Harry Etienne, Pierre-Benoît Pagès, Jules Iquille, Pierre Emmanuel Falcoz, Laurent Brouchet, Jean-Philippe Berthet, Françoise Le Pimpec Barthes, Jacques Jougon, Marc Filaire, Jean-Marc Baste, Valentine Anne, Stéphane Renaud, Thomas D'Annoville, Jean Pierre Meunier, Christophe Jayle, Christian Dromer, Agathe Seguin-Givelet, Antoine Legras, Philippe Rinieri, Sophie Jaillard-Thery, Vincent Margot, Pascal-Alexandre Thomas, Marcel Dahan, Pierre Mordant
{"title":"手术方法对高风险非小细胞肺癌患者肺切除术后 90 天死亡率的影响。","authors":"Harry Etienne, Pierre-Benoît Pagès, Jules Iquille, Pierre Emmanuel Falcoz, Laurent Brouchet, Jean-Philippe Berthet, Françoise Le Pimpec Barthes, Jacques Jougon, Marc Filaire, Jean-Marc Baste, Valentine Anne, Stéphane Renaud, Thomas D'Annoville, Jean Pierre Meunier, Christophe Jayle, Christian Dromer, Agathe Seguin-Givelet, Antoine Legras, Philippe Rinieri, Sophie Jaillard-Thery, Vincent Margot, Pascal-Alexandre Thomas, Marcel Dahan, Pierre Mordant","doi":"10.1183/23120541.00653-2023","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients.</p><p><strong>Methods: </strong>We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV<sub>1</sub>) or diffusing capacity of the lung for carbon monoxide (<i>D</i><sub>LCO</sub>) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients.</p><p><strong>Results: </strong>Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV<sub>1</sub> and <i>D</i><sub>LCO</sub> above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV<sub>1</sub> and/or preoperative <i>D</i><sub>LCO</sub> below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) <i>versus</i> 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% <i>versus</i> 3.18% respectively).</p><p><strong>Conclusion: </strong>By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV<sub>1</sub> or <i>D</i><sub>LCO</sub> below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.</p>","PeriodicalId":11739,"journal":{"name":"ERJ Open Research","volume":"10 1","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10801767/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients.\",\"authors\":\"Harry Etienne, Pierre-Benoît Pagès, Jules Iquille, Pierre Emmanuel Falcoz, Laurent Brouchet, Jean-Philippe Berthet, Françoise Le Pimpec Barthes, Jacques Jougon, Marc Filaire, Jean-Marc Baste, Valentine Anne, Stéphane Renaud, Thomas D'Annoville, Jean Pierre Meunier, Christophe Jayle, Christian Dromer, Agathe Seguin-Givelet, Antoine Legras, Philippe Rinieri, Sophie Jaillard-Thery, Vincent Margot, Pascal-Alexandre Thomas, Marcel Dahan, Pierre Mordant\",\"doi\":\"10.1183/23120541.00653-2023\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients.</p><p><strong>Methods: </strong>We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV<sub>1</sub>) or diffusing capacity of the lung for carbon monoxide (<i>D</i><sub>LCO</sub>) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients.</p><p><strong>Results: </strong>Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV<sub>1</sub> and <i>D</i><sub>LCO</sub> above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV<sub>1</sub> and/or preoperative <i>D</i><sub>LCO</sub> below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) <i>versus</i> 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% <i>versus</i> 3.18% respectively).</p><p><strong>Conclusion: </strong>By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV<sub>1</sub> or <i>D</i><sub>LCO</sub> below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.</p>\",\"PeriodicalId\":11739,\"journal\":{\"name\":\"ERJ Open Research\",\"volume\":\"10 1\",\"pages\":\"\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-01-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10801767/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ERJ Open Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1183/23120541.00653-2023\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ERJ Open Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1183/23120541.00653-2023","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Impact of surgical approach on 90-day mortality after lung resection for nonsmall cell lung cancer in high-risk operable patients.
Introduction: Non-small cell lung cancer (NSCLC) is often associated with compromised lung function. Real-world data on the impact of surgical approach in NSCLC patients with compromised lung function are still lacking. The objective of this study is to assess the potential impact of minimally invasive surgery (MIS) on 90-day post-operative mortality after anatomic lung resection in high-risk operable NSCLC patients.
Methods: We conducted a retrospective multicentre study including all patients who underwent anatomic lung resection between January 2010 and October 2021 and registered in the Epithor database. High-risk patients were defined as those with a forced expiratory volume in 1 s (FEV1) or diffusing capacity of the lung for carbon monoxide (DLCO) value below 50%. Co-primary end-points were the impact of risk status on 90-day mortality and the impact of MIS on 90-day mortality in high-risk patients.
Results: Of the 46 909 patients who met the inclusion criteria, 42 214 patients (90%) with both preoperative FEV1 and DLCO above 50% were included in the low-risk group, and 4695 patients (10%) with preoperative FEV1 and/or preoperative DLCO below 50% were included in the high-risk group. The 90-day mortality rate was significantly higher in the high-risk group compared to the low-risk group (280 (5.96%) versus 1301 (3.18%); p<0.0001). In high-risk patients, MIS was associated with lower 90-day mortality compared to open surgery in univariate analysis (OR=0.04 (0.02-0.05), p<0.001) and in multivariable analysis after propensity score matching (OR=0.46 (0.30-0.69), p<0.001). High-risk patients operated through MIS had a similar 90-day mortality rate compared to low-risk patients in general (3.10% versus 3.18% respectively).
Conclusion: By examining the impact of surgical approaches on 90-day mortality using a nationwide database, we found that either preoperative FEV1 or DLCO below 50% is associated with higher 90-day mortality, which can be reduced by using minimally invasive surgical approaches. High-risk patients operated through MIS have a similar 90-day mortality rate as low-risk patients.
期刊介绍：
ERJ Open Research is a fully open access original research journal, published online by the European Respiratory Society. The journal aims to publish high-quality work in all fields of respiratory science and medicine, covering basic science, clinical translational science and clinical medicine. The journal was created to help fulfil the ERS objective to disseminate scientific and educational material to its members and to the medical community, but also to provide researchers with an affordable open access specialty journal in which to publish their work.
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