Background: The advantages of video-assisted thoracic surgery (VATS) are well-recognized in several studies. However, in the cases of advanced lung cancer after neoadjuvant chemotherapy (nCT), the role of VATS is still questionable, with concerns about safety, technical feasibility, and oncological completeness. The aim of this study was to assess the impact of nCT on patients who had undergone uniportal VATS (U-VATS) anatomic lung resections for lung cancer, by comparing the short-term outcomes of patients after nCT with case-matched counterparts (treated by surgery alone). Methods: We performed a retrospective, comparative study enrolling 927 patients (nCT: 60; non-nCT:867) who underwent U-VATS anatomic lung resections from 2014 to 2020 in two centers. Data were collected in a shared database with standardized variables’ definition. Propensity score matching using 15 baseline preoperative patients’ characteristics was performed in order to minimize selection-confounding factors between the two groups, which then were directly compared in terms of perioperative outcomes. Results: After propensity score matching, two groups of 60 patients had been defined. The nCT-group had a higher conversion rate compared to the control group (13.3% vs. 0%,p= 0.003) without an increase in operation time or cardiopulmonary complications. In addition, no differences between the two groups were recorded in terms of prolonged air leaks, length of stay, and readmission. Conclusions: U-VATS after nCT is a feasible approach, showing a similar rate of cardiopulmonary complications and length of stay when compared with the control group. However, it remains a challenging surgery due to its great technical complexity as well as the clinical status of the patients.
背景：多项研究已证实电视辅助胸腔镜手术（VATS）的优势。然而，对于新辅助化疗（nCT）后的晚期肺癌病例，VATS的作用仍存争议，主要涉及安全性、技术可行性和肿瘤学完整性等问题。本研究旨在通过比较接受nCT治疗的患者与仅接受手术治疗的患者（对照组）的短期结果，评估nCT对接受单孔VATS（U-VATS）解剖性肺切除术的肺癌患者的影响。方法：我们进行了一项回顾性比较研究，纳入了2014年至2020年间在两个中心接受U-VATS解剖性肺切除术的927例患者（nCT组：60例；非nCT组：867例）。数据收集于一个共享数据库中，变量定义标准化。为减少两组间的选择偏倚，采用15项基线术前患者特征进行倾向评分匹配，随后直接比较两组围手术期结果。结果：经过倾向评分匹配后，两组各纳入60例患者。与对照组相比，nCT组中转开胸率更高（13.3% vs. 0%，p=0.003），但手术时间或心肺并发症并未增加。此外，两组在持续性漏气、住院时间和再入院率方面无显著差异。结论：nCT后行U-VATS是一种可行的方法，与对照组相比，其心肺并发症发生率和住院时间相似。然而，由于技术复杂性和患者临床状况，该手术仍具挑战性。
肿瘤(癌症)患者之家