Facciolo F, Cardillo G, Lopergolo M, Pallone G, Sera F, Martelli M
Thoracic Surgery Unit, Carlo Forlanini Hospital, Istituto Dermopatico dell'Immacolata, Rome, Italy.
J Thorac Cardiovasc Surg. 2001 Apr;121(4):649-56. doi: 10.1067/mtc.2001.112826.
The choice of surgical approach to non-small cell lung cancer invading the chest wall, extrapleural resection versus en bloc chest wall resection, is much more related to the experience of the surgeon than to objective criteria. The aim of the present study is to help to establish a rationale for en bloc chest wall resection in lung cancer invading the chest wall.
From January 1990 to June 1999, of 1855 patients having major pulmonary resections for non-small cell lung carcinoma, 104 (5.6%) patients with neoplasms involving the chest wall underwent en bloc chest wall and lung resection plus radical mediastinal lymphadenectomy.
All patients underwent complete resection with microscopically disease-free tissue margins. Depth of invasion was into the parietal pleura only in 28 (26.92%), into the pleura and soft tissue in 36 (34.62%), and into the pleura, soft tissue, and bone in 40 (38.46%). No operative mortality was reported. Follow-up was completed in 96 patients. One patient had a local recurrence. The overall 5-year estimated survival was 61.4%. Survival in the subsets T3 N0 and T3 N2 were, respectively, 67.3% and 17.9% (P =.007). The 5-year survival was 79.1% in involvement of parietal pleura only and 54.0% in involvement of soft tissue with or without bone invasion (P =.014). Five-year survival was 53.0% in adenocarcinoma versus 71.8% in squamous cell carcinoma (P =.329) and 74.1% in patients who did undergo radiation therapy versus 46.7% in patients who did not undergo radiation therapy (P =.023).
En bloc resection of the chest wall and lung is the procedure of choice to obtain complete resection in lung carcinoma invading the chest wall. Survival is highly dependent on the completeness of resection, nodal involvement, and depth of chest wall invasion.
对于侵犯胸壁的非小细胞肺癌，手术方式的选择，即胸膜外切除术与胸壁整块切除术，更多地取决于外科医生的经验而非客观标准。本研究的目的是帮助确立在侵犯胸壁的肺癌中行胸壁整块切除术的理论依据。
1990年1月至1999年6月，在1855例行非小细胞肺癌肺大部切除术的患者中，104例（5.6%）肿瘤累及胸壁的患者接受了胸壁和肺整块切除以及纵隔淋巴结根治性清扫术。
所有患者均实现了显微镜下切缘无肿瘤组织的完整切除。侵犯深度仅累及壁层胸膜的有28例（26.92%），累及胸膜和软组织的有36例（34.62%），累及胸膜、软组织和骨骼的有40例（38.46%）。未报告手术死亡病例。96例患者完成了随访。1例患者出现局部复发。总体5年预计生存率为61.4%。T3 N0和T3 N2亚组的生存率分别为67.3%和17.9%（P = 0.007）。仅累及壁层胸膜时5年生存率为79.1%，累及软组织伴或不伴骨骼侵犯时为54.0%（P = 0.014）。腺癌的5年生存率为53.0%，鳞状细胞癌为71.8%（P = 0.329），接受放疗患者的5年生存率为74.1% , 未接受放疗患者为46.7%（P = 0.023）。
胸壁和肺整块切除术是侵犯胸壁的肺癌实现完整切除的首选术式。生存率高度依赖于切除的完整性、淋巴结受累情况以及胸壁侵犯深度。
