Hong Qian, Wang Yan, Ma Fengyan, Gao Yinyan, Zhang Guochao, Yi Hang, Mu Juwei
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Thoracic Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
Surg Endosc. 2025 Sep 9. doi: 10.1007/s00464-025-12172-8.
Surgical resection is the cornerstone for early-stage non-small cell lung cancer (NSCLC), with lobectomy historically standard. Evolving techniques have spurred debate comparing lobectomy and segmentectomy. This study analyzed early postoperative patient-reported symptoms and functional status in patients with early NSCLC undergoing either procedure.
This observational cohort study included 248 patients (Lobectomy = 92, Segmentectomy = 156) with early-stage NSCLC (tumor diameter ≤ 2 cm) who underwent uniport video-assisted thoracoscopic surgery (VATS), from December 2021 to December 2023. Patient-reported outcomes were collected using the Perioperative Symptom Assessment for Patients Undergoing Lung Surgery scale at preoperative day 1, daily from postoperative days 1-4, and weekly for postoperative weeks 1-4. We compared early postoperative symptom/functional impairment scores, recovery time from moderate-to-severe symptoms, and short-term clinical outcomes.
Both groups exhibited comparable early postoperative symptoms and functional status. No significant differences were observed between the two groups in any of the 7 symptom items or the 2 function items (all P > 0.05). The time to recovery from moderate-to-severe symptoms and functional impairment was also similar between the groups. Furthermore, there were no statistically significant differences in short-term clinical outcomes, including operative time, postoperative hospital stays, drainage time, discharge scores, or complication rates (all P > 0.05).
For early-stage NSCLC (tumor diameter ≤ 2 cm) undergoing uniport VATS, lobectomy and segmentectomy yield largely similar early postoperative symptom/functional burden, recovery times, and short-term outcomes. Considering external evidence on long-term oncology and function, segmentectomy is supported as a highly suitable option for this patient population.
手术切除是早期非小细胞肺癌（NSCLC）的基石，肺叶切除术一直是标准术式。技术的不断发展引发了关于肺叶切除术和肺段切除术比较的争论。本研究分析了早期NSCLC患者接受这两种手术术后早期患者报告的症状和功能状态。
本观察性队列研究纳入了2021年12月至2023年12月期间接受单孔电视辅助胸腔镜手术（VATS）的248例早期NSCLC患者（肺叶切除术组=92例，肺段切除术组=156例），肿瘤直径≤2cm。在术前第1天、术后第1 - 4天每天以及术后第1 - 4周每周使用肺手术患者围手术期症状评估量表收集患者报告的结局。我们比较了术后早期症状/功能损害评分、从中度至重度症状恢复的时间以及短期临床结局。
两组术后早期症状和功能状态相当。两组在7项症状项目或2项功能项目中的任何一项上均未观察到显著差异（所有P>0.05）。两组从中度至重度症状和功能损害恢复的时间也相似。此外，在短期临床结局方面，包括手术时间、术后住院时间、引流时间、出院评分或并发症发生率，均无统计学显著差异（所有P>0.05）。
对于接受单孔VATS的早期NSCLC（肿瘤直径≤2cm）患者，肺叶切除术和肺段切除术在术后早期产生的症状/功能负担、恢复时间和短期结局大致相似。考虑到关于长期肿瘤学和功能的外部证据，肺段切除术被认为是该患者群体的高度合适选择。
