Chen Hei Yu Matthew, Wong Tsz Ho Andrew, Li Ki Kwong, Chan Ho Yan Howard
Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Hong Kong, China.
J Thorac Dis. 2024 Jul 30;16(7):4137-4145. doi: 10.21037/jtd-24-303. Epub 2024 Jul 11.
Low-dose computed tomography (CT) has been increasingly utilized for lung cancer screening. Localization of solitary pulmonary nodules (SPN) is crucial for resection. Two-stage localization method involves dye injection by radiologists prior to the operation. The significant interval between localization and resection is associated with a higher risk of marker failure, psychological distress and procedural complications. Single-stage localization and resection procedure under general anesthesia poses unique challenges. The aim of the study is to compare the safety, efficacy and patient satisfaction between the two methods.
This is a retrospective study comparing outcomes between two-stage and single-stage pre-operative localization of SPN. The primary study outcome was total operating time. Secondary outcomes included successful lesion localization, complication rate, 30-day readmission, mortality, patient satisfaction, and pain level.
A total of 26 and 56 patients were included for the single and two-stage group respectively. Total operative time was significantly longer in the single-stage arm (mean: 188 min) than that of the two-stage arm (mean: 172 min, P<0.001) due to the additional time needed for intra-operative localization. Mean satisfaction score was significantly higher in the single-stage group than that of the two-stage group (92 52.69, P=0.004). Pain level assessed by numerical rating scales was better in the single-stage arm compared to the two-stage arm (mean: 8.8 4.85, P=0.007).
Single-stage localization and resection resulted in a minor increase in total operative time, higher patient satisfaction and less pain with comparable safety and efficacy to conventional two-stage approach.
低剂量计算机断层扫描（CT）已越来越多地用于肺癌筛查。孤立性肺结节（SPN）的定位对于切除至关重要。两阶段定位方法包括放射科医生在手术前注射染料。定位与切除之间的显著间隔与标记物失败、心理困扰和手术并发症的较高风险相关。全身麻醉下的单阶段定位和切除手术带来了独特的挑战。本研究的目的是比较两种方法在安全性、有效性和患者满意度方面的差异。
这是一项回顾性研究，比较SPN两阶段和单阶段术前定位的结果。主要研究结果是总手术时间。次要结果包括病变定位成功、并发症发生率、30天再入院率、死亡率、患者满意度和疼痛程度。
单阶段组和两阶段组分别纳入了26例和56例患者。由于术中定位需要额外时间，单阶段组的总手术时间（平均：188分钟）明显长于两阶段组（平均：172分钟，P<0.001）。单阶段组的平均满意度得分明显高于两阶段组（92±52.69，P=0.004）。与两阶段组相比，单阶段组用数字评分量表评估的疼痛程度更好（平均：8.8±4.85，P=0.007）。
单阶段定位和切除导致总手术时间略有增加，患者满意度更高，疼痛更少，与传统两阶段方法相比，安全性和有效性相当。
