Objectives

Advances in thoracoscopic surgery have made skin incisions smaller, but there are concerns about cancer cell contamination during sample extraction. We performed retrieval bag lavage cytology (BLC) during thoracoscopic surgery to evaluate the risk of cancer dissemination and the prognostic influence of BLC status.

Methods

BLC was investigated in 893 patients who underwent thoracoscopic lobectomy or segmentectomy for lung cancer between 2013 and 2018. The clinicopathological features and prognosis were compared between the BLC-positive and BLC-negative groups.

Results

Forty-nine patients (5.5%) were positive for BLC. BLC correlated with pleural invasion (49.0% vs. 12.9%, P < 0.001); however, BLC was positive in 3.3% of cases without pleural invasion. Multivariate analysis revealed that tumor size, lymph node metastasis, lymphatic and pleural invasion were predictive factors for positive BLC. Prognosis was poorer in the BLC-positive group than in the BLC-negative group (5-year overall survival, 73.6% vs. 90.2%, P < 0.001); nevertheless, positive BLC was not an independent prognostic factor. The locoregional recurrence rate was higher among BLC-positive patients than among BLC-negative patients, whereas there was no significant difference in the distant recurrence rate. Positive BLC was associated with locoregional recurrence (hazard ratio 1.87, P = 0.044) and the correlation was stronger in stage I lung cancer. There were no cases of extraction bag breakage or port-site recurrence.

Conclusions

BLC positivity was correlated with the risk of locoregional recurrence in patients with surgically resected lung cancer, although it was not an independent prognostic factor. Careful manipulation is essential for extracting specimens from the thoracic cavity.

中文翻译：

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肺癌胸腔镜手术中袋灌洗细胞学阳性是局部复发的重要预测因素

目标

胸腔镜手术的进步使皮肤切口更小，但在样本提取过程中存在癌细胞污染的担忧。我们在胸腔镜手术期间进行了取回袋灌洗细胞学 (BLC)，以评估癌症传播的风险和 BLC 状态对预后的影响。

方法

对 2013 年至 2018 年间接受胸腔镜肺叶切除术或肺段切除术的 893 例肺癌患者进行 BLC 研究。比较 BLC 阳性组和 BLC 阴性组的临床病理学特征和预后。

结果

49 名患者 (5.5%) 为 BLC 阳性。BLC 与胸膜浸润相关（49.0% vs. 12.9%，P  < 0.001）；然而，在没有胸膜侵犯的病例中，3.3% 的 BLC 呈阳性。多因素分析显示，肿瘤大小、淋巴结转移、淋巴和胸膜浸润是 BLC 阳性的预测因素。BLC 阳性组的预后比 BLC 阴性组差（5 年总生存率，73.6% vs. 90.2%，P  < 0.001）；然而，阳性 BLC 并不是独立的预后因素。BLC阳性患者的局部复发率高于BLC阴性患者，而远处复发率无显着差异。BLC 阳性与局部复发相关（风险比 1.87，P  = 0.044)，并且在 I 期肺癌中相关性更强。没有提取袋破损或端口部位复发的病例。

结论

BLC 阳性与手术切除肺癌患者的局部复发风险相关，尽管它不是独立的预后因素。仔细操作对于从胸腔中提取标本至关重要。