Comparison of uniportal video-assisted thoracoscopic and thoracotomy double sleeve lobectomy for the treatment of non-small cell lung cancer

doi:10.3877/cma.j.issn.2095-8773.2024.04.03

Abstract

Abstract:

Objective

To retrospectively compare and analyze the cases of non-small cell lung cancer receiving uniportal thoracoscopy double sleeve lobectomy with thoracotomy approach in Shanghai Pulmonary Hospital，and explore the advantages and safety of uniportal thoracoscopy double sleeve lobectomy.

Methods

A total of 85 cases of double sleeve lobectomy performed in Shanghai Pulmonary Hospital from June 2018 to December 2022 were included consecutively.Patients were followed up by phone every 6 months after surgery.The surgical duration，intraoperative blood loss，drainage on the first day after surgery，postoperative hospital stay，intraoperative lymph node dissection，postoperative complications，Numeric Rating Scale of pain 3 months after surgery，and survival rates were statistically analyzed.

Results

Fifty cases were included in the uniportal group and 35 cases were included in the thoracotomy group.The proportion of patients with a history of smoking was higher in the thoracotomy group，while there was no difference in baseline data between the two groups.The surgery duration of the uniportal group was shorter than that of the thoracotomy group（2.7±0.8 vs 3.2±0.5，P=0.006）.There was no statistically significant difference in intraoperative blood loss，postoperative drainage on the first day，and postoperative hospital stay between the two groups.There was no statistically significant difference in the number and stations of lymph node dissection during surgery and the number of positive lymph nodes after surgery between the two groups.No postoperative death or life-threatening postoperative complications were observed in both groups 30 days after surgery.The proportion of moderate pain in the thoracotomy group was higher than that in the uniportal group at 3 months after surgery（42.4% vs 13.0%，P=0.008）.The median follow-up time was 28（12-56） months，and the 3-year disease-free survival of the uniportal group and thoracotomy group were 74.9% and 63.8%，respectively（P=0.534）；the 3-year overall survival of the uniportal group and thoracotomy group were 81.4% and 79.9%，respectively（P=0.914）.

Conclusions

Uniportal thoracoscopic double sleeve lobectomy has similar surgical effects and postoperative survival rates as traditional thoracotomy approaches.However，uniportal surgery has a shorter surgical duration and significantly reduce postoperative pain in patients.

Key words: Uniportal video-assisted thoracoscopic surgery, Thoracotomy, Non-small cell lung cancer, Double sleeve lobectomy

Jianqiao Cai, Lei Jiang. Comparison of uniportal video-assisted thoracoscopic and thoracotomy double sleeve lobectomy for the treatment of non-small cell lung cancer[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(04): 225-230.

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Figures/Tables 4

References 23

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参数	单孔组（n=50）	开胸组（n=35）	P值
性别［例（%）］			0.936
男	44（88.0）	31（88.6）
女	6（12.0）	4（11.4）
吸烟史［例（%）］			0.045
有	28（56.0）	27（77.1）
无	22（44.0）	8（22.9）
年龄（岁）	60.32±7.96	61.14±6.86	0.612
体重指数（kg/m²）	23.10±2.96	22.91±2.46	0.751
第1秒用力呼气容积（L）	2.38±0.42	2.27±0.45	0.278
病灶直径（cm）	3.89±1.21	4.22±1.19	0.214
手术部位［例（%）］			0.479
左肺上叶	45（90.0）	33（94.3）
右肺上叶	5（10.0）	2（5.7）
病理类型［例（%）］			0.521
鳞癌	33（66.0）	26（74.3）
腺癌	12（24.0）	6（17.1）
大细胞癌	3（6.0）	3（8.6）
肉瘤样癌	2（4.0）	0（0.0）
TNM分期*［例（%）］			0.664
Ⅰ期	9（18.0）	3（8.6）
Ⅱ期	18（36.0）	14（40.0）
Ⅲ期	21（42.0）	16（45.7）

参数	单孔组（n=50）	开胸组（n=35）	P值
性别［例（%）］			0.936
男	44（88.0）	31（88.6）
女	6（12.0）	4（11.4）
吸烟史［例（%）］			0.045
有	28（56.0）	27（77.1）
无	22（44.0）	8（22.9）
年龄（岁）	60.32±7.96	61.14±6.86	0.612
体重指数（kg/m²）	23.10±2.96	22.91±2.46	0.751
第1秒用力呼气容积（L）	2.38±0.42	2.27±0.45	0.278
病灶直径（cm）	3.89±1.21	4.22±1.19	0.214
手术部位［例（%）］			0.479
左肺上叶	45（90.0）	33（94.3）
右肺上叶	5（10.0）	2（5.7）
病理类型［例（%）］			0.521
鳞癌	33（66.0）	26（74.3）
腺癌	12（24.0）	6（17.1）
大细胞癌	3（6.0）	3（8.6）
肉瘤样癌	2（4.0）	0（0.0）
TNM分期*［例（%）］			0.664
Ⅰ期	9（18.0）	3（8.6）
Ⅱ期	18（36.0）	14（40.0）
Ⅲ期	21（42.0）	16（45.7）

项目	单孔组	开胸组	P值
术中失血（mL）	164.0±161.6	200.0±124.3	0.271
手术时间（h）	2.7±0.8	3.2±0.5	0.006
术后第1天引流（mL）	278.6±131.2	270.3±119.5	0.766
术后住院天数	5.9±2.8	6.2±3.0	0.584
淋巴结清扫站数	5.0（4.5～6.0）	5.0（5.0～6.0）	0.067
淋巴结清扫个数	9.0（7.5～13.5）	10.0（8.0～15.25）	0.253
阳性淋巴结数	1.0（0～2.5）	2（0～4.0）	0.218

项目	单孔组	开胸组	P值
术中失血（mL）	164.0±161.6	200.0±124.3	0.271
手术时间（h）	2.7±0.8	3.2±0.5	0.006
术后第1天引流（mL）	278.6±131.2	270.3±119.5	0.766
术后住院天数	5.9±2.8	6.2±3.0	0.584
淋巴结清扫站数	5.0（4.5～6.0）	5.0（5.0～6.0）	0.067
淋巴结清扫个数	9.0（7.5～13.5）	10.0（8.0～15.25）	0.253
阳性淋巴结数	1.0（0～2.5）	2（0～4.0）	0.218

疼痛情况	单孔组（n=46）	开胸组（n=33）
无痛	2（4.3%）	0
轻度疼痛	38（82.6%）	19（57.6%）
中度疼痛	6（13.0%）	14（42.4%）
重度疼痛	0	0

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