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肺癌肺叶切除术中单孔与多孔电视辅助胸腔镜手术的当前观点

Current perspective on uniportal and multiportal video-assisted thoracic surgery during lobectomy for lung cancer.

作者信息

Coco Danilo, Leanza Silvana

机构信息

Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro (PU), Italy.

Department of General Surgery, Carlo Urbani Hospital, Jesi (AN), Italy.

出版信息

Kardiochir Torakochirurgia Pol. 2022 Sep;19(3):146-151. doi: 10.5114/kitp.2022.119763. Epub 2022 Oct 6.

Abstract

Non-small cell lung cancer (NSCLC) is the most typical type of lung cancer, and it is the leading cancer-related mortality globally. Lobectomy for early-stage NSCLC has been characterized in the previous decade using a wide range of methodologies. The development of video-assisted thoracoscopic surgery (VATS) allowed surgeons first to reduce the thoracotomy size, which is generally anterior, limiting it to trocar incisions or a single portal approach. This review aimed to describe current perspectives on operative outcomes, lymph node removal, oncologic outcomes, and advantages for surgeons performing uniportal VATS (uVATS) and multiportal (mVATS) lobectomy. The advantages of uVATS include comfortable operating for surgeons with a direct view and safety, and for patients more favourable operative outcomes. Also, the uVATS approach has previously been demonstrated to be effective and safe, with positive outcomes not just with respect to cosmetics but also in terms of a speedy recovery. Oncological uVATS clearance is comparable to multiportal VATS with respect to early mid-term survivability as well as nodal staging, as per retrospective comparison studies. However, the interpretation of outcomes must be made cautiously due to selection bias as well as lack of long-term follow-up; the choice of which VATS approach to utilize for patients' treatment following pulmonary resection is largely based on the preferences of the surgeon. As a result, it is difficult to say if one VATS method is better than another.

摘要

非小细胞肺癌(NSCLC)是最常见的肺癌类型,也是全球癌症相关死亡的主要原因。在过去十年中,使用了多种方法对早期NSCLC的肺叶切除术进行了描述。电视辅助胸腔镜手术(VATS)的发展使外科医生首先能够减小开胸切口的尺寸,该切口通常位于前方,将其限制为套管针切口或单孔入路。本综述旨在描述当前关于手术结果、淋巴结清扫、肿瘤学结果以及单孔VATS(uVATS)和多孔(mVATS)肺叶切除术对外科医生的优势的观点。uVATS的优势包括对外科医生来说操作直观舒适且安全,对患者来说手术结果更有利。此外,uVATS方法此前已被证明是有效且安全的,不仅在美容方面有积极效果,而且在快速恢复方面也有积极效果。根据回顾性比较研究,在早期中期生存率以及淋巴结分期方面,肿瘤学上的uVATS清扫与多孔VATS相当。然而,由于选择偏倚以及缺乏长期随访,对结果的解释必须谨慎;肺切除术后患者治疗采用哪种VATS方法很大程度上取决于外科医生的偏好。因此,很难说一种VATS方法是否优于另一种。

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