Department of Thoracic Surgery, Hebei Medical University Fourth Hospital, 12 Jiankang Road, Shijiazhuang, 050011, Hebei Province, China.
Medical Oncology, Hebei Medical University Fourth Hospital, Shijiazhuang, China.
J Cardiothorac Surg. 2023 Apr 11;18(1):126. doi: 10.1186/s13019-023-02215-3.
Synchronous bilateral lung lesions are emerging as a common but tricky disease for surgical management. Whether one or two-stage surgery should be taken remains in debate. We retrospectively analysed 151 patients who underwent one and two-stage Video Assisted Thoracic Surgery (VATS) to investigate the safety and feasibility of the two surgical approaches.
A total of 151 patients were included in the study. Propensity score matching was performed to minimize the baseline characteristics difference between one and two-stage groups. Clinical factors including in-hospital days after surgery, chest tube drainage days, types and severity of post-operative complications were compared between the two groups. Logistic univariate and multivariate analyses were used to find the risk factors for post-operative complications. Nomogram was built to select the low risk candidates for the one-stage VATS.
After propensity score matching, 36 one-stage and 23 two-stage patients were enrolled. The age (p = 0.669), gender (p = 0.3655), smoking status (p = 0.5555), pre-operative comorbidity (p = 0.8162), surgical resection (p = 0.798) and lymph node dissection (p = 9036) were balanced between the two groups. There was no difference in post-surgery hospital days (8.67 ± 2.68 versus 8.46 ± 2.92, p = 0.7711) and chest tube retaining days (5.47 ± 2.20 versus 5.46 ± 1.95, p = 0.9772). Moreover, post-operative complications also showed no difference between one-stage and two-stage groups (p = 0.3627). Univariate and multivariate analysis revealed that advanced age (p = 0.0495), pre-surgical low haemoglobin (p = 0.045) and blood loss (p = 0.002) were risk factors for post-operative complications. Nomogram built with the three risk factors showed reasonable predictive value.
One-stage VATS for synchronous bilateral lung lesion patients was proved to be a safety procedure. Advanced age, pre-surgical low haemoglobin and blood loss may predict complications after surgery.
同期双侧肺部病变作为一种常见但棘手的疾病，其手术治疗方案仍存在争议。目前对于同期或分期行电视辅助胸腔镜手术（Video Assisted Thoracic Surgery，VATS）仍存在争议。我们回顾性分析了 151 例行同期和分期 VATS 手术的患者，旨在探讨两种手术方式的安全性和可行性。
本研究共纳入 151 例患者。采用倾向评分匹配（propensity score matching，PSM）来最小化同期和分期两组间的基线特征差异。比较两组患者的术后住院时间、胸腔引流管留置时间、术后并发症的类型和严重程度等临床因素。采用单因素和多因素 logistic 回归分析确定术后并发症的危险因素。建立列线图以选择一期 VATS 的低风险患者。
PSM 后，纳入 36 例一期和 23 例分期患者。两组患者的年龄（p=0.669）、性别（p=0.3655）、吸烟状态（p=0.5555）、术前合并症（p=0.8162）、手术切除范围（p=0.798）和淋巴结清扫范围（p=9036）差异无统计学意义。两组患者术后住院时间（8.67±2.68 天比 8.46±2.92 天，p=0.7711）和胸腔引流管留置时间（5.47±2.20 天比 5.46±1.95 天，p=0.9772）差异无统计学意义。此外，两组患者术后并发症发生率差异无统计学意义（p=0.3627）。单因素和多因素分析显示，高龄（p=0.0495）、术前低血红蛋白（p=0.045）和术中出血量（p=0.002）是术后并发症的危险因素。基于这三个危险因素建立的列线图具有较好的预测价值。
同期行双侧肺部病变 VATS 手术是安全可行的。高龄、术前低血红蛋白和术中出血量可能是预测术后并发症的危险因素。
