Dai Zhang-Yi, Jiang Yu, Cheng Jia-Jun, Mi Xing-Qi, Xing Yi-Kai, Zhang Xiao-Long, Wang Yun, Pu Qiang
Department of Thoracic Surgery, West China hospital, Sichuan University, Chengdu, China.
Department of Critical Care Medicine, West China hospital, Sichuan University, Chengdu, China.
World J Surg Oncol. 2024 Dec 28;22(1):350. doi: 10.1186/s12957-024-03650-9.
The equivalence between left upper lobectomy (LUL) and left upper tri-segmentectomy (LUTS) for stage I left upper non-small cell lung cancer (NSCLC) remains unclear. This study compares the perioperative and oncological outcomes of LUL and LUTS in this patient population.
This study included patients who underwent LUL or LUTS at West China Hospital of Sichuan University and Sichuan ShangJin Hospital between August 2018 and November 2023. Patients with tumors located at least 2 cm from the lingular segment were included. Propensity score matching (PSM) addressed baseline imbalances between groups. Perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), lung cancer-specific survival (LCSS), and subgroup analyses were assessed.
A total of 1019 patients were included (LUL: 524; LUTS: 495) with a median follow-up of 4.8 years (IQR: 2.5-8.1). Compared to LUL, LUTS was associated with significantly shorter operative times (103 vs. 120 min, p = 0.001), reduced postoperative drainage volume at 3 days (335 vs. 485 ml, p = 0.001) and total (360 vs. 530 ml, p = 0.001), lower conversion to thoracotomy rates (1.0% vs. 3.4%, p = 0.009), and fewer postoperative complications (9.9% vs. 14.9%, p = 0.016). No significant differences were observed in 5-year OS (86.7% vs. 85.4%, HR: 0.96; 95% CI: 0.66-1.39; p = 0.821), 5-year RFS (78.4% vs. 75.3%, HR: 0.85; 95% CI: 0.63-1.13; p = 0.258), or 5-year LCSS (90.2% vs. 91.3%, HR: 0.99; 95% CI: 0.62-1.57; p = 0.956) between the two groups.
For stage I left upper NSCLC, LUTS, while preserving adequate surgical margins, achieves superior perioperative and comparable oncological outcomes to LUL.
对于I期左上非小细胞肺癌（NSCLC），左上肺叶切除术（LUL）和左上三叶切除术（LUTS）之间的等效性仍不明确。本研究比较了该患者群体中LUL和LUTS的围手术期及肿瘤学结局。
本研究纳入了2018年8月至2023年11月期间在四川大学华西医院和四川上锦医院接受LUL或LUTS的患者。纳入肿瘤距舌叶至少2 cm的患者。倾向评分匹配（PSM）解决了组间的基线不平衡问题。评估围手术期结局、总生存期（OS）、无复发生存期（RFS）、肺癌特异性生存期（LCSS）以及亚组分析。
共纳入1019例患者（LUL：524例；LUTS：495例），中位随访时间为4.8年（IQR：2.5 - 8.1年）。与LUL相比，LUTS的手术时间显著缩短（103 vs. 120分钟，p = 0.001），术后3天引流量减少（335 vs. 485 ml，p = 0.001）且总引流量减少（360 vs. 530 ml，p = 0.001），开胸转换率更低（1.0% vs. 3.4%，p = 0.009），术后并发症更少（9.9% vs. 14.9%，p = 0.016）。两组在5年总生存期（86.7% vs. 85.4%，HR：0.96；95% CI：0.66 - 1.39；p = 0.821）、5年无复发生存期（78.4% vs. 75.3%，HR：0.85；95% CI：0.63 - 1.13；p = 0.258）或5年肺癌特异性生存期（90.2% vs. 91.3%，HR：0.99；95% CI：0.62 - 1.57；p = 0.956）方面未观察到显著差异。
对于I期左上NSCLC，LUTS在保留足够手术切缘的同时，围手术期结局优于LUL，肿瘤学结局相当。
