雙側肺癌病人同一次胸腔鏡手術的成果

The Outcome of Bilateral Lung Cancer Patients Who Underwent One-stage Thoracoscopic Surgery

本研究的目的為探討雙側肺癌患者接受同一次胸腔鏡手術的風險和總生存率。我們從電子病歷中回顧性地回顧了由一名外科醫師進行手術的肺癌病人。雙側肺癌病人被納入研究。2012年2月至2022年6月，共有362例肺癌病人接受了胸腔鏡手術。結果顯示其中27例（7.4%）雙側肺癌病人接受了同一次雙側胸腔鏡手術。這些雙側肺癌病人的年齡大於單側肺癌病人（69.9±1.9 vs 63.4±0.60歲，P = 0.019）。與單側肺癌病人相比，患有雙側肺癌的女性多於男性（18/27, 66.6% vs 169/335, 50.4%, P = 0.077）。在這27例雙側肺癌患者中，14例（51.8%）患者被確認為同時性原發性肺癌，其中每側有6例不同細胞類型的肺癌患者。13名（48.1%）患者被確定為肺間轉移，其中3名患者出現胸內淋巴結轉移。平均手術時間為228.5分鐘，從165分鐘到328分鐘不等。平均手術失血量為155.9 mL，從10到1850 mL。術後平均住院時間為5.66±0.81天，與單側肺癌病人相似（5.67±0.19天，P = 0.998）。沒有手術併發症或手術死亡。雙側同時原發性肺癌病人的總生存期與<1期單側肺癌病人的總生存期無顯著差異（P = 0.285）。肺癌轉移另側肺病人的總生存率高於>2期的單側肺癌（P < 0.001）。本研究的結論是同一次雙側胸腔鏡手術治療雙側肺癌手術風險少，總體生存率可接受。

This aim of this study was to assess the risks and overall survival rate of patients with bilateral lung cancer who underwent one-stage thoracoscopic surgery. Here, we conducted a retrospectively review of electronic medical records of lung cancer patients who underwent thoracoscopic curative surgery by a single surgeon from February 2012 to June 2022. Among the 362 patients who underwent surgery, 27 (7.4%) had bilateral lung cancer and underwent one-stage bilateral thoracoscopic surgery. The age of bilateral lung cancer patients was higher than that of the unilateral lung cancer patients (69.9±1.9 vs 63.4±0.60 years old, P = 0.019). Female patients were more likely to have bilateral lung cancer compared to male patients (18/27, 66.6% vs 169/335, 50.4%, P = 0.077). Of the 27 bilateral lung cancer patients, 14 (51.8%) patients had synchronous bilaterally primary lung cancers, including six patients with different cell types of lung cancer on each side. 13 (48.1%) patients had lung-to-lung metastasis, including three patients with intrathoracic lymph node metastasis. The average operating time was 228.5 minutes, ranging from 165 to 328 minutes. The average operative blood loss was 155.9 mL, ranging from 10 to 1850 mL. The average postoperative hospital stay was 5.66±0.81 days, which was similar to that of patients with unilateral lung cancer patients (5.67±0.19 days, P = 0.998). No surgical morbidity or operative death was observed. The overall survival of patients with synchronous bilaterally primary lung cancer was not significantly different from those with <1 stage unilateral lung cancer (P = 0.285). However, the overall survival of lung-to-lung metastasis patients was longer than those with unilateral lung cancer of > stage 2 (P < 0.001). Collectively, surgical risks of one-stage bilateral thoracoscopic surgery for bilateral lung cancers are rare and the overall survival rate is acceptable.