Comparative study of surgical and endoscopic treatment of resectable lung adenoid cystic carcinoma
Du Lin1, Li Jiangbo2, Wang Zixiao1, Wen Hui1, Lu Xike1, Zhang Xun1, Sun Daqiang1
1Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300222, China; 2Department of Respiratory and Critical Care, Tianjin Chest Hospital, Tianjin 300222, China
Abstract:Objective To investigate the clinical effect of surgical and endoscopic treatments on resectable lung adenoid cystic carcinoma. Methods This study was a retrospective study. Twenty-five patients with resectable lung adenoid cystic carcinoma, including 18 males and 7 females aged 42–87 (56.6±12.5) years who were admitted to Tianjin Chest Hospital between January 2010 and December 2017, were enrolled. The patients were divided into two groups according to treatment, namely, the endoscopy group (n=11) and surgery group (n=14). Operation time, intraoperative blood loss, postoperative hospital stay, and perioperative complications (respiratory disease, cardiovascular disease) were compared between the two groups. Tumor recurrence and metastasis were compared during the follow-up period. The overall survival and recurrence-free survival were compared between the two groups during regular follow-up. Results No significant differences in gender, age, body mass index, tumor size, tumor location, and tumor stage were found between the two groups (all P values >0.05). Surgery was successfully completed in all patients, and no R2 resection. The operative time ([187.4±37.6] min), and intraoperative bleeding ([107.2±31.3] mL) of the patients in the surgery group were higher than those of the endoscopy group ([105.8±19.6] min, and [45.89±14.66] mL, respectively) with statistically significant differences (t=7.00, 6.51; all P values <0.001). In the surgery group, 8 patients had respiratory complication, 3 patients had cardiovascular complication. In the endoscopy group, 4 patients had a respiratory complication, 2 patients cardiovascular complication. No significant difference in the incidence of complications was found between the two groups (all P values >0.05). The patients were followed up for 6–84 months with a median follow-up of 62.3 months. Two patients from the surgery group and five patients from the endoscopy group died during the follow-up period. In the endoscopy group, five cases of postoperative recurrence, including one case of gastrointestinal metastasis and four cases of local progression, were recorded. In the surgery group, one case had an ipsilateral lung metastasis without local recurrence. No significant differences in recurrence and metastasis rates were observed between the two groups (P=0.056). The overall survival ([61.9, 95% credibility interval 48.0-75.9] months) and recurrence-free survival ([50.7, 95% credibility interval 31.6-69.8] months) in the endoscopy group were shorter than those in the surgery group ([83.1, 95% credibility interval 75.8-90.4] and [86.7, 95% credibility interval 78.6-94.8] months, respectively). The recurrence-free survival has statistically significant differences (χ2=5.46, P=0.020). Conclusion Surgical treatment of resectable lung adenoid cystic carcinoma has better overall 5-year progression-free cumulative survival and recurrence-free cumulative survival and lower recurrence rate than endoscopic treatment. Therefore, it is worthy of clinical recommendation as a treatment plan for resectable lung adenoid cystic cancer.
杜林, 李江波, 王梓骁, 文辉, 卢喜科, 张逊, 孙大强. 外科手术与内镜介入治疗可切除肺腺样囊性癌的疗效比较[J]. 中华解剖与临床杂志, 2022, 27(6): 396-400.
Du Lin, Li Jiangbo, Wang Zixiao, Wen Hui, Lu Xike, Zhang Xun, Sun Daqiang. Comparative study of surgical and endoscopic treatment of resectable lung adenoid cystic carcinoma. Chinese Journal of Anatomy and Clinics, 2022, 27(6): 396-400.
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