York J E, Walsh G L, Lang F F, Putnam J B, McCutcheon I E, Swisher S G, Komaki R, Gokaslan Z L
Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
J Neurosurg. 1999 Jul;91(1 Suppl):74-80. doi: 10.3171/spi.1999.91.1.0074.
Traditionally, superior sulcus tumors of the lung that involve the chest wall and spinal column have been considered to be unresectable, and historically, patients harboring these tumors have been treated with local radiation therapy with, at best, modest results. The value of gross-total resection remains unclear in this patient population; however, with the recent advances in surgical technique and spinal instrumentation, procedures involving more radical removal of such tumors are now possible. At The University of Texas M. D. Anderson Cancer Center, the authors have developed a new technique for resecting superior sulcus tumors that invade the chest wall and spinal column. They present a technical description of this procedure and results in nine patients in whom stage IIIb superior sulcus tumors extensively invaded the vertebral column.
These patients underwent gross-total tumor resection via a combined approach that included posterolateral thoracotomy, apical lobectomy, chest wall resection, laminectomy, vertebrectomy, anterior spinal column reconstruction with methylmethacrylate, and placement of spinal instrumentation. There were six men and three women, with a mean age of 55 years (range 36-72 years). Histological examination revealed squamous cell carcinoma (three patients), adenocarcinoma (four patients), and large cell carcinoma (two patients). The mean postoperative follow-up period was 16 months. All patients are currently ambulatory or remained ambulatory until they died. Pain related to tumor invasion improved in four patients and remained unchanged in five. In three patients instrumentation failed and required revision. There was one case of cerebrospinal fluid leakage that was treated with lumbar drainage and one case of wound breakdown that required revision. Two patients experienced local tumor recurrence, and one patient developed a second primary lung tumor.
The authors conclude that in selected patients, combined radical resection of superior sulcus tumors of the lung that involve the chest wall and spinal column may represent an acceptable treatment modality that can offer a potential cure while preserving neurological function and providing pain control.
传统上，累及胸壁和脊柱的肺上沟瘤一直被认为无法切除，从历史上看，患有这些肿瘤的患者接受局部放射治疗，效果充其量只能说是一般。在这类患者中，肿瘤全切的价值仍不明确；然而，随着手术技术和脊柱内固定技术的最新进展，现在有可能进行更彻底切除此类肿瘤的手术。在德克萨斯大学MD安德森癌症中心，作者们开发了一种新的技术来切除侵犯胸壁和脊柱的肺上沟瘤。他们介绍了该手术的技术描述以及9例IIIb期肺上沟瘤广泛侵犯脊柱的患者的治疗结果。
这些患者通过联合手术进行肿瘤全切，该联合手术包括后外侧开胸、肺尖叶切除、胸壁切除、椎板切除、椎体切除、用甲基丙烯酸甲酯进行脊柱前路重建以及放置脊柱内固定装置。患者中有6名男性和3名女性，平均年龄55岁（范围36 - 72岁）。组织学检查显示为鳞状细胞癌（3例患者）、腺癌（4例患者）和大细胞癌（2例患者）。术后平均随访期为16个月。所有患者目前均能行走，或直至死亡前一直保持能行走状态。4例与肿瘤侵犯相关的疼痛有所改善，5例未变。3例内固定装置出现故障，需要进行翻修。有1例脑脊液漏，通过腰椎引流进行治疗，1例伤口裂开，需要进行翻修。2例患者出现局部肿瘤复发，1例患者发生了第二原发性肺癌。
作者们得出结论，对于选定的患者，联合根治性切除累及胸壁和脊柱的肺上沟瘤可能是一种可接受的治疗方式，这种方式在保留神经功能和控制疼痛的同时，有可能实现治愈。
