Abstract：
OBJECTIVE: Aim of this study is to identify the factors that may influence the lymphadenectomy during VATS anatomical lung resection with particular interest on operator experience.
METHODS: Clinical and pathological data from the prospective VATS Italian nationwide registry were reviewed and analysed. Patients with incomplete data regarding tumor and surgical characteristics, GGO, or with distant metastases were excluded. Patients clinical data, tumor characteristics, operation information and surgeon experience were collected and compared to resected lymph nodes number (#RN), resected N2 nodes number (#N2RN) and resected N2 stations number. A multivariable model was built using logistic regression analysis. Surgeon experience was categorized considering the number of VATS major anatomical resection and years after residency.
RESULTS: The final analysis was conducted on 3727 patients. The median #RN and #N2RN were 11 (1-51) and 5 (0-41). Regarding the analysed outcomes, #N2RN > 6 resulted in 1812 (48.8%)cases, #RN > 10 in 2124 (57.0%)cases and more than 3 N2 stations were harvested in 1447 (38.8%)patients. First operator experience with number of VATS lobectomies>50 (p < 0.001), operator seniority after residency5-10years (p < 0.001), cTNM II/III(p = 0.017), lobectomy/bilobectomy vs segmentectomy (p < 0.001), and upper/middle lobe tumor location (p < 0.005)resulted significantly associated to #N2RN > 6 at the multivariable analysis. First operator experience with number of VATS lobectomies>50 (p < 0.001), operator seniority after residency5-10years (p < 0.001) and lobectomy/bilobectomy (p < 0.001) resulted significantly associated to #RN > 10 at the multivariable analysis.
CONCLUSIONS: Our study showed that lymphadenectomy during VATS lobectomy is influenced by tumor factors such as cTstage and tumor location but also by operator experience, with a higher number of resected lymph nodes in surgeons with a high number of VATS procedures and years after residency compared to surgeons with less experience.
METHODS: Clinical and pathological data from the prospective VATS Italian nationwide registry were reviewed and analysed. Patients with incomplete data regarding tumor and surgical characteristics, GGO, or with distant metastases were excluded. Patients clinical data, tumor characteristics, operation information and surgeon experience were collected and compared to resected lymph nodes number (#RN), resected N2 nodes number (#N2RN) and resected N2 stations number. A multivariable model was built using logistic regression analysis. Surgeon experience was categorized considering the number of VATS major anatomical resection and years after residency.
RESULTS: The final analysis was conducted on 3727 patients. The median #RN and #N2RN were 11 (1-51) and 5 (0-41). Regarding the analysed outcomes, #N2RN > 6 resulted in 1812 (48.8%)cases, #RN > 10 in 2124 (57.0%)cases and more than 3 N2 stations were harvested in 1447 (38.8%)patients. First operator experience with number of VATS lobectomies>50 (p < 0.001), operator seniority after residency5-10years (p < 0.001), cTNM II/III(p = 0.017), lobectomy/bilobectomy vs segmentectomy (p < 0.001), and upper/middle lobe tumor location (p < 0.005)resulted significantly associated to #N2RN > 6 at the multivariable analysis. First operator experience with number of VATS lobectomies>50 (p < 0.001), operator seniority after residency5-10years (p < 0.001) and lobectomy/bilobectomy (p < 0.001) resulted significantly associated to #RN > 10 at the multivariable analysis.
CONCLUSIONS: Our study showed that lymphadenectomy during VATS lobectomy is influenced by tumor factors such as cTstage and tumor location but also by operator experience, with a higher number of resected lymph nodes in surgeons with a high number of VATS procedures and years after residency compared to surgeons with less experience.
摘要：
目的：这项研究的目的是确定在VATS解剖肺切除术中可能影响淋巴结清扫的因素，特别是对操作者经验感兴趣。
方法：回顾并分析了前瞻性VATS意大利全国注册的临床和病理数据。关于肿瘤和手术特征的数据不完整的患者，GGO,或远处转移被排除。患者临床资料,肿瘤特征，收集手术信息和外科医生经验，并与切除的淋巴结数（＃RN）进行比较，切除的N2节点号(#N2RN)和切除的N2站号。采用logistic回归分析建立多变量模型。考虑到VATS主要解剖切除的次数和住院后的年限，对外科医生的经验进行了分类。
结果：对3727例患者进行了最终分析。#RN和#N2RN的中位数分别为11(1-51)和5(0-41)。关于分析的结果，#N2RN>6导致1812例(48.8%)，在2124例（57.0%）病例中，#RN>10，在1447例（38.8%）患者中收获超过3个N2站。第一次操作经验，VATS肺叶切除术数量>50(p<0.001)，居住5-10年后的操作员资历(p<0.001)，cTNMII/III(p=0.017)，肺叶切除术/双叶切除术与肺段切除术（p<0.001），在多变量分析中,上/中叶肿瘤位置(p<0.005)与#N2RN>6显著相关。第一次操作经验，VATS肺叶切除术数量>50(p<0.001)，在多变量分析中,住院5-10年(p<0.001)和肺叶切除术/双叶切除术(p<0.001)后的操作者资历与#RN>10显著相关.
结论：我们的研究表明，VATS肺叶切除术中的淋巴结清扫术受到诸如cT分期和肿瘤位置等肿瘤因素的影响，也受到手术经验的影响。与经验较少的外科医生相比，在接受VATS手术的外科医生中，切除淋巴结的数量较多，并且在住院后数年。
方法：回顾并分析了前瞻性VATS意大利全国注册的临床和病理数据。关于肿瘤和手术特征的数据不完整的患者，GGO,或远处转移被排除。患者临床资料,肿瘤特征，收集手术信息和外科医生经验，并与切除的淋巴结数（＃RN）进行比较，切除的N2节点号(#N2RN)和切除的N2站号。采用logistic回归分析建立多变量模型。考虑到VATS主要解剖切除的次数和住院后的年限，对外科医生的经验进行了分类。
结果：对3727例患者进行了最终分析。#RN和#N2RN的中位数分别为11(1-51)和5(0-41)。关于分析的结果，#N2RN>6导致1812例(48.8%)，在2124例（57.0%）病例中，#RN>10，在1447例（38.8%）患者中收获超过3个N2站。第一次操作经验，VATS肺叶切除术数量>50(p<0.001)，居住5-10年后的操作员资历(p<0.001)，cTNMII/III(p=0.017)，肺叶切除术/双叶切除术与肺段切除术（p<0.001），在多变量分析中,上/中叶肿瘤位置(p<0.005)与#N2RN>6显著相关。第一次操作经验，VATS肺叶切除术数量>50(p<0.001)，在多变量分析中,住院5-10年(p<0.001)和肺叶切除术/双叶切除术(p<0.001)后的操作者资历与#RN>10显著相关.
结论：我们的研究表明，VATS肺叶切除术中的淋巴结清扫术受到诸如cT分期和肿瘤位置等肿瘤因素的影响，也受到手术经验的影响。与经验较少的外科医生相比，在接受VATS手术的外科医生中，切除淋巴结的数量较多，并且在住院后数年。
