局部晚期中央型肺癌化疗联合免疫新辅助治疗后机器人辅助支气管袖状切除的安全性与可行性  

Experience of Thoracotomy and Robot-assisted Bronchial Sleeve Resection after Neoadjuvant Chemoimmunotherapy for Local Advanced Central Lung Cancer

作　　者：刘欣龙 孙滕 洪涛 袁延亮 张昊 Xinlong LIU;Teng SUN;Tao HONG;Yanliang YUAN;Hao ZHANG(Department of Thoracic Surgery,Affiliated Hospital of Xuzhou Medical University,Thoracic Surgery Laboratory,The First College of Clinical Medicine,Xuzhou Medical University,Xuzhou 221006,China)

机构地区：[1]徐州医科大学附属医院胸外科,徐州医科大学第一临床医学院胸外科实验室,徐州221006

出　　处：《中国肺癌杂志》2022年第2期71-77,共7页Chinese Journal of Lung Cancer

摘　　要：背景与目的免疫新辅助为局部晚期肺癌治疗打开新局面。本研究探讨局部晚期中央型非小细胞肺癌(non-small cell lung cancer, NSCLC)患者在化疗联合免疫新辅助治疗后机器人辅助支气管袖状切除的安全性与可行性。方法回顾性分析2020年8月-2021年2月接受化疗联合免疫新辅助治疗后支气管袖状切除的13例局部晚期中央型NSCLC患者的临床资料,患者依据手术方式不同分为开胸手术(thoracotomy bronchial sleeve resection, TBSR)组和机器人辅助手术(robot-assisted bronchial sleeve resection,BSR)组,比较两组患者肿瘤学特征、术中和术后的资料。结果两组患者手术顺利,术后病理证实均实现肿瘤R0切除,BSR组患者无中转开胸。TBSR组中患者影像学部分缓解(partial remission, PR)率为71.43%,主要病理缓解(major pathological remissions, MPR)率为42.86%,完全病理缓解(complete pathological response, p CR)率为28.57%,BSR组分别为66.67%、50.00%和33.33%。两组患者平均手术时长、淋巴结清扫数目、术中平均出血量、术后平均引流时间、术后住院时间无明显差异,但是BSR组支气管吻合时间相对较短。两组患者均预后良好,顺利出院,术后90 d死亡率为0。结论局部晚期中央型NSCLC患者经过化疗联合免疫新辅助治疗后可实现缩瘤降期、增加R0切除率,支气管袖状切除安全可行。在遵循手术安全性和实现肿瘤R0切除两个原则的前提下可优先选择机器人行袖状切除。Background and objective Immunoneoadjuvant therapy opens a new prospect for local advanced lung cancer.The aim of our study was to explore the safety and feasibility of robotic-assisted bronchial sleeve resection in patients with locally advanced non-small cell lung cancer(NSCLC) after neoadjuvant chemoimmunotherapy.Methods Data of 13 patients with locally advanced NSCLC that underwent bronchial sleeve resection after neoadjuvant chemoimmunotherapy during August 2020 and February 2021 were retrospectively included.According to the surgical methods,patients were divided into thoracotomy bronchial sleeve resection(TBSR) group and robot-assisted bronchial sleeve resection(RABSR) group.Oncology,intraoperative,and postoperative data in the two groups were compared.Results The two groups of patients operated smoothly,the postoperative pathology confirmed that all the tumor lesions achieved R0 resection,and RABSR group no patient was transferred to thoracotomy during surgery.Partial remission(PR) rate and major pathological remissions(MPR)rate of patients in the TBSR group were 71.43 % and 42.86%,respectively.Complete pathological response(pCR) was 28.57%.They were 66.67%,50.00% and 33.33% in RABSR group,respectively.There were no significant differences in operative duration,number of lymph nodes dissected,intraoperative blood loss,postoperative drainage time and postoperative hospital stay between the two groups,but the bronchial anastomosis time of RABSR group was relatively short.Both groups of patients had a good prognosis.Successfully discharged from the hospital and post-operative 90-d mortality rate was 0.Conclusion In patients with locally advanced central NSCLC after neoadjuvant chemoimmunotherapy can achieve the tumor reduction,tumor stage decline and increase the R0 resection rate,bronchial sleeve resection is safe and feasible.Under the premise of following the two principles of surgical safety and realizing the tumor R0 resection,robot-assisted bronchial sleeve resection can be preferred.

关 键 词：肺肿瘤 中央型肺癌 新辅助免疫治疗 达芬奇机器人 支气管袖状切除 

分 类 号：R734.2[医药卫生—肿瘤]