Choi Si Young, Moon Youngkyu
Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Transl Cancer Res. 2022 Jan;11(1):72-84. doi: 10.21037/tcr-21-2113.
Uniportal video-assisted thoracoscopic surgery (VATS) is considered a challenging procedure in cases of lung cancer where the entire pleura and lung are attached (whole pleural adhesion). The purpose of this study was to evaluate the surgical results of uniportal VATS for the treatment of lung cancer with whole pleural adhesion.
For all patients who underwent VATS lung cancer surgery at a single hospital in Korea, multiportal VATS was performed before 2017 and uniportal VATS was performed after January 2017 by the same surgeons. The surgical results of multiportal VATS and uniportal VATS for the treatment of lung cancer with whole pleural adhesion were compared retrospectively.
There were 16 eligible uniportal VATS cases and 57 multiportal VATS cases. There were no significant differences of clinicopathologic characteristics between the two groups. There were 5 conversions to open thoracotomy in the multiportal VATS group and no conversion to open thoracotomy in the uniportal group (P=0.579). The perioperative and postoperative outcomes were not different between the two groups. There was no mortality in all patients. For patients undergoing VATS lobectomy, the perioperative and postoperative outcomes were similar after uniportal and multiportal VATS lobectomy. For all patients, the 3-year recurrence-free survival (RFS) was 80.0% after uniportal VATS and 79.5% after multiportal VATS (P=0.951) and for patients with stage I non-small cell lung cancer (NSCLC), the 3-year RFS after uniportal VATS was 91.7% and the 3-year RFS after multiportal VATS was 89.3% (P=0.999). Uniportal VATS was not a significant risk factor for recurrence in the multivariate analysis.
Uniportal VATS was not inferior to multiportal VATS in surgical outcome or short-term prognosis in resection of lung cancer with whole pleural adhesion. Whole pleural adhesion is not a contraindication to uniportal VATS, which has been safe and feasible in cases of lung cancer with whole pleural adhesion.
在肺癌伴有全胸膜粘连（即整个胸膜与肺粘连）的病例中，单孔电视辅助胸腔镜手术（VATS）被认为是一项具有挑战性的手术。本研究的目的是评估单孔VATS治疗伴有全胸膜粘连的肺癌的手术效果。
在韩国一家医院接受VATS肺癌手术的所有患者中，2017年之前由同一组外科医生进行多孔VATS手术，2017年1月之后进行单孔VATS手术。对多孔VATS和单孔VATS治疗伴有全胸膜粘连的肺癌的手术结果进行回顾性比较。
有16例符合条件的单孔VATS病例和57例多孔VATS病例。两组之间的临床病理特征无显著差异。多孔VATS组有5例转为开胸手术，单孔组无转为开胸手术的情况（P = 0.579）。两组的围手术期和术后结果无差异。所有患者均无死亡。对于接受VATS肺叶切除术的患者，单孔和多孔VATS肺叶切除术后的围手术期和术后结果相似。对于所有患者，单孔VATS术后3年无复发生存率（RFS）为80.0%，多孔VATS术后为79.5%（P = 0.951）；对于I期非小细胞肺癌（NSCLC）患者，单孔VATS术后3年RFS为91.7%，多孔VATS术后为89.3%（P = 0.999）。在多因素分析中，单孔VATS不是复发的显著危险因素。
在伴有全胸膜粘连的肺癌切除术中，单孔VATS在手术效果或短期预后方面并不逊于多孔VATS。全胸膜粘连不是单孔VATS的禁忌症，在伴有全胸膜粘连的肺癌病例中，单孔VATS是安全可行的。
