70岁以上Ⅰ期非小细胞肺癌患者胸腔镜亚肺叶切除与肺叶切除术近远期结果

Abstract

目的：总结分析70岁以上Ⅰ期非小细胞肺癌（ NSCLC）患者胸腔镜亚肺叶切除与肺叶切除术近远期疗效。方法回顾2003年1月至2013年12月北京大学人民医院147例70岁及以上病理Ⅰ期NSCLC行胸腔镜手术患者的临床资料。其中男94例、女53例，年龄（75.4±4.0）岁；肺叶切除术101例，亚肺叶切除术46例。分析两组病例围手术期结果和远期预后。结果两组病例均无围手术期死亡，亚肺叶切除组与肺叶切除组相比，术中出血[（58.7±58.2） ml对（194.5±262.0） ml]、手术时间[（103.0±39.7） min对（196.1±57.6） min]、术后带管时间[（5.7±4.0）天对（7.3±3.7）天]和术后住院天数[（8.6±4.6）天对（10.0±4.3）天]明显较少（P＜0.01），但两组术后并发症无明显差异。全组的5年总生存率72.6％，亚肺叶切除组较肺叶切除组局部复发率高（30.4％对9.9％，P＜0.05），而远处转移率相近（28.3％对17.8％，P＝0.150）。胸腔镜肺叶切除组较亚肺叶切除组5年的无病生存率明显增高（67.5％对33.6％，P＝0.008），两组5年总生存率相似（76.2％对67.7％，P＝0.569）。结论70岁以上病理Ⅰ期NSCLC患者行胸腔镜亚肺叶切除术安全有效，并可获得与胸腔镜肺叶切除术相似的远期生存预后；此结果尚需大样本随机对照临床试验证实。

Objective To analyse the role of vedio-assisted thoracic sublobar resection for clinical effect and long term survival in the elderly with stage Ⅰnon-small cell lung cancer.Methods Conducted a retrospective review of the clinical da-tabase.A total of 147 patients with age≥70,stage Ⅰ NSCLC were enrolled from Jan 2003 to Dec 2013 in our department. There 94 males and 53 females, with the age of(75.4 ±4.0) years.101 patients underwent VATS standard lobectomy,while 46 patients underwent VATS sublobar resection .Perioperative results were reviewed and survival was analyzed between the VATS sublobar resection group and the standard lobectomy group.Results Patients and tumor characteristics were similar.No mortality was reported.Compared with lobectomy group, the sublobar group had a less bleed in surgery[(58.7 ±58.2) ml vs. (194.5 ±262.0) ml], shorter operation time[(103.0 ±39.7) min vs.(196.1 ±57.6) min] and subsequently shorter length of stay[(8.6 ±4.6) days vs.(10.0 ±4.3) days].The overall 5-year OS survival is 72.6%.Locoregional recurrence rates were higher after sublobar resection than those after standard lobectomy(30.4% vs.9.9%, P<0.05).No differences were seen in distant metastatic recurrence.The 5-year OS survival for sublobar resection and lobectomy is similar(76.2% vs. 67.7%, P>0.05)while the 5-year DFS survival for VATS lobectomyis higher than those for sublobar resection (67.5% vs. 33.6% respectively,P<0.05).Conclusion For elderly patients with stage Ⅰ NSCLC, VATS sublobar resection is an ap-propriate alternative for VATS lobectomy with a similar oncological long-term outcome.A larger scale of prospective clinical study is necessary to confirm the noninferiority of VATS sublobar resection .