Department of Surgery, Division of Esophageal and Thoracic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Clin Lung Cancer. 2024 Sep;25(6):560-566. doi: 10.1016/j.cllc.2024.03.007. Epub 2024 Apr 2.
The purpose of this study is to utilize a representative national sample to investigate the factors associated with margin positivity after attempted surgical resection. Given the changes in surgical approaches to lung cancer for the last 10 years, margin positivity and outcomes between robotic, video assisted thoracoscopic surgery (VATS) and open surgical resections may vary.
This retrospective cohort study utilized the National Cancer Database. Patients with non-small-cell lung cancer, 18 or older and who had a surgical lung resection between 2010 and 2019 were included. Demographic data, along with patient-level clinical variables were extracted. Patient-level outcome variables including 30-day, 90-day mortality and readmission rates were analyzed. Univariable and multivariable logistic regression was utilized to assess factors associated with margin positivity.
A total of 226,884 patients were identified. Of the total cohort, 9229 had positive margins (4.2%). Patients with positive margins had statistically significant increased 30-day, 90-day mortality, as well as increased readmission rate. Older age, male sex, patients undergoing an open resection, patients who underwent a wedge resection, higher clinical stage, larger tumor size, squamous and adenosquamous histologies, and higher Charlson-Deyo Comorbidity Index were all associated with having a positive margin after resection.
In conclusion, there was no difference in margin positivity when comparing robotic and VATS resection, however, open resection had increased rates of margin positivity. Increasing tumor size, clinical stage, squamous and adenosquamous histologies, male sex, and patients undergoing a wedge resection were all associated with increased rates of margin positivity.
本研究旨在利用代表性的全国样本，调查与尝试手术切除后切缘阳性相关的因素。鉴于过去 10 年来肺癌手术方法的变化，机器人手术、电视辅助胸腔镜手术（VATS）和开放性手术切除的切缘阳性率和结果可能有所不同。
本回顾性队列研究利用了国家癌症数据库。纳入了年龄在 18 岁及以上、在 2010 年至 2019 年间接受过肺癌手术切除的非小细胞肺癌患者。提取了人口统计学数据以及患者水平的临床变量。分析了患者水平的结局变量，包括 30 天和 90 天死亡率以及再入院率。采用单变量和多变量逻辑回归来评估与切缘阳性相关的因素。
共确定了 226884 名患者。在总队列中，有 9229 名患者切缘阳性（4.2%）。切缘阳性的患者在 30 天和 90 天死亡率以及再入院率方面均有显著增加。年龄较大、男性、接受开放性切除术、接受楔形切除术、临床分期较高、肿瘤较大、鳞状细胞癌和腺鳞癌组织学类型以及较高的 Charlson-Deyo 合并症指数均与切除后切缘阳性有关。
总之，与 VATS 切除相比，机器人切除的切缘阳性率没有差异，但开放性切除的切缘阳性率更高。肿瘤大小、临床分期、鳞状细胞癌和腺鳞癌组织学类型、男性以及接受楔形切除术的患者切缘阳性率均增加。
