Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
Division of Thoracic and Cardiovascular Surgery, Lahey Hospital & Medical Center, Burlington, Maryland; Division of Thoracic and Cardiovascular Surgery, Tufts University School of Medicine, Boston, Massachusetts.
Ann Thorac Surg. 2022 Dec;114(6):2023-2031. doi: 10.1016/j.athoracsur.2021.10.060. Epub 2021 Dec 10.
Lung cancer invading the chest wall is treated with concomitant en bloc lung and chest wall resection (CWR). It is unclear how CWR affects postoperative outcomes of lung resection. We hypothesized that CWR would be associated with increased risk of adverse outcomes after lung cancer resection.
We performed a retrospective analysis of The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database from 2016-2019. Patients with superior sulcus tumors were excluded. Patient demographic and operative outcomes were compared between those with and without CWR. Chest wall resection was added to existing STS lung risk models to determine the association with a composite adverse outcome, which included major morbidity and death.
Among 41 310 lung resections, 306 (0.74%) occurred with concomitant CWR. Differences between those with and without CWR included demographic and comorbidities. Patients undergoing CWR were more likely to have the composite adverse outcome (64 of 306 [20.9%] vs 3128 of 41 004 [7.6%] for non-CWR resections, P < .001). Mortality was also increased among the CWR cohort (2.9% vs 1.1%, P = .003). CWR was associated with an increased risk of adverse composite outcome among all lung resection patients in a multivariable model (odds ratio 1.74, P = .0003) and the lobectomy subgroup (odds ratio 2.35, P < .0001). Among institutions with ≥10 lung resections, 49.1% performed lung resections with CWR.
Concomitant CWR adds risk of adverse outcomes after lung cancer resection. As a subset of intuitions perform CWR, quality assessments should control for CWR. This variable will be incorporated into the STS lung cancer and lobectomy quality composite measures.
肺癌侵犯胸壁时采用肺和胸壁整块切除术（CWR）进行治疗。目前尚不清楚 CWR 对肺癌切除术后的结果有何影响。我们假设 CWR 与肺癌切除术后不良结果的风险增加有关。
我们对 2016 年至 2019 年胸外科医师学会（STS）普通胸外科数据库进行了回顾性分析。排除了尖峰上肿瘤患者。比较了 CWR 组和非 CWR 组患者的人口统计学和手术结果。将胸壁切除术添加到现有的 STS 肺癌风险模型中，以确定与复合不良结局（包括主要发病率和死亡）的关联。
在 41310 例肺切除术中，有 306 例（0.74%）进行了 CWR。CWR 组和非 CWR 组之间的差异包括人口统计学和合并症。CWR 组更有可能发生复合不良结局（64 例[20.9%]与 41004 例[7.6%]非 CWR 切除术相比，P<.001）。CWR 组的死亡率也较高（2.9%比 1.1%，P<.001）。在多变量模型中，CWR 与所有肺切除术患者的不良复合结局风险增加相关（比值比 1.74，P<.0003），并且与肺叶切除术亚组相关（比值比 2.35，P<.0001）。在进行了≥10 例肺切除术的机构中，有 49.1%的机构进行了 CWR 肺切除术。
肺癌切除术后同时进行 CWR 会增加不良结果的风险。由于某些机构会进行 CWR，因此质量评估应控制 CWR。该变量将被纳入 STS 肺癌和肺叶切除术质量综合指标中。
