| Objective:In recent years,the detection of early-stage NSCLC(non-small cell lung cancer)has been promoted with the popularity of LDCT screening.With recent advances in three-dimensional computed tomography(3D-CT)simulation and surgical techniques,lung segmental resection has become more common in clinical practice.The oncologic outcomes may be comparable compared with lobectomy,but whether early-stage patients benefit from lung segmental resection remains controversial.In this article,we demonstrate the safety and feasibility of thoracoscopic pulmonary segmental resection for stage IA NSCLC by retrospectively analyzing the recent clinical outcomes of thoracoscopic pulmonary segmental resection for stage IA NSCLC.Methods:A total of 180 patients in thoracic surgery at the Second Hospital of Jilin University from June 2018 to September 2022 were retrospectively analyzed.All patients met the inclusion criteria and were divided into two groups: thoracoscopic pulmonary segmental resection group(n=90)and thoracoscopic lobectomy group(n=90).General clinical data were collected for both groups: gender,age,preoperative comorbidities,etc.;clinical and pathological data: tumor location,size,major components,pathological type,TNM stage;perioperative data: operative time(min),intraoperative bleeding(ml),number of intraoperative lymph node dissection(ml),postoperative chest drainage(ml),postoperative chest drainage tube retention time(d),postoperative hospitalization days(d);postoperative complications(d);postoperative complications: pulmonary atelectasis,pulmonary air leak,pulmonary infection,cardiac arrhythmia,hypoxemia;postoperative pain(VAS)scores: 24 H,48H and 72 H postoperatively;postoperative quality of life scores(QOL): preoperatively,1 month postoperatively and 6 months postoperatively.Statistical analysis was performed using SPSS 26,and t-test and χ2-test were used for comparison between groups.Differences were considered statistically significant when P < 0.05.Results:(1)Comparison of general clinical data:(1)The main component of tumors in both lung segment and lobe groups was GGO,but it was more common in the lung segment group(87.7% vs.72.2%,P=0.016),which was statistically different(P<0.05);(2)On TNM stage,86.6% were in the stage IA1 lung segment group,66.7 in the lobe group,13.3% in the stage IA2 lung segment group accounted for 13.3%,lung lobe group accounted for 26.6%,stage ⅠA3 lung segment group accounted for 1.1%,lung lobe group accounted for 7.8%(P=0.005),and there was a statistical difference(P<0.05).There was no statistically significant difference between the two groups in the comparison of gender,smoking history,body mass index,type of pathology,and preoperative comorbidities(P > 0.05).(2)Comparison of clinical indicators related to the perioperative period:intraoperative bleeding [(194.78±20.39)ml vs.(202.56±24.59)ml,P=0.007],chest drainage flow on the first postoperative day [(265.83±57.79)ml vs.(327.17±76.23)ml,P=0.024],postoperative chest cavity in the lung segment group Total drainage volume [(681.57±171.76)ml vs.(808.22±133.95)ml,P=0.007],duration of postoperative chest drainage tube retention [(3.63±1.77)d vs.(4.54±1.96)d,P=0.035],number of postoperative hospital days [(4.74±1.67)d vs.(5.51± 1.86)d,P=0.04] were statistically superior compared with the lobar group(P<0.05);in terms of operative time [(118.1±29.38)min vs.(98.28±22.32)min,P=0.005],the lung segment group was longer than the lobar group(P<0.05);the number of intraoperative lymph node dissection [(14.98±2.2)The number of intraoperative lymph node dissection[(14.98±2.2)vs.(18.39±2.39),P=0.084] was less in the lung segment group than in the lobe group,but it was not statistically significant(P>0.05).(3)Comparison of the occurrence of postoperative complications: postoperative complications in the lung segment group included pulmonary atelectasis in 3 cases(3.3%),pulmonary air leak in 8 cases(8.9%),pulmonary infection in 6 cases(6.7%),cardiac arrhythmia in 7 cases(7.8%),and hypoxemia in 2 cases(2.2.%),totaling 26cases(28.9%),and postoperative complications in the lobe group included pulmonary infection in 8 cases(8.9%),pulmonary atelectasis in 4 cases(4.4%),cardiac arrhythmia in 5 cases(5.6%),hypoxemia in 3 cases(3.3%),and hypoxemia in 5 cases(5.6%),totaling 25 cases(27.8%).cases(4.4%),arrhythmias 5 cases(5.6%),hypoxemia 3 cases(3.3%),and pulmonary air leak 5 cases(5.6%),for a total of 25cases(27.8%).There was no statistical difference in postoperative complications between the two groups(P > 0.05).(4)Comparison of postoperative pain(VAS)scores: at 24 h [(3.45±1.74)points vs.(4.92±1.96)points,P=0.256],48 h [(2.90±1.20)points vs.(3.99±1.71)points,P=0.004],and 72 h [(2.20±0.82)points vs.(2.34±(1.01)score,P=0.106] pain VAS score comparisons were better in the lung segment group than in the lobe group,but there was a statistical difference(P<0.05)only in the comparison of scores at 48 h postoperatively.(5)Comparison of postoperative quality of life scores(QOL): there was no statistically significant difference between the two groups in preoperative QOL scores[(36.94±3.44)points vs.(35.36±3.74)points,P=0.271];the lung segment group had better QOL scores at 1 month postoperatively [(39.24±3.34)points vs.(37.41±4.25)points,P=0.001] and at 6 months postoperatively [(44.82±2.50)points vs.(43.01±3.76)points,P=0.003] were superior to the lobar group on QOL scores,which were statistically significant(P<0.05).Conclusions:With the use of CT screening for lung cancer,there is an increasing need to use less invasive interventions for patients with normal risk and high risk early stage disease.Thoracic surgeons need to pursue not only therapeutic goals but also the least invasive surgical procedures and retain the possibility of more extensive treatment of impending life-threatening disease.According to our study,patients who underwent lung segmental resection had the advantages of faster postoperative recovery,less postoperative pain and better quality of life compared to lobectomy,confirming that the implementation of thoracoscopic lung segmental resection for stage IA NSCLC is feasible. |
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