Department of Surgery, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia.
Division of Thoracic Surgery, Department of Surgery, Beaumont Health, Detroit, Michigan.
J Surg Res. 2024 Apr;296:674-680. doi: 10.1016/j.jss.2024.01.028. Epub 2024 Feb 15.
Minimally invasive approaches to lung resection have become widely acceptable and more recently, segmentectomy has demonstrated equivalent oncologic outcomes when compared to lobectomy for early-stage non-small cell lung cancer (NSCLC). However, studies comparing outcomes following segmentectomy by different surgical approaches are lacking. Our objective was to investigate the outcomes of patients undergoing robotic, video-assisted thoracoscopic surgery (VATS), or open segmentectomy for NSCLC using the National Cancer Database.
NSCLC patients with clinical stage I who underwent segmentectomy from 2010 to 2016 were identified. After propensity-score matching (1:4:1), multivariate logistic regression analyses were performed to determine predictors of 30-d readmissions, 90-d mortality, and overall survival.
22,792 patients met study inclusion. After matching, approaches included robotic (n = 2493; 17%), VATS (n = 9972; 66%), and open (n = 2493; 17%). An open approach was associated with higher 30-d readmissions (7% open versus 5.5% VATS versus 5.6% robot, P = 0.033) and 90-d mortality (4.4% open versus 2.2% VATS versus 2.5% robot, P < 0.001). A robotic approach was associated with improved 5-y survival (50% open versus 58% VATS versus 63% robot, P < 0.001).
For patients with clinical stage I NSCLC undergoing segmentectomy, compared to the open approach, a VATS approach was associated with lower 30-d readmission and 90-d mortality. A robotic approach was associated with improved 5-y survival compared to open and VATS approaches when matched. Additional studies are necessary to determine if unrecognized covariates contribute to these differences.
微创肺切除术已被广泛接受，最近，与肺叶切除术相比，段切除术在早期非小细胞肺癌（NSCLC）中也显示出了相当的肿瘤学结果。然而，比较不同手术方法行段切除术的研究结果尚缺乏。我们的目的是利用国家癌症数据库（National Cancer Database）研究接受机器人手术、电视辅助胸腔镜手术（video-assisted thoracoscopic surgery，VATS）或开放性段切除术的 NSCLC 患者的结局。
从 2010 年至 2016 年，确定了临床 I 期接受段切除术的 NSCLC 患者。在进行倾向评分匹配（1:4:1）后，进行多变量逻辑回归分析，以确定 30 天再入院、90 天死亡率和总生存率的预测因素。
22792 名患者符合研究纳入标准。匹配后，手术方法包括机器人（n=2493；17%）、VATS（n=9972；66%）和开放性（n=2493；17%）。开放性手术与较高的 30 天再入院率（7%开放性手术，5.5%VATS 手术，5.6%机器人手术，P=0.033）和 90 天死亡率（4.4%开放性手术，2.2%VATS 手术，2.5%机器人手术，P<0.001）相关。机器人手术与改善的 5 年生存率相关（50%开放性手术，58%VATS 手术，63%机器人手术，P<0.001）。
对于临床 I 期 NSCLC 患者行段切除术，与开放性手术相比，VATS 手术与较低的 30 天再入院率和 90 天死亡率相关。在匹配后，与开放性和 VATS 手术相比，机器人手术与改善的 5 年生存率相关。需要进一步研究以确定是否存在未被识别的混杂因素导致这些差异。
