Spaggiari L, Pastorino U
Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Ann Thorac Surg. 2000 Oct;70(4):1172-5. doi: 10.1016/s0003-4975(00)01724-0.
Combined superior vena cava and tracheal sleeve resections are occasionally indicated in the treatment of non-small cell lung cancer. However, more effective induction therapy may potentially expand the benefit of locally extended resections.
From January 1998 to December 1999, 6 consecutive patients had combined tracheal sleeve and superior vena cava resections for non-small cell lung cancer after induction treatment. Surgical approach was muscle-sparing lateral thoracotomy in 4 patients and hemiclam-shell approach in 2 patients. There were four tracheal sleeve pneumonectomies, one tracheal sleeve bilobectomy, and one tracheal sleeve lobectomy. Three patients (50%) had complete superior vena cava resection with graft replacement, whereas the other patients had partial superior vena cava resection using vascular staplers.
There were no perioperative complications. Three patients (50%) had major postoperative complications, but there were no postoperative deaths. Four patients are still alive, 2 without evidence of disease. The median survival was 14.5 months (range, 3 to 17 months).
These combined resections are technically feasible with no postoperative mortality but high morbidity (50%). This aggressive surgery may be useful in highly selected patients where adequate local control can achieve long-term survival.
在非小细胞肺癌的治疗中，偶尔会采用上腔静脉和气管联合袖状切除术。然而，更有效的诱导治疗可能会扩大局部扩大切除术的益处。
1998年1月至1999年12月，6例连续患者在诱导治疗后接受了非小细胞肺癌的气管袖状和上腔静脉联合切除术。手术入路中，4例采用保留肌肉的外侧开胸术，2例采用半蛤壳式入路。进行了4例气管袖状全肺切除术、1例气管袖状双叶切除术和1例气管袖状肺叶切除术。3例患者（50%）进行了上腔静脉完全切除并移植置换，而其他患者使用血管吻合器进行了上腔静脉部分切除。
围手术期无并发症。3例患者（50%）出现主要术后并发症，但无术后死亡。4例患者仍存活，2例无疾病证据。中位生存期为14.5个月（范围3至17个月）。
这些联合切除术在技术上是可行的，无术后死亡率，但发病率高（50%）。这种积极的手术可能对经过严格挑选的患者有用，在这些患者中，充分的局部控制可实现长期生存。
