Video-Assisted Thoracic Surgery Lobectomy: Single Institutional Experience With 704 Cases
Video-Assisted Thoracic Surgery Lobectomy: Single Institutional Experience With 704 Cases
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DOI：
10.1016/j.athoracsur.2010.03.017
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发表时间：
2010-06-01
影响因子：
4.6
通讯作者：
Shim, Young Mog
中科院分区：
文献类型：
--
作者：
Kim, Kwhanmien;Kim, Hong Kwan;Shim, Young Mog
背景在过去的十年中，电视胸腔镜手术（VATS）肺叶切除术在早期非小细胞肺癌（NSCLC）患者中的使用频率越来越高。然而，关于VATS肺叶切除术是否能减少NSCLC患者的局部复发并提高其长期生存率仍存在疑问。我们回顾性分析了接受电视胸腔镜肺叶切除术患者的短期和中期结果，包括术后发病率、死亡率、复发率和生存率。2003年至2008年，704例患者因以下适应症接受了VATS肺叶切除术：NSCLC（n = 548）、类癌（n = 7）、肺转移瘤（n = 22）和良性疾病（n = 127）。548例临床I期NSCLC患者中有111例（20.3%）在术后发生了病理分期上调。院内死亡9例（1.3%），均死于急性呼吸窘迫综合征。64例患者发生术后并发症（9.1%）。NSCLC患者的中位随访时间为20个月。随访期间，54例患者复发，13例患者死亡。病理I期患者的1年无病生存率为92.7%，3年为87.6%。对于病理N1（n = 55）和N2疾病（n = 41）患者，3年无病生存率分别为79.3%和57.1%。电视胸腔镜肺叶切除术是治疗早期肺癌的一种安全可行的手术方式。对于VATS肺叶切除术后病理性N1或N2疾病的患者，这种微创方法不会影响生存率。(Ann Thorac Surg 2010; 89：S2118-22）（C）2010，胸外科医师协会
Background. During the past decade, video-assisted thoracic surgery (VATS) lobectomy has been performed with increasing frequency in patients with early-stage non-small cell lung cancer (NSCLC). However, questions remain as to whether VATS lobectomy reduces local recurrence and improves long-term survival in patients with NSCLC.Methods. We retrospectively reviewed short-term and midterm outcomes, including postoperative morbidity, mortality, recurrence rate, and survival, in patients undergoing VATS lobectomy.Results. Between 2003 and 2008, 704 patients underwent VATS lobectomy for the following indications: NSCLC (n = 548), carcinoid tumors (n = 7), pulmonary metastases (n = 22), and benign diseases (n = 127). One hundred eleven of 548 clinical stage I NSCLC patients (20.3%) experienced pathologic upstaging postoperatively. There were 9 in-hospital deaths (1.3%); all of these patients died of acute respiratory distress syndrome. Sixty-four patients experienced postoperative complications (9.1%). The median follow-up was 20 months for patients with NSCLC. During follow-up, 54 patients had a recurrence, and 13 patients died. Disease-free survival for patients with pathologic stage I disease was 92.7% at 1 year and 87.6% at 3 years. For patients with pathologic N1 (n = 55) and N2 diseases (n = 41), disease-free survival at 3 years was 79.3% and 57.1%, respectively.Conclusions. Video-assisted thoracoscopic surgery lobectomy is a technically feasible and safe operation with excellent survival for early-stage lung cancer. For patients with pathologic N1 or N2 diseases after VATS lobectomy, survival was not compromised by this minimally invasive approach. (Ann Thorac Surg 2010; 89: S2118-22) (C) 2010 by The Society of Thoracic Surgeons