Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: A multi-institutional study
Long-term outcomes after a variety of video-assisted thoracoscopic lobectomy approaches for clinical stage IA lung cancer: A multi-institutional study
复制标题
DOI：
10.1016/j.jtcvs.2006.03.058
复制
发表时间：
2006-09-01
影响因子：
6
通讯作者：
Sawa, Yoshiki
中科院分区：
文献类型：
--
作者：
Shigemura, Norihisa;Akashi, Akinori;Sawa, Yoshiki
背景：虽然电视胸腔镜手术（VATS）已经使用了十多年，但其在肺癌肺大部切除术中的应用仍未得到广泛应用。癌症手术的成功取决于接受治疗的患者的长期生存。因此，本研究的目的是评估各种电视辅助肺叶切除技术和常规手术对直径小于或等于 2 cm 的周围型非小细胞肺癌（IA 期）患者的长期结局。方法：对 145 名连续患者进行了多机构回顾性评价。来自三个机构的临床 IA 期疾病、肿瘤直径小于或等于 2 cm 的患者接受了完整 VATS (c-VATS，n = 56)、辅助 VATS (a-VATS，n = 34) 或传统开腹 (open, n = 55) 入路肺叶切除术和淋巴结清扫术。 结果：接受 c-VATS 肺叶切除术和淋巴结清扫术的患者失血少、恢复快、时间短与接受 a-VATS 和开放手术的肺叶切除术的患者相比，住院时间和手术时间更长。平均随访 38.8 个月，Kaplan-Meier 5 年生存概率如下：c-VATS，96.7%； a-VATS，95.2%；打开，97.2%。 3种不同手术方式的复发率无显着差异。结论：VATS肺叶切除术是一种安全的手术方式，可以较早恢复正常活动，对于直径小于或等于2 cm的周围型非小细胞肺癌（临床分期IA期）患者来说，可以视为可接受的癌症手术，其长期生存率与开放手术相同。
Background: Although video-assisted thoracic surgery (VATS) has been in use for more than a decade, its application to major lung resection for lung cancer is still not widely practiced. The success of a cancer operation is judged by the long-term survival of the treated patients. Therefore, the goal of the present study was to evaluate long-term outcomes associated with various video-assisted lobectomy techniques and conventional surgery in patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (stage IA).Methods: A multi-institutional, retrospective review was performed in 145 consecutive patients. Patients with clinical stage IA disease, with tumor size less than or equal to 2 cm in diameter, from three institutions underwent a complete VATS (c-VATS, n = 56), an assisted VATS (a-VATS, n = 34), or a conventional open (open, n = 55) approach for pulmonary lobectomy and lymph node dissection.Results: Patients undergoing lobectomy and lymph node dissection with c-VATS had less blood loss, faster recovery, shorter hospitalization, and longer operating times than did patients undergoing the lobectomy with the a-VATS and open approaches. At a mean follow-up of 38.8 months, Kaplan-Meier probabilities of survival at 5 years were as follows: c-VATS, 96.7%; a-VATS, 95.2%; open, 97.2%. There was no significant difference in the rate of recurrence among the 3 different procedures.Conclusion: VATS lobectomy, a safe procedure with earlier return to normal activities, can be regarded as an acceptable cancer operation for the patients with peripheral non-small cell lung cancer less than or equal to 2 cm in diameter (clinical stage IA) with the same long-term survivals as open surgery.