| Background:Lung cancer,which originates from bronchial mucosa epithelium,is the malignant tumor with the highest morbidity and mortality worldwide.The incidence of lung cancer is increasing year by year.The first choice for the treatment of early-stage lung cancer is lobectomy.With the development of minimally invasive technology,single-port video-assisted thoracoscopic surgery(VATS)has replaced traditional thoracotomy and become the first choice for lobectomy.However,some patients have more pleural drainage volume(PDV)and longer drainage duration after lobectomy,which results in a more extended hospital stay and increased hospitalization cost.The concept of enhanced recovery after surgery(ERAS)is gaining more and more attention.How to reduce the amount of PDV and shorten the drainage duration after lobectomy,especially single-port VATS,is an essential issue for quick recovery.The factors that affect the postoperative PDV and drainage duration are diverse,including systemic factors of the body(nutritional status,organ function,comorbid diseases,intraoperative anesthesia management,etc.),as well as localfactors of the thoracic cavity(chest adhesions,lymph nodes dissection,surgical resection,etc.).Percentage of predicted forced expiratory volume in the first second(FEV1%)and percentage of predicted diffusing capacity of the lung for carbon monoxide(DLCO%),as important items in pulmonary function,are the routine preoperative examination and the most important indicators of pulmonary ventilation and ventilation function.The effect of preoperative FEV1% and DLCO% on PDV and pleural drainage duration after single-port VATS is still lacking in in-depth study.Objectives:To study the effect of preoperative FEV1% and DLCO% on PDV and drainage duration after single-port VATS in lung cancer patients.Materials and methods:According to the inclusion and exclusion criteria,the clinicopathological characteristics of 386 patients who underwent lobectomy by single-port VATS from June 2017 to October 2019 were retrospectively analyzed.All patients underwent preoperative examinations,and they were divided into two groups based on the median of FEV1% and DLCO%,namely high FEV1% group vs.low FEV1%group and high DLCO% group vs.low DLCO1% group.After removing the chest tube,PDV and pleural drainage duration were recorded.AJCC Eighth Edition TNM staging criteria were adopted for lung cancer staging.The staging for small cell lung cancer(SCLC)referred to non-small cell lung cancer(NSCLC)staging criteria.An independent sample t-test was used to analyze the difference of PDV,pleural drainage,age,and body mass index(BMI)between different groups.Chi-square test was used to analyze the differences in gender,smoking history,pathological type,and pathological period.Spearman rank correlation was used to study the relationship between pulmonary function(FEV1% and DLCO%)and drainage outcome(PDV and pleural drainage duration after surgery).All statistics were performed using SPSS25.0 statistical software.P <0.05 was considered as having statistical differences.Results:Among all the patients,there were 140 males and 246 females.The average age was 57.90 ± 8.99 years(27 to 79 years).The BMI was24.11 ± 3.59 kg / ?.106 patients had a history of smoking(27.46%).Three hundred forty-five patients were diagnosed with adenocarcinoma(89.38%),while 35 patients with squamous cell carcinoma(9.07%),six patients with small cell carcinoma(1.55%).Three hundred twenty-three patients were diagnosed with stage I(83.68%),while 43 patients with stage II(11.14%),and 20 patients with stage III(5.18%).The mean PDV of all the patients was 962.12±583.63 ml,and the mean pleural drainage duration was 4.25±1.57 days.There was no difference in the patients' age,gender,smoking history,BMI,pathological type,and pathological stagebetween different groups.The PDV of the low FEV1% group had more PDV than the high FEV1% group(1055.52±45.39 ml vs.868.73±37.27 ml,P=0.001).The pleural drainage duration of the low FEV1% group was longer than the high FEV1% group(4.49 ± 1.67 days vs.4.01 ± 1.42 days,P=0.009).PDV and pleural drainage duration were negatively correlated with FEV1%(R=-0.1786,P=0.0004;R=-0.1672,P=0.0010).The PDV in low DLCO% group was more than high DLCO% group(1019.07 ±44.67 ml vs.905.18 ± 539.85 ml,P = 0.017).The pleural drainage duration of the low DLCO% group was longer than the high DLCO% group(4.40± 1.68 days vs.4.09 ± 1.44 days,P = 0.004).PDV was negatively correlated with DLCO%(R=-0.1007,P=0.0481).However,pleural drainage duration and DLCO% were not related(R=-0.0978,P = 0.0549).Conclusions:Lung cancer patients with good preoperative pulmonary function(high FEV1% and high DLCO%)had less PDV and shorter pleural drainage duration after single-port thoracoscopic lobectomy.The individualized assessment and improvement of pulmonary function before surgery may contribute to the rapid recovery after single-port thoracoscopic lobectomy. |
PDF Full Text Request