目的:亚段切除术已被用于非小细胞肺癌(NSCLC)数十年。本研究旨在比较亚段切除术的特点,非小细胞肺癌的段切除术和楔形切除术。
方法:接受亚段切除术的NSCLC患者,节段切除术,对2014年至2019年之间的楔形切除术或楔形切除术进行了回顾性筛查。人口统计,放射学,并对患者的围手术期特点进行比较。Further,对数秩检验,采用单因素和多因素Cox回归进行预后评估.
结果:有276、670和494例患者接受了亚段切除术,节段切除术,楔形切除术,分别。与楔形切除术相比,进行段切除术和亚段切除术的患者肿瘤尺寸更大,到胸膜的距离更大。亚段切除术和段切除术比楔形切除术更有可能获得足够的手术切缘(82.0%vs.79.5%与64.7%,P<0.001),对于远离胸膜的结节尤其如此(80.2%vs.81.4%vs.55.8%,P<0.001)。此外,与楔形接收相比,解剖切除可以进行更多的淋巴结清扫,并且需要更少的术前定位。亚段切除术比段切除术保留约两个亚段(P<0.001)。亚段切除术(3.3%)和楔形切除术(1.8%)后长期漏气的发生率相似(P=0.308)。值得注意的是,66.8%的患者接受了段切除术或亚段切除术被认为不适合楔形。在随访期间(55.1个月),亚段切除术患者无肿瘤复发或死亡。两组间无复发生存率(P=0.140)和总生存率(P=0.370)无显著差异。
结论:亚段切除术比楔形切除术可以获得更充分的手术切缘,并且在深结节方面具有优势。与节段切除术相比,亚段切除术可以保留更多的肺实质。
OBJECTIVE: Subsegmentectomy has been adopted for non-small cell lung cancer (NSCLC) for decades. This study aimed to compare the features between subsegmentectomy, segmentectomy and wedge resection for NSCLC.
METHODS: NSCLC patients who underwent subsegmentectomy, segmentectomy, or wedge resection between 2014 and 2019 were retrospectively screened. Demographic, radiomic, and perioperative characteristics between patients were compared. Further, log-rank test, univariate and multivariate Cox regression were used for prognostic evaluation.
RESULTS: There were 276, 670, and 494 patients undergoing subsegmentectomy, segmentectomy, and wedge resection, respectively. Patients with segmentectomy and subsegmentectomy had larger tumor sizes and greater distances to the pleura than those with wedge resection. Subsegmentectomy and segmentectomy were more likely to achieve adequate surgical margins than wedge resection (82.0 % vs. 79.5 % vs. 64.7 %, P < 0.001), which was especially true for nodules away from the pleura (80.2 % vs. 81.4 % vs. 55.8 %, P < 0.001). In addition, anatomic resection allowed for more lymph node dissection and required less preoperative localization than wedge reception. Subsegmentectomy preserved about two subsegments than segmentectomy (P < 0.001). The incidence of prolonged air leakage after subsegmentectomy (3.3 %) and wedge (1.8 %) was similar (P = 0.308). Notably, 66.8 % of patients who underwent segmentectomy or subsegmentectomy were considered unsuitable for wedge. During the follow-up (55.1 months), no tumor recurrence or death occurred in patients undergoing subsegmentectomy. No significant recurrence-free survival (P = 0.140) or overall survival (P = 0.370) difference existed between these groups.
CONCLUSIONS: Subsegmentectomy could achieve more adequate surgical margins than wedge resection and showed superiority for deep nodules. Compared to segmentectomy, subsegmentectomy could preserve more lung parenchyma.