Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (11): 44-53.doi: 10.6040/j.issn.1671-7554.0.2022.0960

• Special Issue in Minimally Invasive Surgery and Enhanced Recovery After Surgery in Lung Cancer and Esophageal Cancer • Previous Articles     Next Articles

Comprehensive application of anatomical partial lobectomy and enhanced recovery after surgery

Yue PENG1,2,Lei LIU1,3,Yuan LI1,Fenglong BIE1,Bolun ZHOU1,Runze LI1,Ying JI2,Guangyu BAI1,Fengwei TAN1,Yushun GAO1,Juwei MU1,Qi XUE1,Bin QIU1,*(),Shugeng GAO1,*()   

  1. 1. Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    2. Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
    3. Chengde Central Hospital, The Second Clinical College of Chengde Medical University, Chengde 067000, Hebei, China
  • Received:2022-08-11 Online:2022-11-01 Published:2022-11-04
  • Contact: Bin QIU,Shugeng GAO E-mail:drqiubin@aliyun.com;gaoshugeng@cicams.ac.cn

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Abstract:

Objective: To summarize the application of anatomical partial lobectomy (APL) and enhanced recovery after surgery (ERAS) in order to provide clinical reference and theoretical support for the comprehensive management of minimally invasive surgical treatment of lung cancer. Methods: The clinicopathological and perioperative data of 6, 449 patients who underwent APL during Nov. 1, 2013 and Oct. 31, 2021 were retrospectively collected, including gender, age, smoking history, surgical method, pathology, postoperative hospital stay and other indicators. The period from 2014 to 2018 was regarded as the experience accumulation stage, and the period from 2019 to 2021 the technology maturity stage. The number of surgery, percentage of benign nodules, average postoperative hospital stay, and percentage of postoperative hospital stay over 7 days were compared between the two stages. Results: Of the 6, 449 patients, 2, 094 were males and 4, 355 were females. Among them, 88 bilateral lung surgeries were performed in stages, and 8 bilateral surgeries were performed simultaneously, and altogether 6, 493 APL surgeries were performed. Compared with the experience accumulation stage, in the technology maturity stage, the annual average monthly number of operations increased, the percentage of benign nodules decreased, the average postoperative hospital stay shortened, and the percentage of postoperative hospital stay longer than 7 days decreased (P < 0.05). With the application of ERAS from 2014 to 2021, the average annual postoperative hospital stay for APL gradually decreased from 6.98 days to 3.96 days. The percentage of patients with postoperative hospital stay exceeding 7 days decreased from 23.80% to 2.87%. The results of multivariate Logistic regression analysis showed that gender, age, surgical procedure, and surgical stage were independent risk factors for postoperative hospital stay more than 7 days after APL. Conclusion: ERAS can optimize the perioperative management of APL and accelerate postoperative recovery of patients. APL can be performed on the premise of oncology principles, preserve more healthy lung tissue, minimize the scope of surgical resection and surgical trauma, so that the concept of ERAS can be better applied and promoted in radical surgery for lung cancer.

Key words: Enhanced recovery after surgery, Anatomical partial lobectomy, Thoracoscopy, Lung cancer, Pulmonary nodules

CLC Number: 

  • R734.2

Fig.1

The nodule was in the anterior segment of the right upper lobe (RS3) A: Transverse view (lung window); B: Transverse view (mediastinal window); C: Sagittal view (lung window); D: Coronal view (lung window)."

Fig.2

Three-dimensional (3D) reconstruction of the right upper lung before surgery to plan the surgical area A: 3D reconstruction of bronchus and blood vessels; B: Isometric 3D printed model; C: Safe margin sphere of the anterior segment nodule (yellow); D: Planning of the intended resection range (RS3 extended resection)."

Fig.3

RS3 extended resection of the right upper lung by APL A: Lymph nodes in No.10 zone were dissected and sent for frozen pathology; B: Veins (V3a and V3b+c) were ligated; C: The artery A3 was dissected; D: Dissection of the vein V1b and exposure of bronchus B3; E: The cutting plane was exposed by the expansion-collapse method; F: The cutting plane was marked by electrotome (Electrosurgery Unit, ESU); G: The cutting plane was split by electrotome; H: The lung tissue was severed with a cutting stapler; I: Remove the target lung tissue."

Fig.4

Anteroposteric chest X-ray films on day 1 (POD1) and day 3 (POD3) after APL"

Table 1

The clinicopathological characteristics of 6, 493 patients undergoing APL"

项目 例数(%)
性别
  男 2 094(32.25)
  女 4 399(67.75)
年龄(岁)
  ≤60 4 322(66.56)
  ＞60 2 171(33.44)
吸烟史
  有 1 170(18.02)
  无 5 323(81.98)
病理类型
  良性 458(7.05)
  转移瘤 110(1.69)
  浸润前病变 1 016(15.65)
  腺癌 4 800(73.93)
  鳞状细胞癌 62(0.95)
  小细胞肺癌 10(0.15)
  其他 37(0.57)
手术方式
  APL±楔形等 6 279(96.70)
  肺叶+APL 214(3.30)
手术阶段
  2014~2018年 1 854(28.55)
  2019~2021年 4 639(71.45)

Fig.5

Trend of annual number of APL (A) and percentage of benign pulmonary nodules (B)"

Fig.6

Postoperative hospital stay after APL A: Trend of the annual average postoperative hospital stay; B: Trend of postoperative hospital stay exceeding 7 days."

Table 2

Univariate analysis of postoperative hospital stay over 7 days after APL"

项目 术后住院日[ n(%)] χ2 P
≤7 d ＞7 d
性别
  男 1 972(94.17) 122(5.83) 18.418 ＜0.001
  女 4 244(96.48) 155(3.52)
年龄(岁)
  ≤60 4 171(96.51) 151(3.49) 18.881 ＜0.001
  ＞60 2 045(94.20) 126(5.80)
吸烟史
  有 1 101(94.10) 69(5.90) 9.299 0.002
  无 5 115(96.09) 208(3.91)
手术术式
  APL±楔形等 6 018(95.84) 261(4.16) 5.585 0.018
  肺叶+APL 198(92.52) 16(7.48)
手术阶段
  2014~2018年 1 686(90.94) 168(9.06) 146.107 ＜0.001
  2019~2021年 4 530(97.65) 109(2.35)

Table 3

Multivariate Logistic regression analysis of postoperative hospital stay over 7 days after APL"

项目 B 标准误 Wald P OR 95%CI
性别 0.540 0.155 12.083 0.001 1.715 1.265~2.325
年龄 0.455 0.127 12.815 0.000 1.576 1.228~2.021
吸烟史 -0.123 0.181 0.462 0.497 0.884 0.621~1.260
手术术式 0.626 0.275 5.175 0.023 1.871 1.091~3.209
手术阶段 -1.419 0.127 124.716 0.000 0.242 0.189~0.310
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