肺开放、机器人和胸腔镜肺叶切除术（PORTaL）研究：微创肺叶切除手术中的转化和风险因素

SCI 24 November 2022

Pulmonary Open, Robotic and Thoracoscopic Lobectomy (PORTaL) Study: Outcomes and risk factors of conversion during minimally invasive lobectomy

(The Journal of Thoracic and Cardiovascular Surgery, IF: 6.439)

Luis J. Herrera, MD, Lana Y. Schumacher, MD, Matthew G. Hartwig, MD, Charles T. Bakhos, MD, Rishindra M. Reddy, MD, MBA, Eric Vallières, MD, Michael S. Kent, MD

CORRESPONDENCE TO: Luis J Herrera MD, Orlando Health Cancer Institute, 1400 South Orange Avenue, MP-760, 50 Orlando Florida 32806

Objective 目的

Conversion to thoracotomy continues to be a concern during minimally invasive lobectomy. The aim of this propensity matched study is to analyze the outcomes and risk factors of intraoperative conversion during thoracoscopic (VATS) and robotic lobectomy (RL).

在微创肺叶切除术中，转为开胸手术仍然是一个值得关注的问题。这项倾向匹配研究的目的是分析胸腔镜（VATS）和机器人肺叶切除术（RL）期间术中转换的结果和风险因素。

Methods 方法

Data from consecutive lobectomy cases performed for clinical stage IA-IIIA lung cancer was retrospectively collected from the PORTaL consortium of 21 institutions from 2011-2019. The propensity-score method of inverse-probability of treatment weighting (IPTW) was used to balance the baseline characteristics across surgical approaches. Univariate logistic regression models were applied to test risk factors for conversion. Multivariable logistic regression analysis was conducted using a stepwise model selection method.

回顾性收集2011-2019年间21家机构的PORTaL联合会对临床分期为IA-IIIA肺癌的连续肺叶切除术病例的数据。采用治疗加权逆概率（IPTW）倾向评分法平衡不同手术途径的基线特征。单变量logistic回归模型用于测试转换的风险因素。采用逐步模型选择法进行多变量logistic回归分析。

Results 结果

7,216 patients undergoing lobectomy were identified: RL (n=2968), VATS (n=2831) and open lobectomy (n=1417). RL had lower conversion rate compared to VATS (3.6% vs 12.9%; p<0.0001). In the multivariable regression model, tumor size and neo-adjuvant therapy were the most significant risk factors for conversion, followed by prior cardiac surgery, CHF, COPD, VATS approach, male gender, BMI, and FEV-1 (Figure-1). Conversions for anatomical reasons were more common in VATS than RL (66.6% vs 45.6%, p=0.0002); however, conversions for vascular reasons were more common in RL than VATS (24.8% vs 14%, p=0.01). The rate of emergent conversions was comparable between RL and VATS (0.5% vs 0.7%, p=0.25) with no intraoperative mortalities.

7216例接受肺叶切除术的患者：RL（n=2968）、VATS（n=2831）和开放式肺叶切除（n=1417）。与VATS相比，RL的转化率较低（3.6%vs 12.9%；p<0.0001）。在多变量回归模型中，肿瘤大小和新辅助治疗是转换的最重要风险因素，其次是既往心脏手术、CHF、COPD、VATS方法、男性性别、BMI和FEV-1（图1）。由于解剖原因的转换在VATS中比RL更常见（66.6%对45.6%，p=0.0002）；然而，由于血管原因的转换在RL中比VATS更常见（24.8%对14%，p=0.01）。RL和VATS的急诊转换率相当（0.5%vs 0.7%，p=0.25），无术中死亡。

Conclusions 结论

Converted minimally invasive lobectomies were not associated with worse perioperative mortality compared to open lobectomy. Compared to VATS lobectomy, RL is associated with a lower probability of conversion in this propensity matched study.

与开放式肺叶切除术相比，转为微创肺叶切除手术与较低的围手术期死亡率无关。与VATS肺叶切除术相比，在这项倾向匹配研究中，RL与较低的转换概率相关。