Okada M, Yoshikawa K, Hatta T, Tsubota N
Department of Thoracic Surgery, National Hyogo Central Hospital, Sanda City, Japan.
Ann Thorac Surg. 2001 Mar;71(3):956-60; discussion 961. doi: 10.1016/s0003-4975(00)02223-2.
Lesser resection than the standard lobectomy for small-sized cT1N0M0 non-small cell lung cancers continues to be debated.
We reviewed specimens of 139 patients after lobectomy for cT1N0M0 cancer of 2 cm or less. In addition, we prospectively enrolled 70 patients able to tolerate a lobectomy, in a trial of lesser resection for these lesions. The limited procedure consisted of segmentectomy in which the resection line was delivered beyond the burdened segment, plus exploration of lymph nodes by frozen sectioning. This procedure was modified if the result was positive; this modified procedure was called extended segmentectomy.
The nodal status after lobectomy was pN0, 107 patients; pN1, 12 patients; and pN2, 20 patients. Of the pN1 patients, 2 had only intralobar nodal involvement within the same segment of the main tumor. In the remaining 30 patients with nodal involvement, we ascertained the nodal involvement during the operation. Regarding intrapulmonary metastasis, 1 of 8 patients having this metastasis had the lesion at the segment where the main tumor was not located and had N2 disease, which was detected intraoperatively. If extended segmentectomy had been performed instead of lobectomy, the lesion could have been removed completely. The 5-year survival of patients with cT1N0M0 cancer of 2 cm or less was 87.3% after extended segmentectomy. There were no local recurrences and three noncancer-related deaths. Among patients with pT1N0M0 cancer of 2 cm or less, the 5-year survival was 87.1% in the extended segmentectomy group and 87.7% in the lobectomy group (p = 0.8008).
Extended segmentectomy should be considered as an alternative for patients with cT1N0M0 non-small cell lung cancer of 2 cm or smaller.
对于小尺寸cT1N0M0非小细胞肺癌，采用比标准肺叶切除术范围更小的切除方式仍存在争议。
我们回顾了139例接受肺叶切除术治疗2 cm及以下cT1N0M0癌症患者的标本。此外，我们前瞻性纳入了70例能够耐受肺叶切除术的患者，进行针对这些病变的缩小切除试验。有限手术包括段切除术，切除线延伸至受累段之外，加上通过冷冻切片检查淋巴结。如果结果为阳性，则对该手术进行改良；这种改良后的手术称为扩大段切除术。
肺叶切除术后的淋巴结状态为pN0，107例患者；pN1，12例患者；pN2，20例患者。在pN1患者中，2例仅在主肿瘤同一节段内有叶内淋巴结受累。在其余30例有淋巴结受累的患者中，我们在手术中确定了淋巴结受累情况。关于肺内转移，8例有这种转移的患者中有1例病变位于主肿瘤所在节段之外，且有N2疾病，术中检测到。如果当时进行的是扩大段切除术而非肺叶切除术，该病变本可以被完全切除。扩大段切除术后，2 cm及以下cT1N0M0癌症患者的5年生存率为87.3%。无局部复发，有3例与癌症无关的死亡。在2 cm及以下pT1N0M0癌症患者中，扩大段切除术组的5年生存率为87.1%，肺叶切除术组为87.7%（p = 0.8008）。
对于2 cm或更小的cT1N0M0非小细胞肺癌患者，应考虑将扩大段切除术作为一种替代方案。
