Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Eur J Cardiothorac Surg. 2022 Feb 18;61(3):533-542. doi: 10.1093/ejcts/ezab430.
Only few studies compared the surgical morbidity and mortality of thoracoscopic segmentectomy versus lobectomy for non-small-cell lung cancer, in particular, by relating the segmental resections with the corresponding anatomical lobes.
We enrolled a total of 7487 patients who underwent VATS lobectomy (7269) or segmentectomy (218) from January 2014 to July 2019. A propensity score matching approach was used to account for potential confounding factors between the 2 groups. After matching, 349 lobectomies and 208 segmentectomies were included in the analysis. We analysed the operative and postoperative outcomes of video-assisted anatomical segmentectomy compared with video-assisted lobectomy and, in details, the results of segmentectomy with its corresponding lobectomy in a large cohort of patients from the Italian VATS Group Registry.
The overall conversion rate to thoracotomy was not statistically different between the groups (27 patients 8% vs 7 patients 3%, P = 0.1). The lobectomy group had a greater number of resected lymph nodes (median 11 vs 8, P = 0.006). No significant differences were detected in 30-day mortality (1.4%, 5 patients vs 0.9%, 2 patients), overall complications (18%, 62 patients vs 14%, 29 patients) and prolonged air leakage (31 patients, 9% vs 12 patients, 6%) between lobectomy and segmentectomy, respectively. No statistical differences were found regarding the median duration of drainage (3.2 days, P = 1) and the overall median length of hospital stay (6.4 days, P = 0.1) between the 2 groups. In the context of segmentectomy versus corresponding lobectomy, the right upper lobectomy compared with right upper segmentectomy showed a higher number of resected lymph nodes (P = 0.027). No statistical differences were reported in terms of conversion rate and postoperative complication and mortality.
Segmentectomy could be considered a safe procedure without significant differences compared to thoracoscopic lobectomy in terms of postoperative morbidity and mortality.
仅有少数研究比较了非小细胞肺癌胸腔镜肺段切除术与肺叶切除术的手术发病率和死亡率，特别是通过将肺段切除术与相应的解剖肺叶相关联。
我们共纳入了 7487 例患者，他们于 2014 年 1 月至 2019 年 7 月期间接受了 VATS 肺叶切除术（7269 例）或肺段切除术（218 例）。采用倾向评分匹配方法来考虑两组之间潜在的混杂因素。匹配后，349 例肺叶切除术和 208 例肺段切除术纳入分析。我们分析了与胸腔镜肺叶切除术相比，视频辅助解剖性肺段切除术的手术和术后结果，并详细分析了来自意大利胸腔镜协会注册研究的大样本患者中肺段切除术与其相应肺叶切除术的结果。
两组之间的总体中转开胸率无统计学差异（27 例 8%与 7 例 3%，P=0.1）。肺叶切除术组切除的淋巴结数量更多（中位数 11 枚比 8 枚，P=0.006）。30 天死亡率（1.4%，5 例与 0.9%，2 例）、总并发症发生率（18%，62 例与 14%，29 例）和延长漏气（31 例，9%与 12 例，6%）在肺叶切除术与肺段切除术之间均无显著差异。两组引流中位时间（3.2 天，P=1）和总住院中位时间（6.4 天，P=0.1）无统计学差异。在肺段切除术与相应肺叶切除术的比较中，右肺上叶切除术与右肺上叶段切除术相比，切除的淋巴结数量更多（P=0.027）。在中转率和术后并发症及死亡率方面，两组间无统计学差异。
与胸腔镜肺叶切除术相比，肺段切除术是一种安全的手术方式，在术后发病率和死亡率方面无显著差异。
