SCI

3 April 2023

Neoadjuvant therapy does not increase postoperative morbidity of sleeve lobectomy in locally advanced non-small cell lung cancer 

(The Journal of Thoracic and Cardiovascular Surgery;IF:6.439)

correspondence to：

Xiao Song, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China. Email: songxiao198327@163.com

Liang Duan, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200443, China. Email: duan-liang@163.com

Li X, Li Q, Yang F, Gao E, Lin L, Li Y, Song X, Duan L, Neoadjuvant therapy does not increase postoperative morbidity of sleeve lobectomy in locally advanced non-small cell lung cancer, The Journal of Thoracic and Cardiovascular Surgery (2023), doi: https://doi.org/10.1016/ j.jtcvs.2023.03.016.

Objectives 目的 

To evaluate the feasibility and safety of sleeve lobectomy after neoadjuvant therapy by assessing the postoperative morbidity.

评估新辅助治疗后袖状肺叶切除术的可行性和安全性。

Methods 方法

Patients who underwent sleeve lobectomy for non-small cell lung cancer (NSCLC) were retrospectively analyzed from 23 January 2018 to December 2021. A total of 613 patients were enrolled, including 124 patients who received prior neoadjuvant therapy and 489 patients who did not. Propensity score matching (PSM) was adopted to create a balanced cohort consisting of 97 paired cases. Patient demographics and perioperative outcomes were compared between the two groups, and logistic regression analysis was used to identify risk factors for postoperative complications.

回顾性分析2018年1月23日至2021年12月行袖状肺叶切除术的非小细胞肺癌(NSCLC)患者。共纳入613例患者，包括124例既往接受新辅助治疗的患者和489例未接受新辅助治疗的患者。采用倾向评分匹配法(PSM)建立了一个由97个配对病例组成的平衡队列。比较两组患者的人口统计学特征和围手术期结局，并采用logistic回归分析确定术后并发症的危险因素。

Results 结果 

In the entire cohort, univariable logistic regression analysis showed that smoking history (OR=1.501, 95%CI:1.011-2.229, P=0.044), open thoracotomy (OR=1.748, 95%CI: 1.178-2.593, P=0.006), and operation time more than 150 minutes (OR=1.548, 95%CI:1.029- 2.328, P=0.036) were risk factors for postoperative complications, and multivariable logistic regression analysis showed open thoracotomy was an independent risk factor (OR=1.765, 95%CI:1.178-2.643, P=0.006). In the balanced cohort, the neoadjuvant group had a lower proportion of double-sleeve resections (3.1% vs 11.3%, P=0.035) and longer postoperative chest tube drainage (6.67±3.81 vs 5.13±3.74 days, P＜0.001). However, no significant differences were observed in postoperative morbidity between the two groups (25.8% vs 24.7%, P=0.869). The complete pathologic response (CPR) of chemoimmunotherapy was significantly superior to chemotherapy alone (28.2% vs 4.1%, P＜0.001), and no significant differences were noted in postoperative morbidity in different neoadjuvant therapy modalities.

在整个队列中，单变量logistic回归分析显示吸烟史(OR=1.501, 95%Cl:1.011 ~ 2.229, P=0.044)、开胸手术史(OR=1.748, 95%Cl: 1.178-2.593, P=0.006)、手术时间超过150分钟(OR=1.548, 95%Cl:1.029 ~ 2.328, P=0.036)是术后并发症的危险因素，多变量logistic回归分析显示开胸手术是独立的危险因素(OR-1.765, 95%Cl:1.178 ~ 2.643, P=0.006)。在平衡组中，新辅助治疗组双袖切除术的比例较低(3.1% vs 11.3%， P=0.035)，术后胸管引流时间较长(6.67±3.81 vs 5.13±3.74天，P < 0.001)。两组患者术后发病率差异无统计学意义(25.8% vs 24.7%， P=0.869)。化疗免疫治疗的完全病理缓解(CPR)明显优于单纯化疗(28.2% vs 4.1%， P < 0.001)，不同新辅助治疗方式的术后发病率无显著差异。

Conclusions 结论 

After neoadjuvant therapy, sleeve lobectomy can be safely performed with no increased postoperative morbidity.

新辅助治疗后，袖状肺叶切除术可安全实施，术后发病率无增加。

来源 | 健康界

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