Clinical Application And Analysis Of Anatomic Pulmonary Segmentectomy Combined With 3D-CTBA And 3D-VATS For The Treatment Of Non-small Cell Lung Cancer

Part 1.The survival analysis of anatomic pulmonary segmentectomy compared with lobectomy for the treatment of stage I non-small cell lungcancer.Objective:To analyze postoperative survival data of the papers which published in the past 10 years for the treatment of stage I non-small cell lung cancer(NSCLC)by use of pulmonary segmentectomy and lobectomy,and use meta-analysis to analyze whether the oncological efficacy of segmentectomy is equal to standard lobectomy for the treatment of NSCLC.Methods:Retrieved the papers about anatomic segmentectomy and lobectomy for the treatment of stage I non-small cell lung cancer included survival data on Web of Science,ScienceDirect,Medline,PubMed,Embase from January 2006 to December 2016.According to inclusion criteria,meta-analysis was performed using Rev Man5.3 software provided by the Cochrane Collaboration.The total postoperative recurrence rate and the local recurrence rate were calculated by using odds ratio(OR)as the combined statistic.The postoperative overall survivals were calculated by using hazard ratio(HR)as the combined statistic.The each statistic was estimated by 95%confidence interval(CI),P<0.05 was significant difference,as statistical significance.The results of the analysis are plotted as forest plots and tested using Egger's test for publication bias,P<0.1 for publication bias.Heterogeneity tests were performed on the included papers,setting P>0.1as homogeneous for multiple studies,and heterogeneity was measured in I~2.Results:There was no significant difference in postoperative local recurrence between anatomical segmentectomy and lobectomy in stage I NSCLC(OR=1.12,95%CI:0.79-1.59,P=0.53).There was no significant difference(OR=0.80,95%CI:0.61-1.03,P=0.09)between the anatomical segmentectomy and lobectomy for distant recurrence in stage I NSCLC.Anatomic segmentectomy and lobectomy for recurrence-free survival in stage I NSCLC were significantly different(HR=1.25,95%CI:1.06-1.48,P=0.009).There was a significant difference in postoperative overall survival between anatomic segmentectomy and lobectomy for stage I NSCLC(HR=1.17,95%CI:1.05-1.30,P=0.004).There was no significant difference in the overall survival after surgery between anatomical segmentectomy and lobectomy(HR=1.13,95%CI:0.99-1.29,P=0.06)for tumor diameter?2 cm.Conclusions:There is no significant difference in the postoperative local and distant recurrence rate between anatomical segmentectomy and lobectomy for stage I NSCLC.However,the long-term survival rate of the former is inferior to the latter,while if the tumor diameter is less than or equal to 2 cm,long-term survival was no significant difference.Based on the possible heterogeneity of this study,publication bias and the inherent limitations of mate analysis,the results need to be treated with caution.Part 2.The application of combined 3D-CTBA and 3D-VATS anatomic pulmonary segmentectomy for the treatment of NSCLCObjective: To investigate the clinical effects of segmentectomy for NSCLC by use of 3D-CTBA in the preoperative period and 3D-VATS in the intraoperative period.Methods: To analyze and summarize the clinical data of 73 cases of NSCLC treated by preoperative 3D-CTBA and intraoperative 3D-VATS from October 2015 to October 2017 in Department of Thoracic Surgery,The First Affiliated Hospital of Soochow University.Results: The whole group did not transfer to thoracotomy,which were successfully completed under thoracoscopy.The average operation time was(140.9±27.1)min.The average amount of bleeding during operation was(95.1 ± 43.9)ml.The average number of lymph nodes dissection was(9.0±2.8),postoperative chest drainage average was(418.1±173.2)ml.Postoperative chest tube placement time(2.8±1.3)d.The average hospital length of stay(5.1±1.1)d.Postoperative complications included pulmonary infection in 4 cases(5.2%),atelectasis in 1 case(1.7%),small amount of hemoptysis in 1 case(1.7%),and pulmonary air leakage in 2 cases(>3d,3.5%).Arrhythmia in 4 cases(7.0%).After an average follow-up of 8 months,no complications such as bronchopleural fistula,encapsulated pleural effusion and chylothorax were observed.No recurrence or distant metastasis was observed in patients with malignant nodules.Conclusions: The combined application of 3D-CTBA and 3D-VATS for the treatment of NSCLC can be carried out in a good risk assessment,rational design of surgical options before operation,and operation can be more precise in the intraoperative period,it is worth in the clinical application and promotion.Part 3.The clinical comparison and research of 3D-CTBA combined with 3D-VATS versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of NSCLCObjective: To compare 3D-CTBA combined with 3D-VATS versus conventional 2D-VATS anatomic pulmonary segmentectomy for the treatment of NSCLC.Methods: We retrospectively reviewed the data of randomly selected patients who underwent 3D-CTBA combined with 3D-VATS(3D-CTBA-VATS)or 2D-VATS at the Department of Thoracic Surgery,The First Affiliated Hospital of Soochow University Hospital,from January 2014 to May 2017.Results: The operative duration of 3D group was significantly shorter than the 2D group(P<0.05).There was no significant difference in the number of dissected lymph nodes between the two groups(P>0.05).The extent of intraoperative bleeding and postoperative drainage in the 3D group was significantly lower than in the 2D group(P<0.05).Chest tube duration in the 3D group was shorter than in the 2D group(P<0.05).Incidences of pulmonary infection,atelectasis,and arrhythmia were not statistically different between the two groups(P>0.05).However,hemoptysis and pulmonary air leakage(>3d)occurred significantly less frequently in the 3D than in the 2D group(P<0.05).After an average follow-up of 12 months,no complications such as bronchopleural fistula,encapsulated pleural effusion and chylothorax were observed.No recurrence or distant metastasis was observed in patients with malignant nodules.Conclusion: 3D-CTBA-VATS is a more accurate and smooth technique and leads to reduced intraoperative and postoperative complications.