一项针对 I-III 期胸腺癌的开放性与微创手术胸腺切除术的全国性分析。

A national analysis of open versus minimally invasive thymectomy for stage I-III thymic carcinoma.

机构信息

Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, CA, USA.

出版信息

Eur J Cardiothorac Surg. 2022 Aug 3;62(3). doi: 10.1093/ejcts/ezac159.

DOI:10.1093/ejcts/ezac159

PMID:35259241

Abstract

OBJECTIVES

The oncological efficacy of minimally invasive thymectomy for thymic carcinoma is not well characterized. We compared overall survival and short-term outcomes between open and minimally invasive surgical (video-assisted thoracoscopic and robotic) approaches using the National Cancer Database.

METHODS

Perioperative outcomes and overall survival of patients who underwent open versus minimally invasive thymectomy for Masaoka stage I-III thymic carcinoma from 2010 to 2015 in the National Cancer Database were evaluated using propensity score-matched analysis and multivariable Cox proportional hazards modelling. Outcomes by surgical approach were assessed using an intent-to-treat analysis.

RESULTS

Of the 216 thymectomies that were evaluated, 43 (20%) were performed with minimally invasive techniques (22 video-assisted thoracoscopic and 21 robotic). The minimally invasive approach was associated with a shorter median length of stay when compared to the open approach (3 vs 5 days, P < 0.001). In the propensity score-matched analysis of 30 open and 30 minimally invasive thymectomies, the minimally invasive group did not differ significantly in median length of stay (3 vs 4.5 days, P = 0.27), 30-day readmission (P = 0.13), 30-day mortality (P = 0.60), 90-day mortality (P = 0.60), margin positivity (P = 0.39) and 5-year survival (78.6% vs 54.6%, P = 0.15) when compared to the open group.

CONCLUSIONS

In this national analysis, minimally invasive thymectomy for stage I-III thymic carcinoma was found to have no significant differences in short-term outcomes and overall survival when compared to open thymectomy.

摘要

目的

微创胸腺切除术治疗胸腺癌的肿瘤学疗效尚未得到充分描述。我们使用国家癌症数据库比较了开放手术和微创外科（电视辅助胸腔镜和机器人）方法治疗 Masaoka Ⅰ-Ⅲ期胸腺癌的总生存率和短期结果。

方法

使用倾向评分匹配分析和多变量 Cox 比例风险模型评估了 2010 年至 2015 年期间国家癌症数据库中接受开放与微创胸腺切除术治疗 Masaoka Ⅰ-Ⅲ期胸腺癌的患者的围手术期结果和总生存率。通过意向治疗分析评估了手术方法的结果。

结果

在评估的 216 例胸腺切除术患者中，有 43 例（20%）采用微创技术（22 例电视辅助胸腔镜，21 例机器人）进行。与开放手术相比，微创方法的中位住院时间更短（3 天与 5 天，P < 0.001）。在 30 例开放和 30 例微创胸腺切除术的倾向评分匹配分析中，微创组的中位住院时间（3 天与 4.5 天，P = 0.27）、30 天再入院率（P = 0.13）、30 天死亡率（P = 0.60）、90 天死亡率（P = 0.60）、切缘阳性率（P = 0.39）和 5 年生存率（78.6%与 54.6%，P = 0.15）与开放组无显著差异。