全胸腔镜肺叶切除术治疗临床早期非小细胞肺癌的疗效评价

目的探讨全胸腔镜肺叶切除术治疗临床早期肺癌的安全性和可行性,评价其手术疗效。方法回顾性分析2005年1月至2008年12月复旦大学附属中山医院160例(全胸腔镜手术组,其中男83例,女77例;平均年龄60.8岁)接受全胸腔镜肺叶切除术治疗的临床早期非小细胞肺癌患者的围手术期资料及生存数据,并与同期357例(开放手术组,其中男222例,女135例;平均年龄59.5岁)接受常规开放手术的早期非小细胞肺癌患者数据进行比较。结果全胸腔镜手术组患者中转开胸率为5.0%(8/160)。全胸腔镜组手术时间明显短于开放手术组(113.0 min vs.125.0 min,P=0.039);两组患者术后住院时间差异无统计学意义[(10.3±4.3)d vs.(9.1±4.6)d,P=0.425]。全胸腔镜手术组和开放手术组患者并发症发生率分别为9.4%(15/160)和10.1%(36/357),围术期死亡率为0.6%(1/160)和2.0%(7/357)。两组患者平均淋巴结清扫组数[(2.4±1.5)组vs.(2.4±1.7)组,P=0.743]和平均淋巴结清扫数[(9.8±6.3)枚vs.(10.1±6.4)枚,P=0.626]差异无统计学意义。全胸腔镜手术组总体5年生存率高于开放手术组(81.5%vs.67.8%,P=0.001)。进一步按不同病理分期进行亚组分析显示全胸腔镜手术组5年生存率为pⅠa期86.0%,pⅠb期84.5%,pⅢa期58.8%;开放手术组5年生存率为pⅠa期92.9%,pⅠb期76.4%,pⅢa期25.3%。结论全胸腔镜肺叶切除术治疗临床早期肺癌在技术上安全可行,其淋巴结清扫可达到开放手术的范围,远期疗效优于开放手术,但亟待大样本量的随机对照研究进一步证实。

linical Outcome of Complete Video-assisted Thoracoscopic Surgery Lobectomy for Patients with Early-stage Non-small Cell Lung Cancer

Objective To evaluate the safety,feasibility,and clinical outcome of complete video-assisted thoracoscopic surgery(VATS) lobectomy for patients with early-stage non-small cell lung cancer(NSCLC).Methods We retrospectively analyzed the clinical data of 160 consecutive patients(the VATS group,83 males and 77 females with average age at 60.8 years) with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 and December 2008 in Zhongshan Hospital of Fudan University,and compared them with 357 patients(the thoracotomy group,222 males and 135 females with average age at 59.5 years) who underwent open thoracotomy in the same period.Results The conversion rate of the VATS group was 5.0%(8/160).The operation time of the VATS group was significantly shorter than that of the thoracotomy group(113.0 min vs.125.0 min,P=0.039).Length of postoperative hospital stay was not statistically different between the two groups(10.3±4.3 d vs.9.1±4.6 d,P=0.425).The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%(15/160) and 10.1%(36/357) respectively,and the postoperative mortality of the two groups was 0.6%(1/160)and 2.0%(7/357) respectively.There was no statistical difference in the mean group of lymph node dissection(2.4±1.5 groups vs.2.4±1.7 groups,P=0.743) and the mean number of lymph node dissection(9.8±6.3 vs.10.1±6.4,P=0.626) between the two groups.The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group(81.5% vs.67.8%,P=0.001).Subgroup analysis showed that the 5-year survival rate of pⅠa stage,pⅠb stage,and pⅢa stage was 86.0%,84.5%,and 58.8% respectively in the VATS group,and 92.9%,76.4%,and 25.3% respectively in the thoracotomy group.Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC.The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy,and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy.Randomized controlled trials of large sample size are further needed to demonstrate superiority.