59 min (interquartile range: 48-76 min) for wide wedge resection. Median length of postoperative hospital stay was 4 days (interquartile range: 3-5 days). The 30-day mortality rate was 0.08% for lobectomy, 0.17% for segmentectomy and 0.00% for wide wedge resection.
Minimally invasive open surgery for clinical stage I lung cancer is a feasible approach with a low mortality and a short hospital stay. Oncological outcomes need to be investigated.
许多胸外科医生都试图使肺癌手术创伤更小。目前有多种微创方法可供选择，但其哪种方法最优仍存在争议。我院采用微创开胸手术，即杂交电视辅助胸腔镜手术，进行肺癌手术。本研究旨在评估最近 5 年微创开胸手术的围手术期结果。
2015 年至 2019 年，日本国家癌症中心医院共有 2738 例患者因肺癌接受了肺切除术。其中，2174 例临床 I 期肺癌患者接受了微创开胸手术。评估了几种围手术期参数。
患者中男性 1092 例（50.2%），女性 1082 例（49.8%）。行肺叶切除术 1255 例（57.7%），肺段切除术 603 例（27.7%），广泛楔形切除术 316 例（14.5%）。肺叶切除术的中位出血量为 30ml（四分位距：15-57ml），肺段切除术为 17ml（四分位距：10-31ml），广泛楔形切除术为 5ml（四分位距：2-10ml）。肺叶切除术的中位手术时间为 120min（四分位距：104-139min），肺段切除术为 109min（四分位距：98-123min），广泛楔形切除术为 59min（四分位距：48-76min）。术后中位住院时间为 4 天（四分位距：3-5 天）。肺叶切除术、肺段切除术和广泛楔形切除术的 30 天死亡率分别为 0.08%、0.17%和 0.00%。
对于临床 I 期肺癌，微创开胸手术是一种可行的方法，其死亡率低，住院时间短。需要进一步研究其肿瘤学结果。
