Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications
Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications
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DOI：
10.1016/j.athoracsur.2007.07.080
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发表时间：
2008-01-01
影响因子：
4.6
通讯作者：
Rusch, Valerie W.
中科院分区：
文献类型：
--
作者：
Cattaneo, Stephen M.;Park, Bernard J.;Rusch, Valerie W.
背景资料。本研究的目的是探讨电视胸腔手术(VATS)在老年临床I期非小细胞肺癌肺叶切除术中的应用是否比开胸肺叶切除术(THOR)减少并发症。对同一机构的老年患者(年龄70岁)进行了一项回顾性的、配对的病例对照研究，评价胸腔镜式肺叶切除术与胸腔镜式肺叶切除术的围手术期结局。所有并发症均根据美国国家癌症研究所不良事件通用术语标准3.0版(http://ctep.cancer.gov/reporting/ctc.html).Results.进行分级2002年5月1日至2005年12月31日，333例70岁或以上的老年非小细胞肺癌患者(245例TOR，88例VATS)因临床分期为I期非小细胞肺癌行肺叶切除术。根据年龄、性别、合并疾病情况和术前临床分期进行配对后，每组有82名患者。患者有相似的术前特征。VATS手术的并发症发生率明显低于THOR(28%比45%，P=0.001)，中位住院时间较短(2~20天比6天，2~27天，P<；0.001)。接受VATS肺叶切除术的患者没有出现高于2级的并发症，而雷神组7%的并发症为3级或更高。VATS患者无围手术期死亡，而THOR患者的住院死亡率为3.6%(3/82)。与开胸手术相比，老年临床I期非小细胞肺癌患者采用VATS入路行肺叶切除术后，并发症发生率和严重程度均有所减少，住院时间也较短。
Background. The purpose of this study was to determine if the utilization of video-assisted thoracic surgery ( VATS) for lobectomy for clinical stage I non-small cell lung cancer in elderly patients results in decreased complications compared with lobectomy by thoracotomy (THOR).Methods. A retrospective, matched case-control study was performed evaluating the perioperative outcomes after lobectomy by VATS versus THOR performed in elderly patients (age >= 70 years) at a single institution. All complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 (http://ctep.cancer.gov/reporting/ctc.html).Results. Between May 1, 2002 and December 31, 2005 333 patients (245 THOR, 88 VATS) 70 years old or greater underwent lobectomy for clinical stage I non-small cell lung cancer. After matching based on age, gender, presence of comorbid conditions, and preoperative clinical stage, there were 82 patients in each group. Patients had similar preoperative characteristics. A VATS approach resulted in a significantly lower rate of complications compared with THOR (28% vs 45%, p = 0.04) and a shorter median length of stay (5 days, range 2 to 20 vs 6 days, range 2 to 27, p < 0.001). No patients undergoing VATS lobectomy had higher than grade 2 complications, whereas 7% of complications in the THOR group were grade 3 or higher. There were no perioperative deaths in the VATS patients compared with an in-hospital mortality rate of 3.6% (3 of 82) for THOR patients.Conclusions. A VATS approach to lobectomy for clinical stage I non-small cell lung cancer in the elderly was associated with fewer and overall reduced severity of complications as well as a shorter hospital stay compared with thoracotomy.