Prognostic Analysis Of Early Lung Adenocarcinoma With Ground Glass After Segmentectomy

Background and objective:At present,the incidence of lung cancer in China ranks first among male malignant tumors and second among female malignant tumors,while the mortality of lung cancer ranks first among both male and female malignant tumors.Nowadays,with the popularization of CT,a large number of early lung adenocarcinoma with ground glass are found.With the popularization of video-assisted thoracoscopic surgery(VATS),minimally invasive incision and minimally invasive injury have gradually become the demand of current surgery.In recent years,studies have shown that Segmentectomy has a similar healing effect to lobectomy in patients with early lung cancer.The main purpose of Segmentectomy is to preserve the postoperative pulmonary function.However,due to the complexity of lung anatomy,the preservation and recovery of pulmonary function after Segmentectomy are controversial.This article explores the pathological characteristics of early lung adenocarcinoma with the advantage of grinding glass,and analyzes the comparative changes of survival between Segmentectomy and lobectomy,and the changes of pulmonary function indexes one month after operation and one and a half years after operation.Methods:From January,2017 to December,2018,110 patients with lung adenocarcinoma who underwent VATS lung surgery in the Department of Thoracic Surgery in the second hospital of Dalian Medical University,whose tumor size was11-30 mm,and whose CTR was less than 0.5,were selected as experimental group and110 patients with lobectomy as control group.Clinical data of patients during hospitalization were obtained through the medical record system,including age,sex,smoking history,pulmonary function,CEA,CT findings(nodule diameter,solid component diameter,ground glass component diameter,CTR),pathological types,lymph node dissection,operation methods,etc.Results:1.One case was lost in follow-up,which was a patient in the Segmentectomy group.The rate of loss of follow-up was low and had no obvious effect on the results.The final results included 109 cases in the Segmentectomy group,including 39 males(35.78%)and 70 females(64.22%),with an average age of 60.73±8.79 years.There were 110 cases in the lung lobectomy group,including 48 males(43.64%)and 62females(62.36%),with an average age of 58.66±9.96 years.Chi-square test or independent sample t-test was used for each data in the Segmentectomy group and the lobectomy group.There was no statistical differences in gender,age,smoking history,nodule diameter,nodule number and CEA(P>0.05),but there were statistical differences in CTR,solid diameter,ground glass diameter,number and total number of lymph node dissection groups(P<0.05).No lymph node metastasis was found in all patients.One of the enrolled patients found local recurrence during the follow-up 3 years after segmentectomy,and was cured after lobectomy again.No recurrence and metastasis occurred in the other patients during the follow-up period.The recurrence rate between the two groups was 0.9%vs0%,with no statistical difference.2.According to pathological subtypes,the patients were divided into two groups:173 cases were attached to lepidic group,including 67 males(38.73%)and 106 females(61.27%),with an average age of 59.42±9.20 years.There were 46 cases of non-lepidic type(38 cases of acinar type,7 cases of papillary type,1 case of micropapillary type and 0 case of solid type),among which 20 cases were male(43.38%)and 26 cases were female(56.52%),with an average age of 60.70±10.33 years.Comparing the related factors,there was no significant difference in gender,age,smoking history,nodule number,ground glass diameter and CEA between the two groups(P>0.05),but there were significant difference in CTR,nodule diameter and solid component diameter(P<0.05).3.There were significant differences in pulmonary function between Segmentectomy group and lobectomy group at 1 months and 18 months after operation(P<0.05).After further comparing the changes of pulmonary function between the two groups,it was found that the degree of decline in the Segmentectomy group was significantly lower than that in the lobectomy group one month after operation,and the degree of recovery in the Segmentectomy group was significantly lower than that in the lobectomy group 18 months after operation,and the data of each group had statistical differences(P<0.05).Conclusion:1.For patients with stage IA lung adenocarcinoma,which is mainly ground glass,Segmentectomy may be considered.2.Segmentectomy can obviously preserve the pulmonary function of patients in the early postoperative period.