Menager Jean-Baptiste, Musso Valeria, Issard Justin, Mitilian Delphine, Fabre Dominique, Mercier Olaf, Fadel Elie
Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Hôpital Marie-Lannelongue, Le Plessis Robinson, France.
J Thorac Dis. 2024 Oct 31;16(10):6879-6887. doi: 10.21037/jtd-24-216. Epub 2024 Oct 28.
Thoracic surgeons are increasingly facing situations for which patients are eligible for iterative thoracic surgery. With growing experience in minimally invasive thoracic surgery, the question of the safety and feasibility of minimally invasive redo procedure is rising. Our study aims to report the results of video-assisted thoracoscopic surgery (VATS) as surgical approach for reintervention after a previous ipsilateral intrathoracic surgery.
This retrospective monocentric observational study required review of medical files of patients undergoing minimally invasive ipsilateral redo surgery between 2018 and 2023. Operative data, morbidity, and mortality were studied.
Thirty-eight patients underwent redo-VATS for pulmonary resection. Of these, 22 (57.9%) were males, with a mean age of 66±12.2 years. Primary procedures included lung cancer resection (n=32, 84%) [lobectomy (n=8, 21.1%), segmentectomy (n=4, 10.5%), wedge resection (n=20, 52.6%)], lung transplantation (n=2, 5.3%), esophagectomy (n=1, 2.6%), thoracic aortic bypass (n=1, 2.6%), empyema (n=1, 2.6%), and chemical pleurodesis (n=1, 2.6%). The median duration between surgeries was 30 (range, 2-99) months. Redo-VATS resection included lobectomy (n=21, 55.3%), segmentectomy (n=3, 7.9%), and wedge resection (n=14, 36.8%). The median operating time was 153 (range, 30-287) min. Intraoperative blood loss was less than 200 mL in 34 (89.5%) cases. The conversion rate was 13.2% secondary to pulmonary artery injuries (n=2) and difficulties in dissection and exposure (n=3). Thirty-day mortality was 0%. Median chest drainage time was 3 (range, 1-37) days, median hospital stay was 5 (range, 3-24) days.
redo-VATS lung tumor resection has been demonstrated as a safe and feasible approach with an acceptable conversion risk and morbidity. These encouraging results should question the indication for a systematic open surgical approach in this situation.
胸外科医生越来越多地面临患者适合进行反复胸外科手术的情况。随着微创胸外科经验的增加，微创再次手术的安全性和可行性问题日益凸显。我们的研究旨在报告电视辅助胸腔镜手术（VATS）作为先前同侧胸腔内手术后再次干预的手术方法的结果。
这项回顾性单中心观察性研究需要回顾2018年至2023年间接受微创同侧再次手术患者的病历。研究手术数据、发病率和死亡率。
38例患者接受了VATS再次肺切除术。其中，22例（57.9%）为男性，平均年龄66±12.2岁。初次手术包括肺癌切除术（n=32，84%）[肺叶切除术（n=8，21.1%）、肺段切除术（n=4，10.5%）、楔形切除术（n=20，52.6%）]、肺移植（n=2，5.3%）、食管切除术（n=1，2.6%）、胸主动脉搭桥术（n=1，2.6%）、脓胸（n=1，2.6%）和化学胸膜固定术（n=1，2.6%）。两次手术之间的中位间隔时间为30（范围2-99）个月。VATS再次切除术包括肺叶切除术（n=21，55.3%）、肺段切除术（n=3，7.9%）和楔形切除术（n=14，36.8%）。中位手术时间为153（范围30-287）分钟。34例（89.5%）患者术中失血少于200ml。因肺动脉损伤（n=2）和解剖及暴露困难（n=3）导致的中转开胸率为13.2%。30天死亡率为0%。中位胸腔引流时间为3（范围1-37）天，中位住院时间为5（范围3-24）天。
VATS再次肺肿瘤切除术已被证明是一种安全可行的方法，中转风险和发病率可接受。这些令人鼓舞的结果应促使人们质疑在这种情况下系统性开放手术方法的适应证。
