Background: The morbidity of lung cancer has long been the highest in cancer. Stage I, stage II and partly of stage III non-small cell lung cancer (NSCLC) are mainly treated by surgery. Lobectomy and segmentectomy both are common lung resection methods. Video-assisted thoracoscopic surgery (VATS) has been widely used in clinical, and the application of single-portvideo-assisted thoracoscopic surgery (SP VATS) has gradually been recognized and accepted by professors. With increasing degree of eldly in society, eldly patients already have become inceasingly difficulties in the diagnosis and treatment of NSCLC. The aim of this study is to explore and analyze clinical value of SP VATS lobectomy and segmentectomy in elderly patients with NSCLC.
Methods: In this retrospective observational study, the outcomes of 417 consecutive patients who had undergone SP VATS anatomic segmentectomy or lobectomy for NSCLC from May 2014 to December 2016 on department of thoracic surgery in Fujian Medical University Affiliated Union Hospital were examined, including 139 elderly-case (lobectomy vs segmentectomy: 124 vs 15) and 278 nonelderly-case (lobectomy vs segmentectomy: 248 vs 30). The condition of perioperative period and postoperative short-time recovery could be compared with lobectomy and segmentectomy between elderly and nonelderly cases and lobectomy and segmentectomy in elderly cases.
Results: The morbidty of preoperative complications was significant difference (P<0.05) in comparing with elderly and non-elderly patients with NSCLC either in SP VATS anatomic segmentectomy orlobectomy, except others is no significant difference (P>0.05). Numbers of dissected lymph nodes and mediastinal nodal stations of SP VATS lobectomy in elderly patients with NSCLC were more than segmentectomy (P<0.05), which were (7.61±0.21) vs (20.39±0.97) and (5.60±0.35) vs (15.40±2.64). But there was not significant difference between two elderly groups of SP VATS lobectomy and anatomic segmentectomy in age, morbidty of preoperative complications, average operation time and intraoperative blood loss (P>0.05). Postoperative drainage volume [(1,150.15±140.02) mL vs (853.53±177.04) mL] and duration [(7.00±1.31) d vs (5.00±0.74) d], duration of postoperative hospital stay [(3.18±1.32) d vs (5.04±1.30) d], costs [(70.06±5.23) thousands yuan vs (61.20±5.22) thousands yuan ] or postoperative complications (5.97% vs 20.00%)(P>0.05). Notwithstanding, group of SP VATS anatomic segmentectomy found more postoperative atrialfibrillation and the vein thrombosis of lower limbs (P<0.05).
Conclusions: Elderly patients having more basic diseases and taking increasely risk of postoperative complications. SP VATS anatomic segmentectomy andlobectomy do not increase the risk of elderly patients with surgery. SP VATS segmentectomy is as safe and effective as SP VATS lobectomy in elderly patients, who fit to undergo SP VATS segmentectomy seem to get as same short-time effect as SP VATS lobectomy.
背景与目的 肺癌的发病率长期位于癌症之首。I期、II期和部分III期非小细胞肺癌（non-small cell lung cancer, NSCLC）的主要治疗方式以手术为主，肺叶切除术与肺段切除术为两类较为常见的手术方式。电视辅助胸腔镜手术（video-assisted thoracoscopic surgery, VATS）已广泛应用于临床，单孔电视辅助胸腔镜（single-port video-assisted thoracoscopic surgery, SP VATS）在胸部外科手术中的应用也逐渐被国内外专家所认识和接受。随着社会高龄化程度逐渐加深，这类患者成为NSCLC诊疗的难点。本研究探讨并分析SP VATS肺叶切除术与肺段切除术在治疗高龄NSCLC患者中的临床应用价值。方法 回顾性分析福建医科大学附属协和医院胸外科在2014年5月-2016年12月期间行SP VATS肺叶切除与肺段切除的417例患者资料。其中高龄患者139例（肺叶切除124例 vs 肺段切除15例），非高龄患者278例（肺叶切除248例 vs 肺段切除30例）。分别比较高龄与非高龄患者行SPVATS肺叶或肺段切除术及高龄患者行肺叶、肺段切除术的围手术期及术后短期恢复情况。结果 SP VATS肺叶切除和肺段切除的比较组中，除在术前合并症患病率上，高龄患者均高于非高龄患者（P<0.05），在其余比较项上无明显差异（P>0.05）。在单孔胸腔镜肺叶切除和肺段切除的高龄患者比较中，可发现淋巴结清扫站数[（7.61±0.21）组 vs （5.60±0.35）组]及数目[（20.39±0.97）枚 vs（15.40±2.64）枚]，差异有统计学意义（P<0.05），而在年龄、术前合并症患病率、平均手术时间、术中失血量却无统计学差异（P>0.05）。虽然在术后并发症发生率上肺叶切除和肺段切除的高龄患者无统计学差异（P>0.05），但是在术后房颤和双下肢静脉血栓发生率上却存在明显差异（P<0.05）。在术后住院时间[（3.18±1.32）天 vs （5.04±1.30）天]、胸管放置时间[（7.00±1.31）天 vs （5.00±0.74）天]及总住院费用[（70.06±5.23）千元 vs （61.20±5.22）千元]上，差异无统计学意义（P>0.05）。结论 高龄患者由于合并更多基础疾病，可能增加术后并发症的风险，但单孔胸腔镜肺叶及肺段切除术并不增加高龄患者的手术相关风险，且对合适的高龄病例行肺段切除可获得与肺叶切除相类似的短期疗效。 .
Keywords: Elderly; Lobectomy; Lung neoplasms; Segmentectomy; Single-port video-assisted thoracoscopy.