Abstract:

Objective

To explore the clinical effect of Flex-3D thoracoscopic lobectomy in non-small cell lung cancer （NSCLC）.

Methods

The clinical data of 147 patients with NSCLC admitted from June 2021 to August 2023 were retrospectively analyzed.According to the type of thoracoscopy used during surgery，the patients were divided into observation group 78 cases and control group 69 cases.Patients in the observation group received Flex-3D thoracoscopic lobectomy，and patients in the control group received traditional 2D thoracoscopic lobectomy，and were followed up by outpatient follow-up within 6 month after surgery.The data of the two groups were recorded at different time points before and after operation，including indicators of surgical indexes ，operation time，postoperative extubation time，postoperative hospitalization time，number of lymph node dissection，surgical stress indexes ［prostaglandin E₂（PGE₂），substance P （SP），heat shock protein 70（HSP70）］，blood gas indexes ［partial pressure of oxygen in arterial blood （PaO₂），partial pressure of carbon dioxide in arterial blood （PaCO₂）］，pulmonary function indicators ［diaphragm activity，forced vital capacity（FVC），forced expiratory volume in 1 second （FEV₁）］，postoperative complications，recurrence and metastasis.

Results

The operation time of observation group and control group was （166.26±38.57） min and（182.38±33.05） min，and the postoperative extubation time was （5.64±1.28） d and （6.73±1.56） d，respectively.Postoperative hospitalization time was （7.37±1.66） d，（8.22±1.05） d，and the number of lymph nodes were （13.25±3.01） and （11.89±1.77），respectively，with statistical significance （P＜0.05）.On the 2nd day after surgery，the levels of PGE₂（123.06±21.52） pg/ml，SP （5.33±1.74）μg/ml and HSP70（31.03±6.25 ）ng/ml in the observation group were lower than those in the control group（131.74±22.38 ）pg/ml，（6.28±2.09）μg/ml，（33.28±6.34 ）ng/ml （P＜0.05）； On the 1st and 5th day after surgery，the PaO₂ level in the observation group was higher than that in the control group，and the PaCO₂ level was lower than that in the control group （P＜0.05）.There were no significant differences in FVC，FEV₁ levels and diaphragmatic activity between the two groups at 3 and 6 months after surgery （P＞0.05）.Postoperative complications of the patients included pneumonia，pulmonary embolism，atelectasis，subcutaneous emphysema，arrhythmia，chylothorax.There was no statistical significance in the occurrence of complications between the two groups （P＞0.05）.No distant metastasis or death occurred in patients 6 month after surgery，Local recurrence occurred in 3 cases（3.85%） in the observation group and 6 cases （8.70%） in the control group halfa after operation （P＝0.306）.One case of mediastinal lymph node metastasis in the observation group （1.28%） and one case of mediastinal lymph node metastasis in the control group （1.45%）（P＞0.05）.

Conclusion

Flex-3D thoracoscopic lobectomy has a good application effect in NSCLC patients，which is conducive to shortening the operation time，improving the efficacy of lymph node dissection，and reducing intraoperative injury，and the safety is comparable to that of traditional 2D thoracoscopic lobectomy.

Key words: Non-small cell lung cancer, Lobectomy, Flex-3D thoracoscopy, 2D thoracoscopy, Clinical application