视频辅助胸外科(VATS)肺叶切除术与开放胸腔镜和肺叶切除术围手术期结果的比较:基于倾向评分加权的分析结果。

Walter J Scott, Ronald S Matteotti, Brian L Egleston, Salewa Oseni, James F Flaherty
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引用次数: 42

摘要

背景:比较VATS肺叶切除术和开放式肺叶切除术的随机试验规模较小。为了比较两种技术的临床结果,我们分析了一个病例-对照系列,使用倾向评分加权法来调整重要的协变量。方法:我们比较了采用VATS或开放(THOR)方法行肺叶切除术治疗临床I期肺癌(NSCLC)的患者。治疗加权估计的逆概率,其权重来自倾向得分,用于调整围手术期发病率和死亡率的决定因素,包括年龄、性别、术前FEV1、ASA分级和Charlson合并症指数(CCI)。Bootstrap方法提供了标准误差。终点是术后停留时间(LOS)、胸管时间、并发症和淋巴结回收。结果:我们分析了136例连续肺叶切除术患者。THOR的手术死亡率为1/62 (1.6%),VATS的手术死亡率为1/74 (1.4%),P = 1.00。5/74(6.7%)的VATS转为开放式手术。调整后的中位生存期为7天(THOR) vs 4天(VATS), P < 0.0001, HR = 0.33。调整后中位胸管持续时间(天)为5天(THOR) vs 3天(VATS), P < 0.0001, HR = 0.42。并发症发生率分别为39% (THOR)和34% (VATS), P = 0.61。每位患者经校正的平均淋巴结清扫数为18.1个(THOR) vs 14.8个(VATS), p = 0.17。结论:在使用倾向加权法平衡了影响病例对照系列中发病率、死亡率和LOS的协变量后,结果证实VATS肺叶切除术与临床I期NSCLC患者较短的LOS、相似的死亡率和并发症发生率以及相似的淋巴结切除率具有统计学意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A comparison of perioperative outcomes of video-assisted thoracic surgical (VATS) lobectomy with open thoracotomy and lobectomy: results of an analysis using propensity score based weighting.

Background: Randomized trials comparing VATS lobectomy to open lobectomy are of small size. We analyzed a case-control series using propensity score-weighting to adjust for important covariates in order to compare the clinical outcomes of the two techniques.

Methods: We compared patients undergoing lobectomy for clinical stage I lung cancer (NSCLC) by either VATS or open (THOR) methods. Inverse probability of treatment weighted estimators, with weights derived from propensity scores, were used to adjust cohorts for determinants of perioperative morbidity and mortality including age, gender, preop FEV1, ASA class, and Charlson Comorbidity Index (CCI). Bootstrap methods provided standard errors. Endpoints were postoperative stay (LOS), chest tube duration, complications, and lymph node retrieval.

Results: We analyzed 136 consecutive lobectomy patients. Operative mortality was 1/62 (1.6%) for THOR and 1/74 (1.4%) for VATS, P = 1.00. 5/74 (6.7%) VATS were converted to open procedures. Adjusted median LOS was 7 days (THOR) versus 4 days (VATS), P < 0.0001, HR = 0.33. Adjusted median chest tube duration (days) was 5 (THOR) versus 3 (VATS), P < 0.0001, HR = 0.42. Complication rates were 39% (THOR) versus 34% (VATS), P = 0.61. Adjusted mean number of lymph nodes dissected per patient was 18.1 (THOR) versus 14.8 (VATS), p = 0.17.

Conclusions: After balancing covariates that affect morbidity, mortality and LOS in this case-control series using propensity-weighting, the results confirm that VATS lobectomy is associated with a statistically significant shorter LOS, similar mortality and complication rates and similar rates of lymph node removal in patients with clinical stage I NSCLC.

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