| Objective(s):With the popularization of high-resolution CT and the improvement of people’s health awareness,more and more early NSCLC has been found.At present,surgical resection is the main means for the treatment of early NSCLC.A large number of studies have confirmed that anatomical partial lobectomy has good benefits in the treatment of early NSCLC.Meanwhile,there are various surgical methods for anatomical partial pulmonary resection,and different surgical methods can be adopted based on ground glass nodules in different locations.In this study,the perioperative effects of single-port thoracoscopic modified wedge resection in patients with stage IA1 NSCLC were compared with those of single-port thoracoscopic wedge resection and segmental resection,respectively.The aim of this study is to determine the safety and feasibility of modified wedge resection in patients with stage IA1 NSCLC and provide reference for individualized surgical treatment of patients with stage IA1 NSCLC.Methods:Retrospective analysis was performed on 200 NSCLC patients who received single-port thoracoscopic cuneiform resection,anatomic cuneiform resection and anatomic segmental resection in our department from September 2020 to January 2022,and postoperative pathology indicated tumor stage IA1.According to different surgical methods,the patients were divided into modified pulmonary wedge-shaped resection group(n=45),pulmonary wedge-shaped resection group(n=87)and anatomic pulmonary segmentectomy group(n=68).The surgical status and prognosis of the modified wedge resection group were compared with that of the anatomic segment resection group and the wedge resection group.Age,gender,smoking history,common chronic underlying diseases(hypertension,diabetes,COPD),intraoperative and postoperative clinical indicators of patients in the three groups were recorded.Including operation time,intraoperative blood loss,postoperative hospital stay,postoperative drainage volume,postoperative complications(such as poor pulmonary reexpansion,pulmonary leakage,heart rate disorder,pulmonary infection,respiratory failure,bronchopleural fistula,pulmonary embolism),the number of intraoperative lymph nodes sampled in the modified wedge resection group and the anatomic segmental resection group were recorded,and chronic cough was followed up 3 months after surgery.Recurrence rate and mortality at 12 months after surgery.The data were statistically analyzed by SPSS 26.0 statistical software.Counting data were expressed as frequency and percentage,and chi-square test was used to compare counting data.Measurement data were expressed as mean±standard deviation,and independent sample test was used for comparison of measurement data.P<0.05 was considered statistically significant,and P<0.01 was considered significant.Results:There were no significant differences in age(P=0.095),sex(P=0.312),smoking history(P=0.726),and underlying disease(P=0.08)between the two groups(P>0.05).It is comparable.The surgical time(P=0.000),intraoperative blood loss(P=0.001),postoperative drainage volume(P=0.008)and postoperative hospital stay(P=0.001)in the modified wedge resection group wedge resection group were higher than those in the wedge resection group,and the differences were statistically significant(P<0.05).In terms of complications,the probability of pulmonary air leakage(P=0.027)and poor pulmonary reexpansion(P=0.032)after modified wedge resection group wedge resection was higher than that after wedge resection,and the difference was statistically significant.The incidence of pulmonary embolism after modified cuneiform resection(P=0.47)was lower than that in the cuneiform resection group,but the difference was not statistically significant.The rates of arrhythmia(P=0.186),pulmonary infection(P=0.114)and respiratory failure(P=0.163)after modified wedge-shaped resection were higher than those in the group,but the difference was not statistically significant.Age,sex,smoking history and underlying diseases were compared between modified wedge resection and anatomic segmental resection.There were no significant differences in age(P=0.151),gender(P=0.847),smoking history(P=0.255)and whether there were underlying diseases(P=0.739),indicating comparability.The operative time(P=0.002),intraoperative blood loss(P=0.027),postoperative drainage volume(P=0.018)and postoperative hospital stay(P=0.027)in the modified wedge resection group were all lower than those in the anatomic pulmonary segmentectomy group,and the differences were statistically significant.The mean number of lymph nodes sampled in the modified wedge resection group was less than that in the anatomic segmental resection group(P=0.57).In terms of complications,the incidence of postoperative pulmonary air leakage(P=0.153),poor pulmonary reexpansion(P=0.573),arrhythmia(P=0.264),pulmonary infection(P=0.303)and pulmonary embolism(P=0.414)in the modified wedge resection group were all lower than those in the anatomic pulmonary segmentectomy group.But the difference was not statistically significant.The incidence of postoperative respiratory failure in the modified wedge resection group was higher than that in the anatomic segmental resection group(P=0.767),and the difference was not statistically significant.Three months after the operation,there were patients with chronic cough in all three groups,but the difference was not statistically significant.During the 12 months after the operation,there were no death or recurrence cases in all three groups,and the cumulative survival rate and no recurrence rate were 100%.Conclusion(s):Thoracoscopic modified pulmonary wedge resection is safe and feasible for the treatment of deep stage IA1 NSCLC.At the same time,it has similar short-term prognosis with segmentectomy and pulmonary wedge resection.The advantage of modified pulmonary wedge resection is that it not only accelerates the process of surgery,but also reduces the occurrence of intraoperative and postoperative complications.At the same time,more healthy lung tissues are retained according to the principle of hemodynamics,which accelerates the recovery of patients and improves the quality of life of patients after operation. |
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