新辅助治疗不会增加局部晚期非小细胞肺癌袖状肺叶切除术的术后发病率。
Neoadjuvant therapy does not increase postoperative morbidity of sleeve lobectomy in locally advanced non-small cell lung cancer.
机构信息
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
J Thorac Cardiovasc Surg. 2023 Oct;166(4):1234-1244.e13. doi: 10.1016/j.jtcvs.2023.03.016. Epub 2023 Mar 24.
OBJECTIVES
To evaluate the feasibility and safety of sleeve lobectomy after neoadjuvant therapy by assessing the postoperative morbidity.
METHODS
Patients who underwent sleeve lobectomy for non-small cell lung cancer (NSCLC) were retrospectively analyzed from January 2018 to December 2021. A total of 613 patients were enrolled, including 124 patients who received previous neoadjuvant therapy and 489 patients who did not. Propensity score matching was adopted to create a balanced cohort consisting of 97 paired cases. Patient demographics and perioperative outcomes were compared between the 2 groups, and logistic regression analysis was used to identify risk factors for postoperative complications.
RESULTS
In the entire cohort, univariable logistic regression analysis showed that smoking history (odds ratio [OR], 1.501; 95% confidence interval [CI], 1.011-2.229, P = .044), open thoracotomy (OR, 1.748; 95% CI, 1.178-2.593, P = .006), and operation time more than 150 minutes (OR, 1.548; 95% CI, 1.029-2.328, P = .036) were risk factors for postoperative complications, and multivariable logistic regression analysis showed open thoracotomy was an independent risk factor (OR, 1.765; 95% CI, 1.178-2.643, P = .006). In the balanced cohort, the neoadjuvant group had a lower proportion of double-sleeve resections (3.1% vs 11.3%, P = .035) and longer postoperative chest tube drainage (6.67 ± 3.81 vs 5.13 ± 3.74 days, P < .001). However, no significant differences were observed in postoperative morbidity between the 2 groups (25.8% vs 24.7%, P = .869). The complete pathologic response of chemoimmunotherapy was significantly superior to chemotherapy alone (28.2% vs 4.1%, P < .001), and no significant differences were noted in postoperative morbidity in different neoadjuvant therapy modalities.
CONCLUSIONS
After neoadjuvant therapy, sleeve lobectomy can be safely performed with no increased postoperative morbidity.
目的
通过评估术后发病率来评估新辅助治疗后行袖状肺叶切除术的可行性和安全性。
方法
回顾性分析 2018 年 1 月至 2021 年 12 月期间因非小细胞肺癌（NSCLC）行袖状肺叶切除术的患者。共纳入 613 例患者，其中 124 例患者接受了新辅助治疗，489 例患者未接受。采用倾向性评分匹配方法创建了一个包含 97 对病例的均衡队列。比较两组患者的围手术期结局，并采用 logistic 回归分析识别术后并发症的危险因素。
结果
在整个队列中，单变量 logistic 回归分析显示，吸烟史（比值比 [OR]，1.501；95%置信区间 [CI]，1.011-2.229，P=0.044）、开胸手术（OR，1.748；95%CI，1.178-2.593，P=0.006）和手术时间超过 150 分钟（OR，1.548；95%CI，1.029-2.328，P=0.036）是术后并发症的危险因素，多变量 logistic 回归分析显示开胸手术是独立的危险因素（OR，1.765；95%CI，1.178-2.643，P=0.006）。在均衡队列中，新辅助组双袖式切除的比例较低（3.1%比 11.3%，P=0.035），术后胸腔引流管放置时间较长（6.67±3.81 比 5.13±3.74 天，P<0.001）。然而，两组术后发病率无显著差异（25.8%比 24.7%，P=0.869）。化疗免疫治疗的完全病理缓解明显优于单纯化疗（28.2%比 4.1%，P<0.001），不同新辅助治疗方式术后发病率无显著差异。
结论
新辅助治疗后，行袖状肺叶切除术是安全的，不会增加术后发病率。
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