Comparison Of Short-term And Long-term Outcomes Between Thoracoscopic Pneumonectomy And Open Pneumonectomy For Non-small Cell Lung Cancer

Objective:Comparison of short-term and long-term results of thoracoscopic and open pneumonectomy for non-small cell lung cancer.Methods:We collected clinical data of thoracic surgery of Qingdao University Hospital from January 2008 to December 2016 for patients with non-small cell lung cancer undergoing pneumonectomy.The results were analyzed by propensity score matching(PSM)and multivariate COX regression.Results:A total of 142 patients who underwent pneumonectomy were included in the study,of which 55 patients underwent thoracoscopy and 87 patients underwent open pneumonectomy.Four patients underwent thoracoscopic pneumonectomy were converted to open,with a conversion rate of 7.3%.Before matching,the maximum diameter of tumors in the thoracoscopic and open groups[M(QR):4(1)cm to 4(3)cm,W=1 913,P=0.04]and T stage(W=2292,P=0.00)The difference is statistically significant,and the remaining clinical data are not statistically different between the two groups.There was no significant difference in clinical data between the two groups of patients after PSM.A total of 29 pairs of patients were successfully matched by propensity score matching.After propensity score matching,the thoracoscopic group had longer operative time((209.7±70.2)minutes vs.(171.3±43.5)minutes,t=2.50,P=0.02),more mediastinal lymph node dissection(M(Q_R):17(9)vs.11(10),W=388,P=0.02)and shorter postoperative hospital stay(7.0(3.5))vs.9.0(3.0),W=285,P=0.03)than open group.There is no difference in intraoperative blood loss[M(QR):100(100)ml to 175(175)ml,P=0.82],postoperative extubation time[M(QR):6(3)days vs.4(3)days,P=0.15],the total number of lymph node cleaning stations[(5.8±1.4)stations than(5.1±1.8)stations,P=0.09],the number[M(QR):21(11)to 18(14)],perioperative total complication rate(27.6%vs.20.7%,P=0.76)and the incidence of any complication.Before PSM,there were no significant differences in the 3-year disease-free recurrence rate(52.6%vs68.2%,P=0.40)and the 3-year overall survival rate(52.6%vs 68.2%,P=0.40)in the two groups.And the trend of the survival curves shows that the open group has potential advantages in both disease-free survival and overall survival over the thoracoscopic group.After PSM,there were no significant differences in the 3-year disease-free recurrence rate(71.4%vs 48.1%,P=0.13)and the 3-year overall survival rate(67.4%vs 47.2%,P=0.10)in the two groups.And the trend of the survival curves shows that the thoracoscopic group has potential advantages in both disease-free survival and overall survival over open group.The Further multivariate COX regression analysis showed that lymph node staging,smoking history,tumor location(left and right),and pathological types were independent risk factors that affected long-term prognosis,and that surgical methods were not independent risk factors that affected disease-free survival and overall survival.Conclusion:Thoracoscopic pneumonectomy is safe and feasible for the treatment of non-small cell lung cancer.Although thoracoscopic technique prolongs the operation time,it can make the mediastinal lymph node dissection more thorough and accelerate the patient’s recovery.Thoracoscopic pneumonectomy and open pneumonectomy can achieve the same perioperative and oncology results.