Clinical Analysis Of Sleeve Lobectomy For Central Non-small Cell Lung Cancer:Traditional Thoracotomy With Video-assisted Thoracoscopic Surgery

Objective: The application value of sleeve lobectomy under thoracoscope in resectable central non-small cell lung cancer(NSCLC)still lacks sufficient evidence-based medical evidence.This study compared the clinical data of sleeve lobectomy under total thoracoscopy and traditional thoracotomy,and explored the safety and feasibility of sleeve lobectomy under total thoracoscopy.Materials and methods: A retrospective analysis was made of 82 patients with central non-small cell lung cancer treated by sleeve lobectomy from March 2008 to March 2018 in our Hospital,including 40 patients in the thoracoscopic group(25 cases with three-hole thoracoscopy and 15 cases with single-hole thoracoscopy)and 42 patients in the thoracotomy group.Results: There was no statistical difference in general data between the two groups.The maximum diameter of tumors(cm)group was smaller than the thoracotomy group(2.96±1.47 vs 4.45±1.77,p=0.031).Most of the tumors were located in the right upper lobe(60.00% vs 42.86%,p = 0.634)in the endoscopic group and the thoracotomy group.There was no significant difference in the operation time between the endoscopic group and the thoracotomy group(p = 0.088),but the bronchial anastomosis time(min)in the endoscopic group was shorter(37.03±11.03 vs 32.55±7.29,p = 0.036).The average intraoperative bleeding volume(ml)in the laparoscopic group was less than that in the thoracotomy group(175.79±121.05 vs 297.57 ±271.01,p=0.020),and the total hospital stay(d)in the laparoscopic group was shorter than that in the thoracotomy group(9.51±4.96 vs 14.21±8.36,p=0.012).There was no significant difference in the total number of lymph node dissection stations,VAS score,total drainage volume and drainage tube placement time between the two groups.One case died of respiratory failure in the thoracotomy group(2.38%)and one case died of hoarseness in the laparoscopy group(2.50%).There was no significant difference in the overall incidence of complications between the thoracotomy group and the laparoscopy group.Meaning(p = 0.231).The median survival time was 46 months in the thoracoscopic group and 51 months in the thoracotomy group.The overall 5-year survival rate in the thoracoscopic group was 47.3% vs 49.0%,p = 0.550.There was no significant difference in the 5-year overall survival rate between the two groups.Conclusion: Video-assisted bronchoscopic sleeve lobectomy for resectable central non-small cell lung cancer is safe and feasible;while achieving long-term survival similar to thoracotomy,it does not increase perioperative risk,shorten hospitalization time and reduce intraoperative bleeding.