Thoracoscopic Surgery For Lung Cancer Research Articles

Novel systemic inflammation response index to predict prognosis after thoracoscopic lung cancer surgery: a propensity score-matching study.

Our propensity score-matching (PSM) study evaluated the prognostic significance of systemic inflammation response index (SIRI) for patients undergoing video-assisted thoracoscopic surgery lobectomy for non-small-cell lung cancer (NSCLC). This study was conducted on prospectively maintained database in our institution between December 2013 and March 2015. Pre-operative SIRI was calculated by peripheral monocyte × neutrophil/lymphocyte counts. Survival analysis was performed to distinguish differences in post-operative survival between patients stratified by an optimum cut-off of SIRI. Multivariable Cox proportional hazards regression models were established to determine independent prognostic factors. There were 390 patients with resected NSCLC included. A SIRI of 0.99 was identified as the optimum cut-off regarding to post-operative survival. Both overall survival (OS) and disease-free survival (DFS) in patients with SIRI >0.99 were significantly shortened than those in patient with SIRI ≤0.99. Patients with SIRI >0.99 had significantly lower rates of OS and DFS compared to those patients with SIRI ≤0.99. These differences still remained significant after subgroup analyses and PSM analyses. Multivariable analyses on the entire cohort and the PSM cohort commonly demonstrated that high pre-operative SIRI could be an independent prognostic factor for unfavourable OS and DFS of NSCLC. SIRI serves as a novel risk stratification tool to refine prognostic prediction for surgically resected NSCLC. SIRI may help surgeons to screen high-surgical-risk patients and formulate individualized treatment schemes.

Nonintubated thoracoscopic surgery for early-stage non-small cell lung cancer.

Recent advances in the management of early-stage non-small cell lung cancer have focused on less invasive anesthetic and surgical techniques. Video-assisted thoracoscopic surgery without tracheal intubation is an evolving technique to provide a safe alternative with less short-term complication and faster postoperative recovery. The purpose of this review was to explore the latest developments and future prospects of nonintubated thoracoscopic surgery for early lung cancer. We examined various techniques and surgical procedures as well as the outcomes and benefits. The results indicated a new era of video-assisted thoracoscopic surgery in which there is reduced procedure-related injury and enhanced postoperative recovery for lung cancer. Nonintubated thoracoscopic surgery is a safe and feasible minimally invasive alternative surgery for early non-small cell lung cancer. Faster recovery and less short-term complication are potential benefits of this approach.

OA13.02 Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell Lung Cancer: Survival Outcome of a Randomized Trial

Video-assisted thoracoscopic surgery (VATS) has been widely used in the treatment of early-stage non–small cell lung cancer (NSCLC). However, there has not been a robust randomized control trial (RCT) to confirm the non-inferiority of VATS to open lobectomy in term of oncologic efficacy. Therefore, a large multicenter RCT in China was designed and initiated to verify the role of VATS. A phase 3 RCT was undertaken at five thoracic surgery tertiary centers in China. Patients aged 18-75 years old who were diagnosed of clinically early-stage NSCLCs were randomized in a 1:1 ratio into VATS and thoracotomy groups. Radical lobectomy plus hilar and mediastinal lymph node dissection was the standard surgical intervention. The primary end-point of study was 5-year overall survival (OS). The secondary end-points including 5-year disease-free survival (DFS) and cancer relapse rates would also be reported here. Analysis was by intention to treat. This study is registered with the ClinicalTrials.gov, number NCT01102517. A total of 508 patients were recruited between January 2008 and March 2014. The final follow-up for 5-year survival analysis was completed in March 2019. And 432 patients were eligible for analysis (222 cases in VATS group and 210 cases in thoracotomy group). The cancer relapse (recurrence and metastasis) rates were 39.2% in VATS group and 36.7% in thoracotomy group respectively (P=0.621). Patients who received VATS lobectomies had a similar 5-year DFS to those who underwent open surgery (58% versus 62%, P=0.686). Finally, the 5-year OS rates were of no significant difference between VATS and thoracotomy groups (74% versus 71%, P=0.497). The non-inferiority of VATS to thoracotomy lobectomy was confirmed in our RCT in terms of oncologic efficacy for clinically early-stage NSCLCs.

Successful Sleeve Resection as a Marker for Proficiency for Robotic Pulmonary Resection.

Robot technology is a revolutionary technique to overcome limitations of minimal invasive surgery. The proficiency level varies from study to study. We considered the first sleeve lobectomy as a benchmark procedure to evaluate the proficiency level. We retrospectively analyzed 197 patients who underwent robot-assisted thoracoscopic surgery (RATS) for primary lung cancer between December 2011 and May 2018. Patients were divided into two groups based on undergoing surgery earlier period (EP) or later period (LP) than the first sleeve lobectomy by RATS (May 25, 2015). The preoperative, operative, and short- and long-term postoperative outcomes were compared. Seven-year survival was also compared between two periods for T1N0 and T2N0 diseases. Preoperative features were similar. The mean operative time was 166.8 ± 55.1 and 142.4 ± 43.9 minutes in EP and LP, respectively (p = 0.005). The mean number of dissected lymph nodes in LP was also significantly higher than that in EP (24.4 ± 9.4 vs. 20.8 ± 10.4, p = 0.035). The complication rate was significantly lower in LP (29/86 vs. 25/111, p = 0.048). The extended resection (ER) rate was significantly higher in LP (p = 0.023). The 7-year survival was comparable in EP and LP in both patients with T1N0 and T2N0 (p = 0.28 and p = 0.11, respectively). Perioperative outcomes, such as duration of surgery, number of dissected lymph nodes, complications, and ERs are favorable in patients who underwent surgeries after the first sleeve resection. The first sleeve lobectomy may be considered as the benchmark procedure for the proficiency level in RATS.

Effect of rapid rehabilitation surgery nursing on postoperative pulmonary function recovery and quality of life in patients undergoing thoracoscopic radical lung cancer surgery

目的 探讨快速康复外科对胸腔镜肺癌根治术患者术后肺功能恢复及生活质量的影响。 方法 选择嘉兴市第二医院2017年1－12月拟行电视胸腔镜下肺癌根治术患者168例，按照患者入院时间的不同分为对照组79例、观察组89例，对照组采取常规围术期护理对策，观察组采取快速康复外科护理理念，比较两组患者手术及住院情况、术前以及术后7 d肺功能指标[第1秒用力呼气容积(FEV1)、最大自主通气量(MVV)以及最大呼气流量(PEF)]变化情况、术后30 d生活质量(SF-36)评分情况以及患者并发症发生情况。 结果 观察组患者术后下床时间、术后拔管时间以及术后住院时间均显著短于对照组[(38.96±5.74)h比(20.14±2.27)h，(4.18±0.94)d比(2.86±0.79)d，(7.46±2.35)d比(5.82±1.85)d，t=28.528、9.887、5.053，均P<0.05]；术后7 d两组患者肺功能指标均较术前显著降低[(1.61±0.50)L比(2.59±0.71)L，(64.83±19.27)L/min比(115.94±27.58)L/min，比(4.97±1.26)L/s比(8.04±1.72)L/s；(1.85±0.46)L比(2.65±0.63)L，(71.56±20.49)L/min比(118.92±25.37))L/min，(5.74±1.10)L/s比(8.10±1.58)L/s，t=10.031、13.502、12.798、9.675、13.701、11.565，均P<0.05)，且观察组患者术后肺功能指标降低程度显著低于对照组(t=3.240、2.185、4.229，均P<0.05)；术后30 d，观察组患者生活质量各维度评分均显著高于对照组[(81.46±9.93)分比(70.31±7.94)分，(80.47±7.36)分比(72.31±5.98)分，(77.64±8.02)分比(68.95±6.72)分，(78.37±6.12)分比(69.48±5.89)分，t=7.971、7.824、7.559、9.565，均P<0.05)。观察组患者术后并发症发生率显著低于对照组(3.37%比12.66%)(χ2=5.056，P<0.05)。 结论 快速康复外科护理可有效促进胸腔镜肺癌根治术患者术后恢复，减轻手术对患者肺功能的影响，提高患者术后生活质量，同时降低术后并发症发生率，值得临床推广运用。

Comparison of the perioperative efficacy between single-port and two-port video-assisted thoracoscopic surgery anatomical lung resection for non-small cell lung cancer: a systematic review and meta-analysis.

With the development of novel surgical techniques and instruments over the recent years, more and more surgeons consider single-port video-assisted thoracoscopic surgery (VATS) as a feasible option. However, whether single-port thoracoscopic surgery has more potential advantages than two-port thoracoscopic surgery for non-small cell lung cancer remains unknown. We conducted this systematic review and meta-analysis to compare the perioperative efficacy between single-port and two-port VATS anatomical lung resection for non-small cell lung cancer (NSCLC). Eleven studies were identified from the databases of The Cochrane Library, PubMed, Embase, Web of science, and China Biology Medicine disc (CBMdisc). Prospective studies and retrospective studies that evaluated the perioperative efficacy of single-port VATS compared with two-port VATS were analyzed. We used 95% confidence intervals (CIs) to calculate the odds ratio (OR), and the weight mean difference (WMD). A total of 11 studies (3 prospective studies and 8 retrospective studies), including 1,592 patients, were included. We found that the duration of the operation in single-port VATS anatomical lung resection for NSCLC was shorter (P=0.02). Also, the bleeding volume amount was lower (P=0.01), the length of postoperative drainage was shorter (P<0.00001), the amount of postoperative hospital stay was lower (P<0.0001), and the visual analogue score 24 and 72 h after operation time was lower (P<0.0001, P<0.00001). However, the number of lymph nodes retrieved (P=0.92) and the rates of complications (P=0.15) had no statistical differences between the two groups. These studies show that single-port VATS anatomical lung resection has certain advantages in the treatment of NSCLC compared with two-port VATS. It may be an alternative option for surgeons.

Thoracoscopic surgery for lung cancer is associated with improved survival and shortened admission length: a nationwide propensity-matched study.

Population-based studies comparing long-term survival after minimally invasive and open surgery for lung cancer are lacking. The aim of this study was to compare long-term survival rates between minimally invasive [video-assisted thoracoscopic surgery (VATS)] and open surgery for lung cancer in an unselected nationwide setting. Patients undergoing minimally invasive (n = 710) or open (n = 2814) lung resection for lung cancer between 2004 and 2014 were identified from nationwide complete registries in Finland. Propensity score matching resulted in groups of 632 patients who had VATS and 632 who had a thoracotomy. The primary outcome was the 1-year survival rate. Secondary outcomes were 30-day, 90-day and 5-year survival rates and the length of surgical admission. Cox models were adjusted for sex, age, comorbidity, centre size, year of surgery, histological diagnosis, stage and adjuvant therapy. In the propensity-matched cohort, the 1-year survival rate was 90.8% [confidence interval (CI) 88.3-92.8%] after VATS and 87.1% (CI 84.3-89.6%) after open surgery. The 5-year survival rate in the propensity-matched cohort was 59.6% (CI 54.9-63.9%) after VATS and 53.3% (CI 48.6-57.7%) after open surgery. The 30-day mortality rates showed no differences between approaches, but the 90-day mortality rate was better after VATS when adjusted for patient-, tumour- and operation-specific features (hazard ratio 0.56, 95% CI 0.30-0.92; P = 0.024). According to this population-based nationwide study from Finland, minimally invasive surgery for lung cancer is associated with improved long- and short-term survival rates, supporting the use of VATS as a primary surgical method for treating lung cancer. Due to the complexity of confounding factors in this study, one should, however, interpret the results critically. Additional studies are needed.

Penehyclidine hydrochloride on postoperatively cognitive function

There are many drugs that affect postoperative cognitive function in patients under general anesthesia. Pentanethaquine hydrochloride (PHC), as a new type of anti-cholinergic drug, has been widely used. In clinical practice, many patients, especially elderly patients, have suffered from obvious postoperative cognitive dysfunction, but the incidence of pulmonary infection, reduced probably due to the decease of secretion production. Therefore, the effect of PHC on postoperative cognitive functions and inflammatory factors in elderly lung cancer patients under general anesthesia were mainly discussed to determine the clinical advantages and disadvantages. Ninety elderly patients undergoing thoracoscopic surgery for lung cancer under general anesthesia were selected and divided into PHC group (group A, n = 30), atropine group (group B, n = 30) and normal saline control group (group C, n = 30). The incidence of postoperative blurred vision was higher in group A compared to group B and C (both p < 0.05). The incidence of other adverse reactions was higher in group A compared to group C (all p < 0.05), but there was no difference between group A and group B (all p > 0.05). There was no significant difference in preoperative and day 1 post-surgery mini-mental state examination (MMSE) scores among the three groups (both p > 0.05), but the day 1 post-surgery MMSE scores of three groups were lower (all p < 0.05). PHC increased the incidence of postoperative cognitive impairment and postoperative delirium in elderly lung cancer patients undergoing thoracoscopic surgery under general anesthesia, but reduced the incidence of postoperative pulmonary complications possibly by reducing the expression of pro-inflammatory cytokines.

Comparison of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for non-small cell lung cancer.

Clinical efficacy of single utility port video-assisted thoracoscopic surgery (VATS) and three-port VATS for patients with non-small cell lung cancer (NSCLC) was compared. A total of 156 patients with NSCLC who underwent VATS in Taizhou Hospital of Zhejiang Province from July 2015 to January 2017 were selected as subjects. They were randomly divided into group A (n=74) and group B (n=82), in which group A was treated with single utility port VATS and group B was treated with three-port VATS. Perioperative indicators such as operation time, intraoperative blood loss, postoperative drainage, removal of drainage tube, lymph node dissection, hospitalization time, postoperative complications, postoperative pain and postoperative quality of life were observed. Expression levels of CRP and IL-6 in serum were detected by enzyme-linked immunosorbent assay (ELISA). There was no significant difference in the operation time, postoperative drainage volume, drainage tube removal time and lymph node dissection between groups A and B (P>0.05). Blood loss and hospitalization time in group A were significantly lower than those in group B (P<0.001). VAS scores at 1–3 days after operation in group A were significantly lower than those in group B (P<0.001). Levels of serum CRP and IL-6 at 1–7 days after operation in group A were significantly lower than those in group B (P<0.001). Incidence of complication in group A was not significantly different from that in group B (P>0.05). Overall quality of life scores of group A and B were significantly lower than the preoperative scores (P<0.001). Overall status score of group A was significantly higher than that of group B (P<0.001). Clinical efficacies of single utility port VATS and three-port VATS were similar. Single utility port VATS can reduce trauma during surgery, reduce stress response, relieve postoperative pain, and facilitate the recovery of postoperative quality of life.

Quality assessment using EQ-5D-5L after lung surgery for non-small cell lung cancer (NSCLC) patients.

Aim of this study was to elucidate an alteration of quality of life (QOL) score before and after video-assisted thoracoscopic surgery (VATS) for non-small cell lung cancer (NSCLC) patients using the 5-level EuroQol-5D questionnaire (EQ-5D-5L). We also investigated how the preoperative QOL scores affected the postoperative clinical outcome prospectively. Between July 2018 and December 2018, 24 consecutive NSCLC patients who underwent VATS were recruited. The EQ-5D-5L for Japanese was used with face-to-face interviews to estimate the utility values of QOL. QOL scores were significantly declined after surgery (0.81 ± 0.19 vs. 0.74 ± 0.11: P = 0.049). The levels of EQ-5D-5L questionnaire were not significantly different before and after surgery except Q4 (pain control). The levels of Q4 were significantly worsened after surgery (1.33 ± 0.56 vs. 1.88 ± 0.61, P < 0.001). Operation time and bleeding in the preoperative low-QOL score group (N = 13) was longer (215.4 ± 52.3min. vs. 173.5 ± 42.3min., respectively: P = 0.045) and more (116.2 ± 152.7ml vs. 22.7 ± 20.1ml, respectively: P = 0.049) than those in the high-QOL score group (N = 11). QOL survey for lung cancer patients using EQ-5D-5L is simple and useful to identify the issue facing at the medical team. Preoperative low QOL score could be a predicting factor for the longer operation time and more bleeding.

Uniportal video-assisted thoracoscopic lobectomy surgery for lung cancer—case report

Uniportal video-assisted thoracoscopic surgery (VATS) was introduced by Dr. Gonzalez-Rivas in 2011. We report here our first case performed in Universality Hospital in Saudi Arabia using uniportal VATS lobectomy with complete mediastinal lymph nodes dissection.

A case of bradycardia and asystole during thoracoscopic surgery for left lung cancer

A case of bradycardia and asystole during thoracoscopic surgery for left lung cancer

Current status of robot-assisted thoracoscopic surgery for lung cancer.

The robotic surgical system was designed to overcome the drawbacks of conventional endoscopic surgery. Since national health insurance in Japan began covering robotic-assisted thoracoscopic surgery (RATS) for malignant lung and mediastinal tumors in 2018, the number of RATS procedures being performed domestically has increased rapidly. This review evaluates the advantages and disadvantages of RATS for patients with lung cancers, based on an electronic literature search of PubMed. The main advantages of RATS are its ability to achieve excellent lymph-node removal with low morbidity and mortality, and minimal postoperative pain. Conversely, its disadvantages include a long operation time and the need for specialized instruments. However, the learning curve for RATS is reported to be shorter than that for VATS: some studies recommend that a surgeon needs to perform 18-22 robotic operations to attain sufficient skill. RATS for lung cancer is more expensive than VATS and the cost of training is high. Although the main disadvantage of RATS is that it reduces operator's tactile senses, the endoscope, which is directly manipulated by the surgeon at the console, using various magnifications, and 3D HD images on the monitor, may compensate for this. Ultimately, RATS offers better maneuverability, accuracy, and stability over VATS.

Non-intubated thoracoscopic surgery for lung cancer in patients with impaired pulmonary function.

Patients with impaired lung function or chronic obstructive pulmonary disease (COPD) are considered high-risk for intubated general anesthesia, which may preclude them from surgical treatment of their lung cancers. We evaluated the feasibility of non-intubated video-assisted thoracoscopic surgery (VATS) for the surgical management of lung cancer in patients with impaired pulmonary function. From August 2009 to June 2015, 28 patients with impaired lung function (preoperative forced expiratory volume in 1 second <70% of the predicted value) underwent non-intubated VATS using a combination of thoracic epidural anesthesia or intercostal nerve block, and intra-thoracic vagal block with target-controlled sedation. Eighteen patients had primary lung cancers, 4 had metastatic lung cancers, and 6 had non-malignant lung tumors. In the patients with primary lung cancer, lobectomy was performed in 4, segmentectomy in 3 and wedge resection in 11, with lymph node sampling adequate for staging. One patient required conversion to intubated one-lung ventilation because of persistent wheezing and labored breathing. Five patients developed air leaks more than 5 days postoperatively while subcutaneous emphysema occurred in 6 patients. Two patients developed acute exacerbations of pre-existing COPD, and new-onset atrial fibrillation after surgery occurred in 1 patient. The median duration of postoperative chest tube drainage was 3 days while the median hospital stay was 6 days. Non-intubated VATS resection for pulmonary tumors is technically feasible. It may be applied as an alternative to intubated general anesthesia in managing lung cancer in selected patients with impaired pulmonary function.

Benefits of lung modeling by high-quality three-dimensional computed tomography for thoracoscopic surgery

Although video-assisted thoracoscopic surgery (VATS) has become widely used as a less invasive therapeutic procedure for lung cancer, precise anatomical knowledge of each case remains crucial and greatly contributes to the safety of thoracoscopic surgery. Thus, the development of three-dimensional (3D) imaging technology is anticipated to provide surgeons with essential visualized information of anatomical structures. In this review, we evaluate the pragmatic features of 3D imaging technology for thoracoscopic lung cancer surgery, focusing on complicated surgeries and preoperative evaluation of pulmonary functions or tumor features. We also discuss 3D imaging software and the applications of the 3D image analysis system. Finally, we present our perspectives on the 3D imaging technology for thoracoscopic surgery.

Outcomes of Video-Assisted Thoracoscopic Surgery for Lung Cancer Performed by a Team of General Surgeons - A Retrospective Study

Outcomes of Video-Assisted Thoracoscopic Surgery for Lung Cancer Performed by a Team of General Surgeons - A Retrospective Study

Effect of preoperative smoking cessation on postoperative pain outcomes in elderly patients with high nicotine dependence.

Objective:To investigate the effect of smoking cessation before surgery on postoperative pain and analgesic consumption after thoracoscopic radical resection of lung cancer in elderly patients with high nicotine dependence.Methods:A total of 107 male patients, ages 60 to 70 years, undergoing elective thoracoscopic radical lung cancer surgery from July 2017 to July 2018 were enrolled into 3 groups: group A (highly nicotine-dependent and discontinued smoking <3 weeks before surgery, n = 36), group B (highly nicotine-dependent and discontinued smoking >3 weeks before surgery, n = 38), and group C (nonsmokers, n = 33). Postoperative sufentanil consumption, visual analog scale (VAS) pain scores at rest and during cough, rescue analgesia, opioid-related adverse events, and patient satisfaction were assessed from 0 to 48 h postoperatively.Results:Patient characteristics were comparable among the 3 groups. Sufentanil consumption and VAS pain scores from postoperative 0 to 48 h were significantly higher in groups A and B than in group C. In addition, group B had lower sufentanil consumption and pain scores than group A. No differences in the need for rescue analgesia, patient satisfaction, or occurrence of postoperative adverse events, including nausea, vomiting, respiratory depression, and oversedation, were observed among the 3 groups.Conclusion:Compared with nonsmokers, highly nicotine-dependent male patients who were deprived of cigarettes experienced more severe pain and required treatment with more sufentanil after thoracoscopic radical lung cancer surgery. Moreover, preoperative smoking cessation at least 3 weeks before surgery led to better postoperative pain outcomes than smoking cessation within 3 weeks of surgery.

Intraoperative conversion during video-assisted thoracoscopy does not constitute a treatment failure†.

Intraoperative conversion may be required during video-assisted thoracoscopic surgery (VATS) for lung cancer. We evaluated the morbidity and mortality rates associated with VATS for anatomical pulmonary resection with conversion to thoracotomy and compared this technique with full VATS and an open thoracotomic approach. We performed a retrospective, single-centre study between January 2011 and January 2017 and included 610 consecutive patients having undergone either VATS (with or without intraoperative conversion) or open thoracotomy for anatomical pulmonary resection. Pneumonectomies and angioplastic/bronchoplastic/chest wall resections were excluded. After propensity score adjustment, we assessed the 90-day mortality and determined whether the surgical approach was a risk factor for mortality. Of the 610 patients, 253 patients underwent full VATS, 56 patients underwent VATS + conversion and 301 patients underwent up-front open thoracotomy. Relative to the open thoracotomy group, the VATS + conversion group had a higher incidence of cardiac or respiratory comorbidities and was more likely to have an early-stage tumour. Following adjustment, the 90-day postoperative mortality rate was 5.4% (n = 3/56) in the VATS + conversion group and 3.7% (n = 11/301) in the open thoracotomy group (P = 0.58). Likewise, the morbidity rate was similar in these 2 groups. In a multivariable analysis, the surgical approach was not a risk factor for postoperative mortality. Following anatomical resection for lung cancer, VATS with conversion and open thoracotomy were associated with similar early postoperative morbidity and mortality rates. When in doubt, VATS should be preferred to thoracotomy; it potentially provides the patient with benefits of a fully VATS-based resection but is not disadvantageous when intraoperative conversion is required.

OA06.02 Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell Lung Cancer: Oncologic Outcome of a Randomized Trial

OA06.02 Video-Assisted Thoracoscopic Surgery vs. Thoracotomy for Non-Small Cell Lung Cancer: Oncologic Outcome of a Randomized Trial

Analysis of Prolonged Hospitalizations (Longer than 7 days): 115 Lung Cancer Patients after Video Assistant Thoracic Surgery (VATS)

背景与目的胸腔镜手术已是我科肺癌肺切除手术的主要方式，其特点是创伤小、恢复快，术后7天以内出院患者近90%，但术后并发症仍时有发生；我们对胸腔镜肺癌肺切除术后住院时间 > 7天的患者进行分析，旨在总结并发症的种类及危险因素，提高患者的术后安全性。方法数据来源为北京肿瘤医院胸外一科前瞻性肺癌数据库，选取2010年1月-2014年12月行胸腔镜肺癌肺切除手术，且住院时间 > 7天的患者，调查其并发症种类，并按照改良Clavien分级将其分为轻度及重度并发症，分析临床因素与并发症程度之间的关系。结果术后住院时间 > 7天者共115例，占同期手术比例为10.3%（115/1, 112）。全组患者轻度并发症81例，占同期手术（1, 112例）比例和术后住院时间延长者比例分别为7.3%和70.4%，重度并发症34例，分别为3.1%和29.6%；因并发症死亡者2例，分别为0.18%和1.7%；术后最常见者为漏气超过5日20例，分别为1.8%和17.4%，肺不张19例，分别为1.7%和16.5%，肺部感染18例，分别为1.6%和15.7%；罕见并发症中支气管胸膜瘘4例（0.36%和3.5%），但危险高，其中2例因并发急性呼吸窘迫综合征（acute respiratory distresssyndrome, ARDS）围手术期死亡；临床因素中仅低肺功能（FEV1% < 70%）可能是造成术后严重并发症的因素（45.8% vs 23.6%, P=0.038）；轻度并发症组与重度并发症组5年无疾病生存率（52.2% vs 51.9%, P=0.894）及5年总生存率（64.0% vs 53.5%, P=0.673）均无显著差异。结论术后持续漏气、肺不张及肺部感染等并发症是延长胸腔镜肺癌术后住院时间的主要原因，而支气管胸膜瘘是最凶险的并发症；术前低肺功能患者更易出现术后严重并发症，但并发症严重程度并不会影响远期预后。