Primary outcome of completely thoracoscopic lobectomy for lung cancer of diameter larger than 5 centimeters

目的 探讨肿瘤直径≥5 cm的非小细胞肺癌行全胸腔镜肺叶切除手术治疗的安全性、彻底性及有效性.方法 2006年9月至2009年12月全胸腔镜肺叶切除治疗非小细胞肺癌214例,其中男108例,女106例;年龄29～85岁,平均(62.5±11.0)岁.按肿瘤直径分为A组(肿瘤最大径≥5 cm,30例)和B组(肿瘤最大径＜5 cm,184例),回顾性分析两组病例年龄、性别、病理类型、病变部位、中转开胸、手术时间、术中出血、淋巴结清扫情况、术后病理分期、引流时间、住院时间、并发症及生存复发数据.结果 共行肺叶切除211例,复合肺叶切除2例,全肺切除1例.手术过程顺利,无严重围手术期并发症,围术期B组死亡1例(肺部感染至呼吸功能衰竭).A组鳞癌较B组多见(46.7%对13.6%,P＜0.001).A组与B组在手术安全性方面,中转开胸率(16.67%对7.61%,P=0.204)、手术时间[(214.0 ±58.1)min对(198.6±55.1)min,P=0.160]、术中出血量[(283.3±179.7)ml对(248.5±25.7)ml,P=0.559]和并发症发生率(13.33%对14.67%,P=1.000),差异无统计学意义.两组在手术彻底性方面,淋巴结清扫站数[(5.0±2.4)对(5.0±1.7),P=0.990]、枚数[(19.1±10.1)对(15.8±8.8),P=0.065],在手术有效性方面局部复发率(3.45%对2.23%,P=0.532)、1年生存率(81.25%对92.63%,P=0.226),均差异无统计学意义.结论 全胸腔镜肺叶切除手术治疗部分肿瘤直径≥5 cm的非小细胞肺癌是安全、可靠的.Objective To discuss the safety, completeness and efficiency of the completely thoracoscopic lobectomy for non-small-cell lung cancer(NSCLC) which the tumor's diameter was larger than 5 centimeters. Methods From September 2006 to December 2009, 214 patients of NSCLC received completely thoracoscopic lobectomy in our center. There were 108 males and 106 females with median age of 62.5 years( range from 29 to 85 years). Patients were divided into two groups, group A ( diameter≥5 cm) and group B ( diameter ＜5 cm). We compared all the factors of age, gender, pathological type, location,rate of conversion to thorsctomy, operation time, blood loss, lymph node dissection, pathological stage, time of drainge, hospitalization, complications, overall survival and recurrence between two groups. Results Surgical procedures included lobectomy in 211 cases, composite lobectomy in 2 and pneumectomy in 1. All procedures were carried out safely without serious complication except one operative death result from respiratory failure. There were 30 cases in group A and 184 in group B. Age and gender were similar between two groups. The proportion of squamous cell carcinoma in group A was higher than it in group B (46.7% vs. 13.6% ,P ＜0.001 ). There were no differences in safety factors such as rate of conversion to thorsctomy( 16.67% vs. 7.61%,P =0.204), operation time[(214.0 ±58.1)min vs. (198.6 ±55.1)min, P=0.160], blood loss [(283.3 ±179.7)ml vs. (248.5 ±25.7)ml, P=0.559] and complications (13.33% vs. 14.67%,P=1.000). The completeness factors of lymph node dissection stages (5.0 ± 2.4 vs. 5.0 ± 1.7, P = 0.990 ) and numbers( 19.1 ± 10.1 vs.15.8 ± 8.8, P = 0.065 ) were equivalent between two groups. The estimated overall survival at 1 year was 81.25% for group A and 92.63% for group B ( P = 0.226). The recurrence of two groups was 3.45% vs. 2.23% (P = 0.532 ), respectively.Conclusion Completely thoracoscopic lobectomy can be done safely,completely and efficiently for non-small-cell lung cancer which the tumor's diameter was larger than 5 centimeters.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)05294-296,2902