Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis
单位：[1]Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China浙江大学医学院附属第一医院[2]Department of ThoracicSurgery, Tianjin Chest Hospital, Tianjin, China[3]Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China四川大学华西医院[4]Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China华中科技大学同济医学院附属同济医院[5]Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou, China河南省肿瘤医院[6]Department of Thoracic Surgery, Tangdu Hospital, Fourth MilitaryMedical University, Xi’an, China[7]Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Cancer Institute ofJiangsu Province, Nanjing, China[8]Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province,Nanjing, China[9]Department of Thoracic Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China[10]Department of ThoracicSurgery, Shanghai Chest Hospital, Shanghai, China[11]Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China[12]MedicalAffairs, Linkdoc Technology Co. Ltd., Beijing, China
Background: Compared with open surgery, video-assisted thoracic surgery (VATS) has innovated the concept of the minimally invasive approach for non-small cell lung cancer (NSCLC) patients in past decades. This present study aimed to compare the perioperative and lymph node dissection outcomes between VATS lobectomy and open lobectomy for pathological stage T1 (pT1) NSCLC patients from both surgical and oncologic perspectives. Methods: This was a retrospective multicenter study. Patients who underwent surgical resection for pT1 NSCLC between January 2014 and September 2017 were retrospectively reviewed from 10 thoracic surgery centers in China. Perioperative and lymph node dissection outcomes of pT1 NSCLC patients who accepted VATS or open lobectomies were compared by propensity score matching (PSM) analysis. Results: Of the 11,360 patients who underwent surgery for pT1 NSCLC, 7,726 were enrolled based on the selection criteria, including 1,222 cases of open lobectomies and 6,504 cases of VATS lobectomies. PSM resulted in 1,184 cases of open lobectomies and 1,184 cases of VATS lobectomies being well matched by common prognostic variables, including age, sex, and surgical side. VATS lobectomy led to better perioperative outcomes, including less blood loss (133.5 +/- 200.1 vs. 233.3 +/- 318.4, P<0.001), lower blood transfusion rate (2.4% vs. 6.4%, P<0.001), shorter postoperative hospital stay (8.6 +/- 5.7 vs. 10.1 +/- 5.1, P<0.001), less chest drainage volume (1,109.5 +/- 854.0 vs. 1,324.1 +/- 948.8, P<0.001), and less postoperative complications (4.9% vs. 8.2%, P<0.001). However, open lobectomy had better lymph node dissection outcomes than VATS, with increased lymph node dissection numbers (16.1 +/- 9.4 vs. 13.7 +/- 7.7, P<0.001) and more positive lymph nodes being dissected (1.5 +/- 3.9 vs. 1.1 +/- 2.5, P=0.002). Compared with VATS, open lobectomy harvested more lymph node stations (5.5 +/- 1.9 vs. 5.2 +/- 1.8, P=0.001), including more pathological N2 (pN2) lymph node stations (3.4 +/- 1.4 vs. 3.1 +/- 1.3, P<0.001). Conclusions: VATS lobectomy was associated with better perioperative outcomes, such as less blood loss, lower blood transfusion rate, shorter postoperative hospital stay, less chest drainage volume and less postoperative complications. Open lobectomy has improved lymph node dissection outcomes, as more lymph nodes and positive lymph nodes were dissected for pT1 NSCLC patients during surgery.
基金：
National Key R&D Program of China [2017YFC0113500]; Major Science and Technology Projects of Zhejiang Province [2020C03058]; Diagnosis and Treatment Technology Research Center of Pulmonary Neoplasm in Zhejiang Province [JBZX-202007]; Key Disciplines of Traditional Chinese Medicine in Zhejiang Province [2017-XK-A33]
第一作者单位：[1]Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
通讯作者：
通讯机构：[1]Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China[*1]Department of Thoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qing-chun Road, Hangzhou, China.
推荐引用方式(GB/T 7714)：
Jinming Xu,Heng Ni,Yihe Wu,et al.Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis[J].TRANSLATIONAL LUNG CANCER RESEARCH.2021,10(1):402-414.doi:10.21037/tlcr-20-1132.
APA：
Jinming Xu,Heng Ni,Yihe Wu,Jinlin Cao,Xingpeng Han...&Jian Hu.(2021).Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis.TRANSLATIONAL LUNG CANCER RESEARCH,10,(1)
MLA：
Jinming Xu,et al."Perioperative comparison of video-assisted thoracic surgery and open lobectomy for pT1-stage non-small cell lung cancer patients in China: a multi-center propensity score-matched analysis".TRANSLATIONAL LUNG CANCER RESEARCH 10..1(2021):402-414
