胸腔镜肺段切除术与肺叶切除术：倾向评分匹配分析

Thoracoscopic segmentectomy versus lobectomy: A propensity score-matched analysis.

作者信息

Sesma Julio, Bolufer Sergio, García-Valentín Antonio, Embún Raúl, López Íker Javier, Moreno-Mata Nicolás, Jiménez Unai, Trancho Florentino Hernando, Martín-Ucar Antonio Eduardo, Gallar Juana

机构信息

Thoracic Surgery Department, Hospital General Universitario de Alicante, Alicante, Spain.

Miguel Hernandez de Elche University, Alicante, Spain.

出版信息

JTCVS Open. 2022 Jan 22;9:268-278. doi: 10.1016/j.xjon.2022.01.009. eCollection 2022 Mar.

DOI:10.1016/j.xjon.2022.01.009

PMID:36003470

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9390783/

Abstract

OBJECTIVES

The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy.

METHODS

From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score-matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan-Meier and competing risks method were used to compare survival.

RESULTS

In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; = .003), and shorter median postoperative stay (4.8 vs 6.2 days; = .004) than video-assisted thoracic surgery lobectomy. After propensity score-matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; = .02). Kaplan-Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; = .2), tumor progression-related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; = .4) between groups.

CONCLUSIONS

Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

摘要

目的

本研究旨在比较多中心西班牙电视辅助胸腔镜手术组数据库中接受电视辅助胸腔镜肺叶切除术或电视辅助胸腔镜解剖性肺段切除术患者的术后并发症、围手术期过程及生存率。

方法

2016年１2月至2018年3月，从33个中心共收集了2250例患者。进行总体分析（电视辅助胸腔镜肺叶切除术 = 2070例；电视辅助胸腔镜解剖性肺段切除术 = 180例）和倾向评分匹配调整分析（电视辅助胸腔镜肺叶切除术 = 97例；电视辅助胸腔镜解剖性肺段切除术 = 97例）以比较术后结果。采用Kaplan-Meier法和竞争风险法比较生存率。

结果

在总体分析中，电视辅助胸腔镜解剖性肺段切除术的呼吸系统并发症发生率较低（相对风险，0.56；置信区间，0.37 - 0.83；P = 0.002），术后持续漏气时间较短（相对风险，0.42；95%置信区间，0.23 - 0.78；P = 0.003），术后中位住院时间较短（4.8天对6.2天；P = .004）。倾向评分匹配分析后，电视辅助胸腔镜解剖性肺段切除术的持续漏气仍显著较低（相对风险，0.33；95%置信区间，0.12 - 0.89；P = 0.02）。Kaplan-Meier曲线和竞争风险曲线显示，在3年随访期间（中位随访时间：24.4个月；四分位间距，20.8 - 28.3个月），两组在总生存率（风险比，0.73；95%置信区间，0.45 - 1.7；P = 0.2）、肿瘤进展相关死亡率（亚分布风险比，0.41；95%置信区间，0.11 - 1.57；P = 0.2）和无病生存率（亚分布风险比，0.73；95%置信区间，0.35 - 1.51；P = 0.4）方面无差异。