胸腔镜解剖性肺段切除术在双侧肺癌手术中应用的单中心回顾性研究

Safety and clinical outcomes of thoracoscopic segmentectomy in bilateral lung cancer:A single-center retrospective study

目的探讨电视辅助胸腔镜(video-assisted thoracoscopic surgery,VATS)解剖性肺段切除术在同期和分期双侧肺癌手术患者中应用的安全性及有效性。方法回顾性分析北京协和医院胸外科2013年12月—2022年5月收治的100例应用VATS解剖性肺段切除术进行双侧手术患者的临床资料。根据手术时机将患者分为两组:同期双侧手术组52例,其中男17例、女35例,年龄(55.17±11.09)岁;分期双侧手术组48例,其中男16例、女32例,年龄(59.88±11.48)岁。对两组患者的术中情况及术后疗效进行评价。结果100例患者均顺利完成双侧VATS手术,至少一侧行解剖性肺段切除术。同期双侧手术组患者具有年龄小(P=0.040)、合并疾病比例小(P=0.030)、肺癌家族史罕见(P=0.018)及发现至手术间期更短(P=0.000)的特点。同期双侧手术组以肺段联合楔形切除术为主,分期双侧手术组以联合肺叶切除术为主(P=0.000);同期双侧手术苏醒时间较分期一期和二期手术更长(P=0.000,P=0.002),但手术时间、麻醉时间与分期双侧手术组两次叠加时间差异无统计学意义;淋巴结采样/清扫站数(P=0.041)及个数(P=0.026)较分期双侧手术组两次叠加数量更少;两组术中气道压管理差异无统计学意义(P>0.05)。同期双侧手术组出院后日常生活能力评分更低。结论VATS解剖性肺段切除术在同期及分期双侧肺癌手术中的应用安全可行,对侧可联合亚肺叶或肺叶切除术。同期双侧手术组在手术时间和术后并发症与分期双侧手术组大致相同,但出院后日常生活能力评分更低。在综合考虑患者心理因素、身体情况及个人意愿的基础上可优先选择同期双侧手术。

Objective To assess the safety and clinical outcomes of segmentectomy in one-or two-staged videoassisted thoracoscopic surgery(VATS)for bilateral lung cancer.Methods We retrospectively enrolled 100 patients who underwent VATS segmentectomy for bilateral lung cancer at the Department of Thoracic Surgery of Peking Union Medical College Hospital from December 2013 to May 2022.We divided the patients into two groups:a one-stage group(52 patients),including 17 males and 35 females with a mean age of 55.17±11.09 years,and a two-stage group(48patients),including 16 males and 32 females with a mean age of 59.88±11.48 years.We analyzed multiple intraoperative variables and postoperative outcomes.Results All 100 patients successfully completed bilateral VATS,and at least unilateral lung received anatomical segmentectomy.Patients in the one-stage group were younger(P=0.040),had lower rate of comorbidities(P=0.030),were less likely to have a family history of lung cancer(P=0.018),and had a shorter interval between diagnosis and surgery(P=0.000)compared with patients in the two-stage group.Wedge resection on the opposite side was more common in the one-stage group(P=0.000),while lobectomy was more common in the two-stage group.The time to emerge from anesthesia in the one-stage group was longer than that in the first and second operations of the two-stage group(P=0.000,P=0.002).Duration of surgery and anesthesia were similar between two groups(P>0.05).Total number of lymph node stations for sampling and dissection(P=0.041)and lymph nodes involved(P=0.026)were less in the one-stage group.Intraoperative airway management was similar between two groups(P>0.05).The one-stage group was associated with lower activities of daily living(ADL)scores.Conclusion Segmentectomy is safe in one-or two-staged VATS for bilateral lung cancer,including contralateral sublobectomy and lobectomy.Duration of surgery and perioperative complications are similar between two groups,but the one-stage group is associated with lower ADL scores.On the basis of comprehensive consideration in psychological factors,physical conditions and personal wishes of patients,one-staged sequential bilateral VATS can be the first choice.