Zheng Jianqi, Liang Hengrui, Wang Runchen, Zhong Ran, Jiang Shunjun, Wang Wei, Zhao Yi, Chen Zhuxing, Liang Wenhua, Liu Jun, He Jianxing
Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
Nanshan School, Guangzhou Medical University, Guangzhou, China.
Transl Lung Cancer Res. 2021 Oct;10(10):3875-3887. doi: 10.21037/tlcr-21-629.
Spontaneous ventilation video-assisted thoracoscopic surgery (SV-VATS) exhibits dual intraoperative and postoperative advantages for patients with non-small cell lung cancer (NSCLC). However, there is a lack of data regarding its long-term survival superiority over the double-lumen intubated mechanical ventilation video-assisted thoracoscopic surgery (MV-VATS) or thoracotomy.
A retrospective study was conducted from 2011 to 2018 in the First Affiliated Hospital of Guangzhou Medical University among patients with NSCLC who underwent the SV-VATS or the MV-VATS. Patients receiving the SV-VATS were the study group, and patients receiving the MV-VATS were the control group. Propensity score matching (PSM) was performed to establish 1:1 SV-VATS versus MV-VATS group matching to balance potential baseline confounding factors. Primary endpoints were overall survival (OS) and disease-free survival (DFS). Secondary endpoints were perioperative outcomes. The baseline information of these patients was recorded. The perioperative data and survival data were collected using a combination of electronic data record system and telephone interview. A 1:1:1 SPM was also used to compare the OS in the SV-VATS, the MV-VATS and thoracotomy group by using another database, including patients undergoing thoracotomy and the MV-VATS.
For the two-group comparison, after 1:1 PSM, a matched cohort with 400 (200:200) patients was generated. The median follow-up time in this cohort was 4.78 years (IQR, 3.78-6.62 years). The OS (HR =0.567, 95% CI, 0.330 to 0.974, P=0.0498) and the DFS (HR =0.546, 95% CI, 0.346 to 0.863, P=0.013) of the SV-VATS group were significantly better than the MV-VATS group. There were no statistically differences between the SV-VATS and the MV-VATS group on the operative time (158.56±40.09 172.06±61.75, P=0.200) anesthesia time (247.4±62.49 256.7±58.52, P=0.528), and intraoperative bleeding volume (78.88±80.25 109.932±180.86, P=0.092). For the three-group comparison, after 1:1:1 PSM, 582 (194:194:194) patients were included for the comparison of SV-VATS, MV-VATS and thoracotomy. The OS of the SV-VATS group was significantly better than the thoracotomy group (HR =0.379, 95% CI, 0.233 to 0.617, P<0.001).
Invasive NSCLC patients undergoing SV-VATS lobectomy demonstrated better long-term outcomes compared with MV-VATS.
对于非小细胞肺癌（NSCLC）患者，自主通气电视辅助胸腔镜手术（SV-VATS）在术中和术后均具有双重优势。然而，目前缺乏关于其相对于双腔气管插管机械通气电视辅助胸腔镜手术（MV-VATS）或开胸手术在长期生存方面优越性的数据。
2011年至2018年在广州医科大学附属第一医院对接受SV-VATS或MV-VATS的NSCLC患者进行了一项回顾性研究。接受SV-VATS的患者为研究组，接受MV-VATS的患者为对照组。采用倾向评分匹配（PSM）建立1:1的SV-VATS组与MV-VATS组匹配，以平衡潜在的基线混杂因素。主要终点为总生存期（OS）和无病生存期（DFS）。次要终点为围手术期结局。记录这些患者的基线信息。通过电子数据记录系统和电话访谈相结合的方式收集围手术期数据和生存数据。还采用1:1:1的PSM，通过另一个数据库比较SV-VATS组、MV-VATS组和开胸手术组的OS，该数据库包括接受开胸手术和MV-VATS的患者。
对于两组比较，1:1 PSM后，产生了一个包含400例（200:200）患者的匹配队列。该队列的中位随访时间为4.78年（四分位间距，3.78 - 6.62年）。SV-VATS组的OS（HR = 0.567，95% CI，0.330至0.974，P = 0.0498）和DFS（HR = 0.546，95% CI，0.346至0.863，P = 0.013）显著优于MV-VATS组。SV-VATS组与MV-VATS组在手术时间（158.56±40.09对172.06±61.75，P = 0.200）、麻醉时间（247.4±62.49对256.7±58.52，P = 0.528）和术中出血量（78.88±80.25对109.932±180.86，P = 0.092）方面无统计学差异。对于三组比较，1:1:1 PSM后，纳入582例（194:194:194）患者进行SV-VATS、MV-VATS和开胸手术的比较。SV-VATS组的OS显著优于开胸手术组（HR = 0.379，95% CI，0.233至0.617，P < 0.001）。
与MV-VATS相比，接受SV-VATS肺叶切除术的浸润性NSCLC患者具有更好的长期结局。
