电视胸腔镜在局部晚期非小细胞肺癌新辅助治疗后纵隔淋巴结清扫术中的应用

目的:探讨电视辅助胸腔镜手术(VATS)在局部晚期非小细胞肺癌(LA-NSCLC)新辅助治疗后纵隔淋巴结清扫术(MLND)中的作用,主要通过围术期和长期结果来验证VATS的充分性.方法:根据手术方法的不同将145例LA-NSCLC患者分为VATS组和开胸组,进行倾向评分配对,采用多变量逻辑回归分析进行充分MLND相关预...

Application of VATS in mediastinal lymph node dissection after locally advanced-non-small cell lung cancer neoadjuvant therapy

Objective:To investigate the role of video-assisted thoracic surgery (VATS) in mediastinal lymph node dissection (MLND) after locally advanced-non-small cell lung cancer (LA-NSCLC) neoadjuvant therapy,and to verify the adequacy of VATS by perioperative and long-term results.Methods:145 patients with LA-NSCLC were divided into VATS group and thoracotomy group according to the different surgical methods.Tendency score was matched.Multivariate logistic regression analysis was used to evaluate the predictors of MLND.Survival curve was drawn and long-term survival rate was evaluated by Kaplan-Meier method and multivariate Cox proportional hazard model.Results:There were no significant differences in ypT/N,proportion of patients who met MLND guidelines,number of sites and lymph node dissection,and resection integrity between VATS group and thoracotomy group before and after propensity score matching (P＞0.05).The lymph node dissection rate of VATS group at only the third station at right upper lobe or middle lobe resection was significantly lower than that in thoracotomy group (16.7% vs 56.0%,P=0.006),but in any other location,the lymph node dissection rate in VATS group was not inferior to that in thoracotomy group.Multivariate regression analysis showed that upper or middle lobe surgery was easier to obtain adequate lymph node dissection than lower lobe surgery (OR=3.843,95%CI:1.612~9.171,P=0.002).Surgical method was not an effective predictor of adequent lymph node dissection (OR=0.812,95%CI:0.364~1.803,P=0.606).There was no significant difference in RFS (P=0.292 9) and OS (P=0.216 4) between VATS group and thoracotomy group.Surgical method was not an independent predictor of RFS (HR=0.955,95%CI:0.415~2.198,P=0.913) or OS (HR=0.841,95%CI:0.338~2.093,P=0.709).Conclusion:The application of VATS may be sufficient to ensure the adequacy of MLND in LA-NSCLC patients after neoadjuvant therapy.Compared with thoracotomy,VATS does not significantly affect the long-term survival rate of LA-NSCLC patients.