Thoracoscopic lobectomy is a safe and versatile procedure - Experience with 500 consecutive patients
Thoracoscopic lobectomy is a safe and versatile procedure - Experience with 500 consecutive patients
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DOI：
10.1097/01.sla.0000234892.79056.63
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发表时间：
2006-09-01
影响因子：
9
通讯作者：
D'Amico, Thomas A.
中科院分区：
文献类型：
--
作者：
Onaitis, Mark W.;Petersen, Rebecca P.;D'Amico, Thomas A.
目的：胸腔镜肺叶切除术治疗早期非小细胞肺癌（NSCLC）与传统开胸肺叶切除术相比，具有术后疼痛轻、住院时间短等优点。对患有更复杂肺部疾病的患者进行胸腔镜肺叶切除术后的结果进行分析，以确定安全性、有效性和多功能性。方法：查询了 1999 年 6 月至 2006 年 1 月期间接受胸腔镜肺叶切除术的 500 名连续患者的前瞻性数据库。使用标准描述性统计和 Kaplan-Meier 生存分析来评估人口统计学、组织病理学、围手术期和结果变量。结果：492 名患者成功进行了胸腔镜肺叶切除术（转化率 1.6%）。病理分析包括 416 名患者（83.2%）为原发性 NSCLC，37 名患者（7.4%）为中心继发性肺部恶性肿瘤，45 名患者（9%）为多种良性疾病。在 416 名 NSCLC 患者中，病理分析显示 I 期 330 名患者（55.3%），II 期 40 名患者（9.6%），III 期或以上 NSCLC 44 名患者（10.6%）。手术和围手术期（30 天）死亡率分别为 0% 和 1%。整个队列的总体 2 年生存率为 80%，其中 I 期 NSCLC、II 期或更大 NSCLC、继发性肺部恶性肿瘤和肉芽肿性疾病患者的 2 年总体生存率分别为 85%、77%、73% 和 89%。 结论：胸腔镜肺叶切除术适用于一系列恶性和良性肺部疾病，且围手术期发病率和死亡率较低。存活率与开胸肺叶切除术的存活率相当。
Objective: Advantages of thoracoscopic lobectomy for early stage non-small cell lung cancer (NSCLC), as compared with lobectomy by conventional thoracotomy, include less postoperative pain and shorter length of hospitalization. The outcomes after thoracoscopic lobectomy in patients with more complex pulmonary conditions are analyzed to determine safety, efficacy, and versatility.Methods: A prospective database of 500 consecutive patients who underwent thoracoscopic lobectomy between June 1999 and January 2006 was queried. Demographic, histopathologic, perioperative, and outcome variables were assessed using standard descriptive statistics and Kaplan-Meier survival analyses.Results: Thoracoscopic lobectomy was successfully performed in 492 patients (conversion rate, 1.6%). Pathologic analysis included primary NSCLC in 416 patients (83.2%), centrally located secondary pulmonary malignancy in 37 patients (7.4%), and a variety of benign conditions in 45 patients (9%). Among the 416 patients with NSCLC, pathologic analysis demonstrated stage I in 330 patients (55.3%), stage II in 40 patients (9.6%), and stage III or greater NSCLC in 44 patients (10.6%). The operative and perioperative (30-day) mortality was 0% and 1%, respectively. The overall 2-year survival rate for the entire cohort was 80%, and the 2-year overall survival rates for stage I NSCLC, stage II or greater NSCLC, secondary pulmonary malignancy, and granulomatous disease patients were 85%, 77%, 73%, and 89%, respectively.Conclusions: Thoracoscopic lobectomy is applicable to a spectrum of malignant and benign pulmonary disease and is associated with a low perioperative morbidity and mortality rate. Survival rates are comparable to those for lobectomy with thoracotomy.