Massard G, Kessler R, Gasser B, Ducrocq X, Elia S, Gouzou S, Wihlm J M
Service de Chirurgie Thoracique and Institut de Pathologie, Hôpitaux Universitaires de Strasbourg, France.
Eur J Cardiothorac Surg. 1999 Sep;16(3):276-82. doi: 10.1016/s1010-7940(99)00233-x.
This study was designed to determine whether bronchoplastic resection could be an alternative to pneumonectomy in patients with operable primary lung cancer.
From 1980 to 1996, 63 patients (59 males and four females; mean age 62 +/- 7 years) underwent a bronchoplastic lobectomy for non-small cell lung cancer, indicated because of a disabled respiratory function in 34 patients, and performed electively in 29 patients. There were 38 right upper lobectomies, four bilobectomies, one middle lobectomy combined with lower lobe apical segmentectomy, ten left upper and ten left lower lobectomies. The bronchoplasty was a full sleeve in 24 patients, and a bronchial wedge resection in 39.
A single patient died post-operatively (1.6%). Specific procedure-related complications are summarized as follows: six anastomotic complications managed conservatively (9.5%), 15 space problems (23.8%), nine sputum retentions (14.2%). Pathologic staging classified 30 patients in stage I, 21 patients in stage II, and 12 in stage IIIA. Estimated 5-year survival was 69.7 +/- 9.8% in stage I, 37.1 +/- 12.1% in stage II, and 8.3 +/- 8.0% in stage IIIA. Fourteen patients (22.2%) developed locoregional recurrence. Three of them died with local recurrence alone, whereas 10 developed metastatic progression; a single patient is alive following completion pneumonectomy. According to stage, three recurrences occurred in stage I (10%), six in stage II (28%), and five in stage IIIA (38%). Actuarial freedom from local recurrence was significantly higher after elective procedures (P = 0.019); there was a trend towards improved outcome following right-sided procedures (P = 0.079) and following wedge bronchoplasty (P = 0.055). Five patients experienced a second primary cancer (7.9%), which was resected in four.
Bronchoplastic resections achieve local control and long-term survival comparable to standard resections in patients with stage I or II disease, and may be considered as a valuable alternative to pneumonectomy.
本研究旨在确定支气管成形切除术是否可作为可手术切除的原发性肺癌患者肺切除术的替代方案。
1980年至1996年，63例患者（59例男性，4例女性；平均年龄62±7岁）因非小细胞肺癌接受支气管成形肺叶切除术，其中34例因呼吸功能不全而进行手术，29例为选择性手术。其中38例为右上叶切除术，4例为双叶切除术，1例为中叶切除术联合下叶尖段切除术，10例为左上叶切除术，10例为左下叶切除术。24例行全袖状支气管成形术，39例行支气管楔形切除术。
1例患者术后死亡（1.6%）。具体的手术相关并发症总结如下：6例吻合口并发症经保守治疗（9.5%），15例出现胸腔问题（23.8%），9例痰液潴留（14.2%）。病理分期显示，30例患者为I期，21例为II期，12例为IIIA期。I期患者的预计5年生存率为69.7±9.8%，II期为37.1±12.1%，IIIA期为8.3±8.0%。14例患者（22.2%）出现局部复发。其中3例仅因局部复发死亡，10例出现远处转移进展；1例患者在完成肺切除术后存活。根据分期，I期有3例复发（10%）；II期有6例（28%）；IIIA期有5例（38%）。选择性手术后无局部复发的精算生存率显著更高（P=0.019）；右侧手术（P=0.079）和楔形支气管成形术后（P=0.055）有预后改善的趋势。5例患者发生第二原发性癌（7.9%），其中4例接受了手术切除。
支气管成形切除术在I期或II期患者中可实现与标准切除术相当的局部控制和长期生存，可被视为肺切除术的一种有价值的替代方案。
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