Asbjornsson Viktor, Johannsdottir Gyda, Myer Daniel, Runarsson Thorri Geir, Heitmann Leon Arnar, Oskarsdottir Gudrun N, Silverborn Per Martin, Hansen Henrik Jessen, Gudbjartsson Tomas
Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
Interdiscip Cardiovasc Thorac Surg. 2024 Feb 2;38(2). doi: 10.1093/icvts/ivae018.
Although video-assisted thoracoscopic surgery (VATS) lobectomy has become the gold standard for pulmonary resections of non-small-cell lung cancer (NSCLC), lobectomy is still performed via thoracotomy in many European and North American centres. VATS lobectomy was implemented overnight from thoracotomy in our low-volume centre in early 2019, after 1 senior surgeon undertook observership VATS-training overseas, and immediately became the mainstay of surgical treatment for NSCLC in Iceland. We aimed to investigate our short-term outcomes of VATS lobectomy.
This was a retrospective study on all pulmonary resections for NSCLC in Iceland 2019-2022, especially focusing on VATS lobectomies, all at cTNM stage I or II. Data were retrieved from hospital charts, including information on perioperative complications, mortality, length of stay and operation time.
Out of 204 pulmonary resections, mostly performed by a single senior cardiothoracic surgeon, 169 were lobectomies (82.9%) with 147 out of 169 (87.0%) being VATS lobectomies. Anterolateral thoracotomy was used in 34 cases (16.7%), including 22 lobectomies (64.7%), and 5 (3.4%) conversions from VATS lobectomy. The median postoperative stay for VATS lobectomy was 4 days and the average operating time decreased from 155 to 124 min between the first and last year of the study (P < 0.001). The rate of major and minor complications was 2.7% and 15.6% respectively. One year survival was 95.6% and all patients survived 30 days postoperatively.
The implementation of VATS lobectomy has been successful in our small geographically isolated centre, serving a population of 390 000. Although technically challenging, VATS lobectomy was implemented fast for most NSCLC cases, with short-term outcomes that are comparable to larger high-volume centres.
尽管电视辅助胸腔镜手术（VATS）肺叶切除术已成为非小细胞肺癌（NSCLC）肺切除的金标准，但在许多欧美中心，肺叶切除术仍通过开胸手术进行。2019年初，在1名资深外科医生在海外接受了VATS培训观察后，我们这个手术量较少的中心一夜之间从开胸手术改为VATS肺叶切除术，并立即成为冰岛NSCLC外科治疗的主要手段。我们旨在研究VATS肺叶切除术的短期疗效。
这是一项对2019 - 2022年冰岛所有NSCLC肺切除术的回顾性研究，特别关注cTNM I期或II期的VATS肺叶切除术。数据从医院病历中获取，包括围手术期并发症、死亡率、住院时间和手术时间等信息。
在204例肺切除术中，大部分由1名资深心胸外科医生完成，其中169例（82.9%）为肺叶切除术，169例中有147例（87.0%）为VATS肺叶切除术。34例（16.7%）采用前外侧开胸手术，其中包括22例肺叶切除术（64.7%），5例（3.4%）由VATS肺叶切除术转为开胸手术。VATS肺叶切除术的术后中位住院时间为4天，研究的第一年到最后一年，平均手术时间从155分钟降至124分钟（P < 0.001）。主要和次要并发症发生率分别为2.7%和15.6%。1年生存率为95.6%，所有患者术后30天均存活。
VATS肺叶切除术在我们这个地理位置偏远、服务人口为39万的小中心实施成功。尽管技术上具有挑战性，但对于大多数NSCLC病例，VATS肺叶切除术实施迅速，短期疗效与大型高手术量中心相当。
