Liu Xinlong, Sun Teng, Hong Tao, Yuan Yanliang, Zhang Hao
Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University; Thoracic Surgery Laboratory, The First College of Clinical Medicine, Xuzhou Medical University, Xuzhou 221006, China.
Zhongguo Fei Ai Za Zhi. 2022 Feb 20;25(2):71-77. doi: 10.3779/j.issn.1009-3419.2021.101.46.
Immunoneoadjuvant therapy opens a new prospect for local advanced lung cancer. The aim of our study was to explore the safety and feasibility of robotic-assisted bronchial sleeve resection in patients with locally advanced non-small cell lung cancer (NSCLC) after neoadjuvant chemoimmunotherapy.
Data of 13 patients with locally advanced NSCLC that underwent bronchial sleeve resection after neoadjuvant chemoimmunotherapy during August 2020 and February 2021 were retrospectively included. According to the surgical methods, patients were divided into thoracotomy bronchial sleeve resection (TBSR) group and robot-assisted bronchial sleeve resection (RABSR) group. Oncology, intraoperative, and postoperative data in the two groups were compared.
The two groups of patients operated smoothly, the postoperative pathology confirmed that all the tumor lesions achieved R0 resection, and RABSR group no patient was transferred to thoracotomy during surgery. Partial remission (PR) rate and major pathological remissions (MPR) rate of patients in the TBSR group were 71.43% and 42.86%, respectively. Complete pathological response (pCR) was 28.57%. They were 66.67%, 50.00% and 33.33% in RABSR group, respectively. There were no significant differences in operative duration, number of lymph nodes dissected, intraoperative blood loss, postoperative drainage time and postoperative hospital stay between the two groups, but the bronchial anastomosis time of RABSR group was relatively short. Both groups of patients had a good prognosis. Successfully discharged from the hospital and post-operative 90-d mortality rate was 0.
In patients with locally advanced central NSCLC after neoadjuvant chemoimmunotherapy can achieve the tumor reduction, tumor stage decline and increase the R0 resection rate, bronchial sleeve resection is safe and feasible. Under the premise of following the two principles of surgical safety and realizing the tumor R0 resection, robot-assisted bronchial sleeve resection can be preferred.
免疫新辅助治疗为局部晚期肺癌开辟了新前景。本研究旨在探讨新辅助化疗免疫治疗后局部晚期非小细胞肺癌（NSCLC）患者行机器人辅助支气管袖状切除术的安全性和可行性。
回顾性纳入2020年8月至2021年2月期间13例行新辅助化疗免疫治疗后接受支气管袖状切除术的局部晚期NSCLC患者的数据。根据手术方式，将患者分为开胸支气管袖状切除术（TBSR）组和机器人辅助支气管袖状切除术（RABSR）组。比较两组的肿瘤学、术中及术后数据。
两组患者手术均顺利，术后病理证实所有肿瘤病灶均达到R0切除，RABSR组术中无患者中转开胸。TBSR组患者的部分缓解（PR）率和主要病理缓解（MPR）率分别为71.43%和42.86%。完全病理缓解（pCR）为28.57%。RABSR组分别为66.67%、50.00%和33.33%。两组患者的手术时间、清扫淋巴结数目、术中出血量、术后引流时间和术后住院时间比较，差异均无统计学意义，但RABSR组支气管吻合时间相对较短。两组患者预后均良好。均顺利出院，术后90天死亡率为0。
新辅助化疗免疫治疗后的局部晚期中央型NSCLC患者能够实现肿瘤缩小、肿瘤分期下降并提高R0切除率，支气管袖状切除术安全可行。在遵循手术安全和实现肿瘤R0切除这两个原则的前提下，可优先选择机器人辅助支气管袖状切除术。
