| Introduction: With the increasing use of high-resolution low-dose helical CT for lung cancer screening,making the detection of pulmonary nodules more common,and the presence of multiple nodules in most of these patients,combined with the continuous advancement in diagnosis and treatment,the proportion of diagnosing multiple primary lung cancer(MPLC)is gradually increasing.However,there are still many controversies about the pathogenesis,diagnosis,differential diagnosis and clinical management options,efficacy and prognosis of MPLC,and current guidelines are more general.For patients with clinical suspicion of multiple primary lung cancers,surgery remains the primary treatment modality for lung cancer.Previous experience has considered simultaneous resection of multiple lesions for multiple primary lung cancers,especially bilateral simultaneous thoracoscopy this type of surgery is more invasive,and the possibility of serious postoperative complications becomes greater.Objective: To investigate the safety and short-term efficacy analysis of thoracoscopic bilateral simultaneous pulmonary resection for simultaneous multiple primary lung cancer,and to provide theoretical support for the clinical treatment strategy of patients with multiple primary lung cancer.Methods: The clinical data of patients who underwent unilateral or bilateral pulmonary resection at the Department of thoracic surgery,the Second Affiliated Hospital of Nanchang University,from January 2017 to December 2021 were retrospectively reviewed.Based on the diagnostic criteria for multiple primary lung cancer updated in 2013 by the American College of chest physicians.Inclusion criteria: underwent surgical treatment;Cardiac and pulmonary function tests were not contraindicated for surgery;No previous history of pleurisy and chest injury,no history of serious heart and lung disease.Postoperative pathology confirmed multiple nodules at least two as primary lung cancers.Exclusion criteria: thoracotomy;Patient clinical data incomplete.The safety and short-term efficacy of each group were evaluated by comparing perioperative indicators.Perioperative indicators:(1)general indicators: patient age,gender,smoking history,preoperative pulmonary function(FEV1.0),tumor number,tumor location,maximum tumor diameter,pathological type,clinical stage,etc.(2)intraoperative and postoperative indicators:(1)mode of operation,operative time,operative blood loss,duration of chest drainage,and postoperative hospital stay,(2)Postoperative complications such as pulmonary infection,atelectasis,wound infection,pleural effusion,persistent postoperative air leak,cardiac complications(arrhythmia,cardiac insufficiency,acute myocardial infarction,etc.)They were reviewed by chest CT,abdominal color ultrasound,and pulmonary function tests on the third day and 1 month after operation.Result: A total of 201 patients who underwent thoracoscopic surgery had postoperative pathologically confirmed lung cancer,of whom 76 patients were diagnosed with multiple primary lung cancers.Of these,51 were treated by unilateral thoracoscopic lung resection(unilateral group)and 25 were treated by simultaneous bilateral thoracoscopic lung resection(bilateral group).The operative time of the bilateral group was significantly longer than that of the unilateral group(264.80 ± 60.91 vs 212 ± 58.97 min,P < 0.001),and the intraoperative blood loss of the bilateral group was not significantly greater than that of the unilateral group(113.63 ± 137.35 vs 133.20 ± 66.30 ml,P = 0.51).There were no significant differences between the two groups regarding the duration of chest drainage(H),postoperative hospital stay(d)and the probability of developing postoperative complications(P = 0.33,P = 0.40).Different surgical approaches to the selection defined three groups: lobectomy group,sublobar(including wedge resection and segmentectomy)resection group,and lobectomy + sublobar resection group,of which 9 underwent lobectomy,17 underwent sublobar resection,and 24 underwent lobectomy + sublobar resection in the unilateral group;In the bilateral group with 13 sublobar resections and 12 sublobar resections,there were no statistically significant differences among the three groups in postoperative chest tube drainage time and postoperative complications(P = 0.72),but in terms of postoperative hospital stay,the sublobar + sublobar group had the longest,the lobargroup the second,and the sublobar group the shortest(8.44 ± 1.51 vs 7.53 ± 3.13 vs 9.50 ± 2.61).The bilateral group was further divided into two groups,the sublobar group and the sublobar + lobar group,and patients with sublobar disease underwent sublobar resections bilaterally,including bilateral wedge resection(W-W),bilateral wedge + segmentectomy(W-S).Patients in the sublobar + lobectomy group underwent sublobar resection on one side plus lobectomy on the other side,including wedge resection lobectomy(w-l)and segmentectomy lobectomy(S-L).Operation time,intraoperative blood loss,chest drainage time,and postoperative hospital stay were longer in patients in the sublobar + lobes group than in the sublobar group(P = 0.07,P = 0.79,P = 0.16,and P = 0.08).The pathologic type of multiple lesions was adenocarcinoma predominant,with 182(93.3%)adenocarcinomas,69(35.4%)adenocarcinomas with acinar like predominant invasive adenocarcinoma,36(18.5%)invasive adenocarcinoma with adherent growth predominant(33,16.9%),microinvasive adenocarcinoma(23,11.8%),solid predominant invasive adenocarcinoma(8,4.1%),and micropapillary invasive adenocarcinoma(2,1.0%)Papillary predominant invasive adenocarcinoma(2,1.0%),mucinous adenocarcinoma(2,1.0%).Lesion location results showed 103(52.8%)in the right lung and 92(47.2%)in the left lung.The highest number of upper lobe lung tumor lesions was 113(57.9%);Lower lobe lung(66,33.9%);Middle lobe lung(16,8.2%).Of these,58 were the most numerous in the left upper lung(29.8%),followed sequentially by the right upper lobe(55,28.2%),the left lower lobe(34,17.4%),the right lower lobe(32,16.4%),and the right middle lobe(16,8.2%).Conclusions 1.For patients considering multiple primary lung cancer in clinical practice,it is safe and feasible to simultaneously remove all lesions while ensuring surgical safety.Even for bilateral multiple primary lung cancer,ensuring at least one subpulmonary lobectomy is also safe and feasible.2.In the same period of surgery,tissue samples can be obtained in a timely manner for later pathological and genetic testing,which will have a positive effect on the prognosis assessment and treatment plan development of patients. |
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