Video-Assisted Thoracic Surgery (VATS) Lobectomy for Pathologic Stage I Non-Small Cell Lung Cancer: A Comparative Study with Thoracotomy Lobectomy.
Video-Assisted Thoracic Surgery (VATS) Lobectomy for Pathologic Stage I Non-Small Cell Lung Cancer: A Comparative Study with Thoracotomy Lobectomy.
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DOI：
10.5090/kjtcs.2011.44.1.32
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发表时间：
2011-02-01
期刊：
影响因子：
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通讯作者：
Han, Woo-Sik
中科院分区：
文献类型：
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作者：
Park, Joon Suk;Kim, Kwhanmien;Han, Woo-Sik
背景技术背景：I期非小细胞肺癌（NSCLC）的手术治疗可以通过开胸手术或采用电视胸腔镜手术（VATS）进行。本研究的目的是评估VATS肺叶切除术的可行性病理I期NSCLC.MATERIAL和METHODS：2003年12月至2007年12月，529例病理I期NSCLC进行肺叶切除术（373开胸手术，156电视胸腔镜）。采用倾向评分法对两组患者的年龄、性别、病理分期进行匹配后，将两组患者分为开胸组和VATS组，比较两组患者的总生存期、无复发生存期、并发症发生率及住院时间。在患者按年龄、性别和病理分期匹配后，272例患者仍符合分析条件，每组136例（平均年龄59.5岁; 70名男性，66名女性; 80名IA期，56名IB期）。两组术前其他临床特征无统计学差异。两组均未观察到住院死亡。开胸组和VATS组的3年总生存率分别为97.4%和96.6%（p=0.76）。随访中，开胸组复发20例（14.7%），其中局部复发7例，远处转移13例。VATS组复发13例（9.6%），其中局部复发4例，远处转移9例。开胸组和VATS组的3年无复发生存率分别为81.8%和85.3%（p=0.43）。开胸组和VATS组的术后并发症无显著差异（22例患者中30例vs 17例患者中19例，p=0.65，比值比=1.19）。平均住院时间VATS组比开胸组短2 d（8.8±6.5 d比6.3±3.3 d，p
BACKGROUND: Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to evaluate the feasibility of VATS lobectomy for pathologic stage I NSCLC.MATERIAL AND METHODS: Between December 2003 and December 2007, 529 patients with pathologic stage I NSCLC underwent lobectomies (373 thoracotomy, 156 VATS). Patients in both groups were selected after being matched by age, gender and pathologic stage using propensity score method, to create two comparable groups: thoracotomy and VATS groups, and the overall survival, recurrence-free survival, complication and length of hospitalization were compared between these two groups.RESULTS: After the patients were matched by age, gender and pathologic stage, 272 patients remained eligible for analysis, 136 in each group (mean age of 59.5 years; 70 men, 66 women; 80 stage IA, 56 stage IB). There was no statistical difference in other preoperative clinical characteristics between the two groups. No hospital mortality was observed in both groups. Overall 3-year survival rate was 97.4% in thoracotomy group and 96.6% in VATS groups (p=0.76). During the follow-up, 20 patients (14.7%) developed recurrence in thoracotomy group, including loco- regional recurrence in 7, distant metastasis in 13. In VATS group, 13 patients (9.6%) developed recurrence, including loco-regional recurrence in 4, distant metastasis in 9. Three-year recurrence-free survival rate was 81.8% in thoracotomy group and 85.3% in VATS groups (p=0.43). There was no significant difference in postoperative complications between thoracotomy and VATS groups (30 cases in 22 patients vs. 19 cases in 17 patients, p=0.65, odds ratio=1.19). The mean hospital stay of VATS group was 2 days shorter than that of thoracotomy group (8.8±6.5 days vs. 6.3±3.3 days, p