Department of Surgery, Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Center for Biostatistics, The Ohio State University, Columbus, Ohio.
Cancer. 2022 Apr 1;128(7):1483-1492. doi: 10.1002/cncr.34071. Epub 2022 Jan 7.
Segmentectomy is increasingly used for parenchyma sparing anatomical resection for small stage I non-small cell lung cancer (NSCLC). This study characterizes the national outcomes for lymph node assessment and perioperative outcomes of segmentectomy for clinical stage I NSCLC by robotic-assisted surgery (RATS), video-assisted thoracoscopic surgery (VATS), and open thoracotomy approach.
A retrospective cohort study was conducted of patients who underwent segmentectomy for clinical stage I NSCLC captured in the national Society of Thoracic Surgeons General Thoracic Surgery Database between years 2012 and 2018. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Lymph node (LN) staging and 30-day outcomes were compared by approach.
A total of 3680 patients (VATS 61.9%, RATS 20%, open 18%) underwent segmentectomy. The IPTW adjusted rate of pathologic LN upstaging (pN1/pN2) was 6.2% (RATS 6.3%, VATS 5.6%, open 8.6%; P = .05). On multivariate analysis, there was no differences in pN1/N2 upstaging between RATS (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.44-1.49) or VATS (OR, 0.96; 95% CI, 0.57-1.63) with open segmentectomy. The RATS and VATS approach was associated with fewer postoperative events (RATS 31.3%, VATS 28.8%, open 38.3%; P < .001) and shorter length of stay (RATS 4.3 days, VATS 4.4 days, open 5.2 days; P < .001) as compared with thoracotomy. RATS segmentectomy-specific complications included a higher rate of pneumothorax after chest tube removal and discharge with chest tube. Major complications were lower after RATS and VATS as compared with open segmentectomy (RATS 5.9%, VATS 4.5%, open 7.2%; P = .028).
Segmentectomy by VATS and robotic approach resulted in similar high rates of lymph node upstaging as a global marker of the quality of lymph node dissection and were associated with lower overall morbidity and shorter length of stay as compared with open thoracotomy. These national outcomes may serve as benchmarks for future comparative studies.
段切除术越来越多地被用于小Ⅰ期非小细胞肺癌（NSCLC）的保留实质的解剖性切除术。本研究通过机器人辅助手术（RATS）、电视辅助胸腔镜手术（VATS）和开胸手术来描述临床Ⅰ期 NSCLC 行段切除术的全国淋巴结评估结果和围手术期结局。
对 2012 年至 2018 年间国家胸外科医师学会普通胸外科数据库中接受Ⅰ期 NSCLC 行段切除术的患者进行回顾性队列研究。采用逆概率治疗加权法（IPTW）平衡基线特征。通过方法比较淋巴结（LN）分期和 30 天结局。
共 3680 例患者（VATS 占 61.9%，RATS 占 20%，开胸手术占 18%）接受了段切除术。经 IPTW 校正后，病理 LN 升级率（pN1/pN2）为 6.2%（RATS 为 6.3%，VATS 为 5.6%，开胸手术为 8.6%；P=0.05）。多因素分析显示，RATS（比值比[OR]，0.81；95%置信区间[CI]，0.44-1.49）或 VATS（OR，0.96；95%CI，0.57-1.63）与开胸手术比较，pN1/N2 升级无差异。与开胸手术相比，RATS 和 VATS 方法术后事件（RATS 占 31.3%，VATS 占 28.8%，开胸手术占 38.3%；P<0.001）和住院时间（RATS 为 4.3 天，VATS 为 4.4 天，开胸手术为 5.2 天；P<0.001）更短。与开胸手术相比，RATS 段切除术特有的并发症包括胸腔引流管拔除后气胸和带管出院的发生率更高。RATS 和 VATS 与开胸手术相比，主要并发症发生率更低（RATS 为 5.9%，VATS 为 4.5%，开胸手术为 7.2%；P=0.028）。
VATS 和机器人辅助的段切除术作为淋巴结清扫质量的一个整体标志物，淋巴结升级率相似，与开胸手术相比，总体发病率较低，住院时间较短。这些全国性的结果可以作为未来比较研究的基准。
