Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
Department of Surgery, King Hussein Cancer Center, Amman, Jordan.
J Cardiothorac Surg. 2022 Mar 2;17(1):26. doi: 10.1186/s13019-022-01777-y.
Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country.
Medical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized.
spVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05).
All the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes.
电视辅助胸腔镜手术（VATS）是一种安全有效的肺切除术式。VATS 仅需一个切口即可完成，术后疼痛和感觉异常较轻，美容效果较好，患者满意度较高。单孔胸腔镜手术（spVATS）已越来越多地用于肺切除术。我们评估了在我们的三级癌症中心采用这种新技术后的早期手术和肿瘤学结果，因为这是全国第一家采用该技术的机构。
访问了一家三级癌症中心的 257 名患者的医疗记录，这些患者被诊断为非小细胞肺癌、肺转移或其他胸部局限性病变，以获取围手术期结果、病理结果、术后随访数据以及早期手术和肿瘤学结果。所有患者均接受 spVATS 进行局限性或广泛性肺切除术。采用简单描述性分析。
spVATS 行根治性手术（79.8%，N=205）或诊断性手术（20.2%，N=52）。对于根治性手术组，手术类型分为局限性（73.6%，N=151）、肺叶切除术（16.6%，N=34）和复杂性（9.7%，N=20）。肺原发性癌（PLC）患者的切缘阴性（R0）率为 100%，肺转移癌（PM）组为 97%。并发症发生率为 5%。PLC 和 PM 组的 3 年无病生存率分别为 87%和 68.5%。PLC 和 PM 的 3 年总生存率分别为 91.3%和 82.8%。在每个根治性亚组中，研究期间手术时间呈下降趋势，局限性切除术的差异有边界意义（P 值=0.05）。
无论手术复杂性如何，所有 spVATS 手术均成功完成，无围手术期严重并发症或死亡。R0 切除效果极佳。spVATS 治疗肺癌的中远期疗效需要进一步随访。通过适当的培训、适当的适应证和精细的应用，采用 spVATS 是一种安全可行的技术，不会影响手术和肿瘤学结果。
