胸腔镜下肺段切除与肺叶切除治疗Ⅰ期非小细胞肺癌:系统回顾与荟萃分析

Thoracoscopic segmentectomy versus lobectomy for stageⅠnon-small cell lungcancer:a systematic review and meta-analysis

目的:探索胸腔镜下肺段切除术与肺叶切除术治疗I期非小细胞肺癌(NSCLC)的临床疗效,以期为临床决策提供相关依据。方法:计算机检索PubMed、the Cochrane Library、Embase、Web of Science、Science Direct、Ovid Medline、Scopus数据库及Google Scholar上搜索,检索时间从建库至2019年3月。检索胸腔镜下肺段切除与肺叶切除治疗临床Ⅰ期NSCLC的对比研究,运用Revman 5.3软件进行Meta分析。结果:共纳入16篇回顾性临床对照研究,共计2 090例患者,其中肺段切除术组696例,肺叶切除组1 394例。Meta分析结果显示,对于临床Ⅰ期NSCLC,VATS肺段切除与VATS肺叶切除术后并发症发生率( RR=0.78,95% CI:0.59~1.02, P=0.07)、术后复发率( RR=0.78,95% CI:0.52~1.17, P=0.23)、术后住院时间( MD=-0.27,95% CI:-0.58^-0.05, P=0.10)和5年生存率( RR=0.94,95% CI:0.87~1.03, P=0.17)、无瘤生存时间( RR=0.95,95% CI:0.92~1.09, P=0.34)、手术操作时间( MD=-0.43,95% CI:-10.10~9.25, P=0.93)差异均无统计学意义,但VATS肺段切除可减少术中失血量( MD=-23.81,95% CI:-42.00^-5.63, P=0.01)、缩短术后胸腔引流管留置时间( MD=-0.31,95% CI:-0.51^-0.12, P=0.002),但在淋巴结的清扫方面肺段切除术少于肺叶切除术,淋巴结清扫数目( MD=-4.89,95% CI:-7.57^-2.20, P=0.0004),1年术后/术前FVC%百分比( MD=7.50,95% CI:5.81~9.18, P<0.00001)及1年术后/术前FEV1%百分比( MD=8.26,95% CI:6.43~10.09, P<0.00001)差异有统计学意义。 结论:在临床Ⅰ期NSCLC的治疗过程中,两种术式在术后并发症、手术操作时间、复发率、5年生存率、无瘤生存时间及住院时间上疗效相似,在淋巴结清扫方面肺段少于肺叶切除术,但是在术中失血量、术后胸腔引流管留置时间等方面胸腔镜下肺段切除效果更好且肺段切除术更加有利于对肺功能的保护,胸腔镜下肺段切除术对于早期非小细胞肺癌可能是一种更合适的治疗手段。

Objective This article explores the treatment of stage I thoracoscopic segmentectomy and lobectomy.The clinical efficacy of non-small cell lung cancer is to provide relevant evidence for clinical decision-making.Method Computer searches were conducted on PubMed,the Cochrane Library,Embase,Web of Science,Science Direct,Ovid Medline,Scopus database,and Google Scholar.The search time was from the establishment of the library to March 2019.A comparative study of thoracic segmental resection and lobectomy for clinical stage I NSCLC was performed and meta-analysis was performed using Revman 5.3 software.Restlus A total of 16 retrospective clinical controlled studies were included in the study,with a total of 2090 patients,including 696 in the thoracoscopic segmental resection group and 1394 in the thoracoscopic lobectomy group.Meta-analysis showed that for clinical stageⅠNSCLC,the incidence of complications after laparoscopic resection and lobectomy(RR=0.78,95%CI:0.59-1.02,P=0.07),postoperative recurrence rate(RR=0.78,95%CI:0.52-1.17,P=0.23),postoperative hospital stay(MD=-0.27,95%CI:-0.58 to-0.05,P=0.10)and 5-year survival rate(RR=0.94,95%CI:0.87-1.03,P=0.17),tumor-free survival time(RR=0.95,95%CI:0.92-1.09,P=0.34),operation time(MD=-0.43,95%CI:-10.10-9.25,P=0.93)The difference was not statistically significant,but laparoscopic lung segmentectomy can reduce intraoperative blood loss(MD=-23.81,95%CI:-42.00 to-5.63,P=0.01),shortening Posterior chest tube drainage time(MD=-0.31,95%CI:-0.51 to-0.12,P=0.002),but in the lymph node dissection,the segmentectomy was less than the lobectomy,the number of lymph node dissection(MD=-4.89,95%CI:-7.57 to-2.20,P=0.0004).Percentage of postoperative/preoperative FVC%(MD=7.50,95%CI:5.81-9.18,P<0.00001)and 1-year postoperative/preoperative FEV1%(MD=8.26,95%CI:6.43-10.09,P<0.00001).The difference was statistically significant.Conclusion In The course of clinical stage I NSCLC treatment,the two procedures were similar in terms of postoperative complications,operation time,recurrence rate,5-year survival rate,tumor-free survival time and hospital stay,and fewer lung segments in lymph node dissection.In lobectomy,thoracoscopic segmental resection is better in terms of intraoperative blood loss and postoperative chest drainage time.Thoracoscopic segmentectomy may be more suitable for early stage non-small cell lung cancer.treatment method.