背景:由于手术复杂性和预后差,侵入上腔静脉(SVC)的非小细胞肺癌(NSCLCs)的手术很少进行。已经描述了重建SVC的不同方法,如直接缝合,贴片使用或假体,根据其周围的参与。我们研究的目的是分析不同类型的SVC切除和重建治疗T4NSCLC的短期和长期结果。
方法:在2000年1月至2019年12月之间,在这项多中心回顾性研究中,有80例患者接受了解剖性肺切除术和SVC手术。部分切除和直接缝合或补片重建组包括64例患者,而完整切除和假体重建组包括16例患者。主要终点如下:长期生存率和无病生存率。次要终点如下:围手术期并发症和30天和90天死亡率。非参数变量的非配对t检验或Mann-WhitneyU检验应用于离散或连续数据,对二分或分类数据进行卡方检验。使用Kaplan-Meier方法计算生存率,并使用对数秩检验进行比较。
结果:两组在一般特征和手术方面没有发现差异,肿瘤和生存结果。特别是,在早期方面没有差异(50.0%与68.8%,p=0.178)和晚期并发症频率(12.5%vs.12.5%,p=1.000),30天和90天死亡率,R状态,复发,总生存率(33.89±40.35vs.35.70±51.43个月,p=0.432)和无病生存率(27.56±40.36vs.31.28±53.08个月,p=0.668)。多变量分析表明,年龄是总生存率的唯一独立预测因素。
结论:根据我们的结果,SVC切除术具有良好的肿瘤和生存结果,无论圆周参与的比例和重建的类型。
BACKGROUND: Surgery for non-small-cell lung cancers (NSCLCs) invading the superior vena cava (SVC) is rarely performed due to surgical complexities and reported poor prognoses. Different methods have been described to reconstruct the SVC, such as direct suture, patch use or prosthesis, according to its circumferential involvement. The aim of our study was to analyze the short- and long-term results of different types of SVC resection and reconstruction for T4 NSCLCs.
METHODS: Between January 2000 and December 2019, 80 patients received an anatomical lung resection with SVC surgery in this multicenter retrospective study. The partial resection and direct suture or patch reconstruction group included 64 patients, while the complete resection and prosthesis reconstruction group included 16 patients. The primary endpoints were as follows: long-term survival and disease-free survival. The secondary endpoints were as follows: perioperative complications and 30- and 90-day mortality. Unpaired t-tests or Mann-Whitney U tests for non-parametric variables were applied to discrete or continuous data, and the chi-square test was applied to dichotomous or categorical data. Survival rates were calculated using the Kaplan-Meier method and compared using the log-rank test.
RESULTS: No differences were found between the two groups in terms of general characteristics and surgical, oncological and survival outcomes. In particular, there were no differences in terms of early (50.0% vs. 68.8%, p = 0.178) and late complication frequency (12.5% vs. 12.5%, p = 1.000), 30- and 90-day mortality, R status, recurrence, overall survival (33.89 ± 40.35 vs. 35.70 ± 51.43 months, p = 0.432) and disease-free survival (27.56 ± 40.36 vs. 31.28 ± 53.08 months, p = 0.668). The multivariate analysis demonstrated that age was the only independent predictive factor for overall survival.
CONCLUSIONS: According to our results, SVC resection has good oncological and survival outcomes, regardless of the proportion of circumferential involvement and the type of reconstruction.