Dai Zhangyi, Li Yiming, Mi Xingqi, Yang Zhenyu, Gao Jiayi, Liu Chengwu, Mei Jiandong, Liu Lunxu, Pu Qiang
Department of Thoracic Surgery, Sichuan University West China Medical Center, Chengdu, China.
J Thorac Dis. 2023 Aug 31;15(8):4216-4228. doi: 10.21037/jtd-23-477. Epub 2023 Aug 14.
Single or combined basal segmentectomy (CBS), excluding common basal segmentectomy, is the most difficult of all types of segmentectomies. The purpose of this study was to compare the perioperative outcomes and oncological prognosis between uniport thoracoscopic basal segmentectomy (UTBS) and triport thoracoscopic basal segmentectomy (TTBS).
This study retrospectively collected 300 patients who underwent thoracoscopic single or CBS at the West China Hospital of Sichuan University from April 2015 to May 2022, including 67 and 233 patients in the UTBS and TTBS groups, respectively. Propensity score matching (PSM) was used to reduce confounding bias between the two groups. The primary outcome was recurrence-free survival (RFS). The secondary outcomes were overall survival (OS) and perioperative outcomes.
After PSM, the UTBS group (n=64) had significantly less intraoperative blood loss than the TTBS group (n=64) (20 30 mL, P=0.001). Other perioperative outcomes, including the operation time, number of lymph nodes and lymph node stations harvested, duration of chest tube drainage, postoperative hospital stay, and postoperative complications, were comparable. Subgroup analysis demonstrated that the operative time in the group underwent single basal segmentectomy (SBS) was significantly shorter compared to the group underwent CBS (110 120 min, P=0.002). There were 5 cases of recurrence in the overall cohort and no recurrence in the matched cohort. No deaths were observed in the overall cohort. Therefore, a survival analysis was conducted only for RFS in the overall cohort. The RFS rate and OS rate of the overall cohort were 98.3% and 100%, respectively. The surgical approach (UTBS TTBS) was not an independent risk factor for RFS (HR: 1.120, 95% CI: 0.342-13.051, P=0.879).
UTBS provided similar perioperative outcomes and oncological prognoses compared to TTBS.
单段或联合肺基底段切除术（不包括共同基底段切除术）是所有类型段切术中最困难的。本研究旨在比较单孔胸腔镜肺基底段切除术（UTBS）和三孔胸腔镜肺基底段切除术（TTBS）的围手术期结局和肿瘤学预后。
本研究回顾性收集了2015年4月至2022年5月在四川大学华西医院接受胸腔镜下单段或联合肺基底段切除术的300例患者，其中UTBS组和TTBS组分别有67例和233例患者。采用倾向评分匹配（PSM）以减少两组间的混杂偏倚。主要结局为无复发生存期（RFS）。次要结局为总生存期（OS）和围手术期结局。
PSM后，UTBS组（n = 64）术中失血量显著少于TTBS组（n = 64）（20±30 mL，P = 0.001）。其他围手术期结局，包括手术时间、清扫的淋巴结数量和淋巴结站数、胸管引流持续时间、术后住院时间和术后并发症，两组相当。亚组分析表明，接受单肺基底段切除术（SBS）的组手术时间明显短于接受联合肺基底段切除术（CBS）的组（110±120分钟，P = 0.002）。整个队列中有5例复发，匹配队列中无复发。整个队列中未观察到死亡。因此，仅对整个队列的RFS进行了生存分析。整个队列的RFS率和OS率分别为98.3%和100%。手术方式（UTBS vs TTBS）不是RFS的独立危险因素（HR：1.120，95%CI：0.342 - 13.051，P = 0.879）。
与TTBS相比，UTBS的围手术期结局和肿瘤学预后相似。
