改良剑突下入路胸腔镜胸腺切除术治疗 T 胸腺恶性肿瘤的围手术期结局和生存：一项回顾性对比研究。
Perioperative outcomes and survival of modified subxiphoid video-assisted thoracoscopic surgery thymectomy for T thymic malignancies: A retrospective comparison study.
机构信息
Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China.
出版信息
J Thorac Cardiovasc Surg. 2024 Dec;168(6):1550-1559.e5. doi: 10.1016/j.jtcvs.2024.04.023. Epub 2024 Apr 30.
OBJECTIVE
Our previous study demonstrated that modified subxiphoid video-assisted thoracic surgery thymectomy with an auxiliary sternal retractor is feasible for locally invasive thymic malignancies. This study aimed to compare perioperative and oncological outcomes of modified subxiphoid video-assisted thoracoscopic surgery thymectomy versus median sternotomy thymectomy for locally advanced thymic malignancies.
METHODS
In total, 221 patients with T thymic malignancies who underwent modified subxiphoid video-assisted thoracoscopic surgery thymectomy or median sternotomy thymectomy between 2015 and 2020 were enrolled in our prospectively maintained database. A 1:1 propensity score-matching analysis was performed to balance the bias. Surgical difficulty was evaluated with a modified resection index. Perioperative and oncological results were compared between the modified subxiphoid video-assisted thoracoscopic surgery thymectomy group and the median sternotomy thymectomy group.
RESULTS
There were 72 patients in each group in the final analysis. Our results showed that the modified subxiphoid video-assisted thoracoscopic surgery thymectomy group had a shorter operative duration (98 vs 129 minutes, P < .001), less blood loss (40 vs 100 mL, P < .001), shorter drainage duration (3 vs 5 days, P < .001), shorter length of hospital stay (5 vs 6 days, P < .001), and fewer postoperative complications (5.6% vs 23.6%; P = .005). No significant difference was detected in complete resection (98.6% vs 98.6%, P = 1.000) between the 2 groups. Conversion occurred in 5 of 106 patients (4.7%). Survival analyses indicated similar recurrence-free survival (hazard ratio, 0.94; 95% CI, 0.40-2.20; P = .883) and overall survival (hazard ratio, 0.52; 95% CI, 0.05-5.02; P = .590) between the 2 groups.
CONCLUSIONS
Modified subxiphoid video-assisted thoracoscopic surgery thymectomy was safe and effective for T thymic malignancies and could be an alternative for selected patients with locally advanced thymic diseases. Further prospective studies are needed to evaluate the long-term survival of those undergoing modified subxiphoid approach thoracoscopic thymectomy.
目的
我们之前的研究表明，改良剑突下入路胸腔镜胸腺切除术联合辅助胸骨牵开器对于局部侵袭性胸腺癌是可行的。本研究旨在比较改良剑突下入路胸腔镜胸腺切除术与正中开胸胸腺切除术治疗局部晚期胸腺癌的围手术期和肿瘤学结果。
方法
本研究前瞻性地纳入了 2015 年至 2020 年间接受改良剑突下入路胸腔镜胸腺切除术或正中开胸胸腺切除术的 221 例 T 胸腺癌患者。采用 1:1 倾向评分匹配分析来平衡偏倚。采用改良切除术指数评估手术难度。比较改良剑突下入路胸腔镜胸腺切除术组和正中开胸胸腺切除术组的围手术期和肿瘤学结果。
结果
最终分析中每组各有 72 例患者。结果显示，改良剑突下入路胸腔镜胸腺切除术组的手术时间更短（98 分钟比 129 分钟，P < 0.001），术中出血量更少（40 毫升比 100 毫升，P < 0.001），引流时间更短（3 天比 5 天，P < 0.001），住院时间更短（5 天比 6 天，P < 0.001），术后并发症更少（5.6%比 23.6%；P = 0.005）。两组完全切除率（98.6%比 98.6%，P = 1.000）无显著差异。106 例患者中有 5 例（4.7%）中转开胸。生存分析显示两组无复发生存率（风险比，0.94；95%置信区间，0.40-2.20；P = 0.883）和总生存率（风险比，0.52；95%置信区间，0.05-5.02；P = 0.590）相似。
结论
改良剑突下入路胸腔镜胸腺切除术治疗 T 胸腺癌安全有效，可为局部晚期胸腺疾病的选定患者提供替代治疗方案。需要进一步的前瞻性研究来评估改良剑突下入路胸腔镜胸腺切除术患者的长期生存情况。
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