Comparison Of Perioperative Clinical Efficacy And Symptom Recovery Of Thoracoscopic Segmentectomy And Lobectomy For Small Pulmonary Nodules

Objective:To explore and compare the safety and clinical outcomes and symptoms of thoracoscopic segmentectomy and lobectomy.The objective medical clinical data and the subjective symptom report of the patients were collected to evaluate whether thoracoscopic segmentectomy was better than thoracoscopic lobectomy for patients with small pulmonary nodules.Materials and methods:We collected and analyzed the clinical data of 60 consecutive patients with pulmonary nodules who admitted to our department during October 2017 and February2018.20 patients undergoing thoracoscopic segmentectomy were included in the thoracoscopic segmentectomy group and 40 patients undergoing thoracoscopic lobectomy were included in the thoracoscopic lobectomy group.The clinical data in the perioperative period were collected in terms of the operative time,the amount of intraoperative blood loss,the chest tube duration and the length of hospital stay.The lung cancer subtabulation score of MD Anderson Symptom Inventory was recorded every day from the day before the operation to the day discharge,including pain,fatigue,nausea,sleep,distress,short of breath,remember,appetite,drowsy,drymonth,sad,vomiting,numbness,coughing,constipation,sorethroat,a total of 16 items of normal symptoms of patients diagnosed as lung cancer.The score of Patients-Reported Outcomes(PRO)were compared for the two groups.SPSS 21.0 software was used for statistical analysis of the clinical data and the objective index of operation.Normal distribution of measurement data were analyzed by student t test,Non-normal distribution of measurement data were analyzed by Wilcoxon rank sum test and count data were analyzed by chi-square test,difference was statistically significant(P <0.05).With MDASI-LC scale,patients suffered from thoracic surgery were examined before and after operation.Linear mixed-effects modeling(LMM)was applied to fit the change of symptoms which were longitudinal datas within 5 days after operation.All patients scored the baseline of the 16 common symptoms of lung cancer on 1 day before the operation and assessed the changes of symptoms every day after surgery.Result:1.There was no perioperative death case in the two groups,and the comparison of perioperative complications has no statistically significance2.The operative time of thoracoscopic segmentectomy group and the thoracoscopic lobectectomy group are 115.63±27.02 min,96.50±14.57min(P =0.003),the amount of intraoperative blood loss are 111.00±151.69 ml,44.00±16.98ml(P<0.001),the chest tube duration are 4.45±1.24 days,3.35±0.99 days(P=0.002)and the length of hospital stay are 5.80±1.47 days,4.45±1.19 days(P=0.002).The thoracoscopic segmentectomy group is better than thoracoscopic lobectomy group in the comparison of perioperative clinical efficacy data.3.Except for forgetfulness and vomiting,the score of the other symptoms were increased on 1 day after the operation compared with the 1 day before the operation in the two groups,but no significant changes were found on the 1 day before the operation and 1-5 days after the operation of the forgetfulness and vomiting.4.In the thoracoscopic segmentectomy group,there were no significant changes in the score of grief and distress in the patients after surgery compared with the 1 day before the operation.The score of grief and distress in the patients of the thoracoscopic lobectomy group were significantly increased on 1 day after the operation and returned to the baseline level on the 2 day after the operation.5.In the two groups,all the symptom scores of pain,fatigue,cough,nausea,drowsiness,numbness showed an increasing trend on 1 day after operation.The symptom scores of pain and fatigue were significantly increased on 1 day after the operation,and decreased from 1 to 5 days after the operation,but the two groups did not return to the baseline level.There was not significantly decreased from 1 to 5 days after the operation in the terms of cough.The symptom scores of numbness and drowsiness returned to the baseline level at the same time on 2 and 3 days respectively for the two groups.6.The symptom scores of shortness of breath,appetite,dry mouth,sleep uneasiness,constipation,and sore throat were significantly increased on the 1 day after the operation for the two groups.The time length of the above 6 symptom scores returned to the baseline level in the thoracoscopic segmentectomy group were shorter than that in the thoracoscopic lobectomy group.Conclusion1.In this study,the thoracoscopic segmentectomy group was obvious better than thoracoscopic lobectomy the group in terms of the operative time,the amount of intraoperative blood loss,the chest tube duration and the length of hospital stay,which reveals that thoracoscopic segmentectomy is safe and feasible.2.In this study,the lung cancer subtabulation score of MD Anderson Symptom Inventory was used to record the patient’s perioperative symptoms,which shows that patients diagnosed as pulmonary nodule suffered from extreme psychological and physiological problems after thoracic surgery.Furthermore,the recovery rate of the recorded symptoms of patients with thoracoscopic segmentectomy is better than that of the patients with thoracoscopic lobectomy,which reveals that thoracoscopic segmentectomy is more benefit for patients’ postoperative recovery.