Lymph Node Evaluation Achieved by Open Lobectomy Compared With Thoracoscopic Lobectomy for N0 Lung Cancer
Lymph Node Evaluation Achieved by Open Lobectomy Compared With Thoracoscopic Lobectomy for N0 Lung Cancer
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DOI：
10.1016/j.athoracsur.2013.05.044
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发表时间：
2013-10-01
影响因子：
4.6
通讯作者：
Shrager, Joseph B.
中科院分区：
文献类型：
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作者：
Merritt, Robert E.;Hoang, Chuong D.;Shrager, Joseph B.
背景关于电视辅助胸外科（VATS）肺叶切除术治疗肺癌所实现的淋巴结评估的充分性仍然存在争议。本研究比较了开胸肺叶切除术与电视胸腔镜手术治疗临床N 0肺癌患者的淋巴结清扫或取样的完整性。回顾性分析2008年12月至2012年1月间129例临床N 0肺癌患者行肺叶切除术的临床资料。69例患者（53.5%）的肺叶切除术为开放手术，60例患者（46.5%）采用VATS。VATS组和开放组在年龄（p = 0.50）和1秒用力呼气量百分比预测值（p = 0.16）方面匹配良好。平均病理肿瘤大小无显著差异（分别为2.9 +/- 0.26 vs 3.4 +/- 0.25 cm; p = 0. 001）。14）。开放组中切除的平均淋巴结数量显著更高（14.7 +/- 1.3 vs. 9.9 +/- 0.8个淋巴结; p = 0.003）。在开放性肺叶切除术组中，24.6%的患者升级为病理N1或N2，而VATS组为10%（p = 0.05）。两组的Kaplan-Meier 3年生存率相似。在我们的手中，在临床分期为N 0的肺癌患者中，与VATS肺叶切除术相比，开放肺叶切除术中清扫的淋巴结明显更多，并且更高比例的患者升级为N1/N2。尽管这并没有转化为3年生存率的提高，但人们对电视胸腔镜肺叶切除术中淋巴结清扫的充分性表示担忧。(C)2013年由胸外科医师协会
Background. Controversy remains regarding the adequacy of the lymph node evaluation achieved by video-assisted thoracic surgery (VATS) lobectomy for lung cancer. This study compared the completeness of the lymph node dissection or sampling for patients undergoing lobectomy by open thoracotomy vs VATS for clinical N0 lung cancer.Methods. This study was a retrospective review of 129 patients who underwent lobectomy for clinical N0 lung carcinoma from December 2008 to January 2012.Results. Lobectomy was an open procedure in 69 patients (53.5%) and by VATS in 60 (46.5%). The VATS and open groups were well matched for age (p = 0.50) and forced expiratory volume in 1 second percentage predicted (p = 0.16). The mean pathologic tumor sizes were not significantly different (2.9 +/- 0.26 vs 3.4 +/- 0.25 cm, respectively; p = 0. 14). The mean number of nodes dissected in the open group was significantly higher (14.7 +/- 1.3 vs. 9.9 +/- 0.8 nodes; p = 0.003). In the open lobectomy group, 24.6% of the patients were upstaged to pathologic N1 or N2 compared with 10% in the VATS group (p = 0.05). The Kaplan-Meier 3-year survival was similar between the groups.Conclusions. In our hands, significantly more lymph nodes were dissected, and a higher percentage of patients were upstaged to N1/N2, during open lobectomy compared with VATS lobectomy in patients with clinical stage N0 lung cancer. Although this did not translate into improved survival at 3 years, concern is raised about the adequacy of lymph node dissection during VATS lobectomy. (C) 2013 by The Society of Thoracic Surgeons