Kotoulas C, Lazopoulos G, Karaiskos T, Tomos P, Konstantinou M, Papamichalis G, Politi D, Lioulias A
Second Department of General Thoracic Surgery, Chest Diseases Hospital, Athens, Greece.
Eur J Cardiothorac Surg. 2001 Aug;20(2):330-4. doi: 10.1016/s1010-7940(01)00718-7.
In the staging of lung cancer, pleural effusion that is malignant on cytologic examination is regarded as T4 disease, and curative resection cannot be performed. We conducted this study to determine whether cancer cells can be present in the pleural cavity with no pleural effusion, to investigate the factors contributing to that occurrence, and to evaluate its prognostic significance.
Eighty-five patients (77 males, eight females) with a median age 60.1-+/--7.9 years (31--74 years) underwent a major lung resection, due to lung cancer in our department. From January 1998 to December 1999, 30 pneumonectomies, seven bilobectomies, 46 lobectomies and two wedge-resections were performed. Chest wall resection was performed in four patients. After performing a posterolateral thoracotomy and lung resection with extended mediastinal lymph node dissection, the pleural cavity was filled with 1 l physiologic saline solution (PSS) and the fluid was shaken. The lavage fluid was suctioned off (S1). Immediately after the lavage, the pleural cavity was refilled with 3 l PSS. The surgeon washed out the pleural cavity by hand for 1 min and the fluid was suctioned off. Finally, the pleural cavity was refilled with 1 l PSS and a new lavage fluid was suctioned off (S2). A cytologic examination was carried out for each sample.
The pathology report showed 39 adenocarcinomas, 33 squamous-cell, two adenosquamous, four large-cell, two neuroendocrine and five undifferentiated carcinomas. S1 was positive in eight patients (9.4%), while S2 was positive in four patients (4.7%). The correlation of positive pleural lavage and infiltrated lymph nodes demonstrated a statistically significant relation between presence of N2 disease and positive S2 sample (P = 0.049). No significant correlation existed between positive lavage sample (S1 or S2) and TNM stage, level of T, extent of tumor invasion, kind of operation, histological type or differentiation of the cancer (Chi square test). The mean follow-up is 11.3 +/- 6.2 months (4--22 months). There are 78 patients alive. A significance difference in survival was identified in-patients with positive S1 (P = 0.0081), and positive S2 (P = 0.0251) (Kaplan--Meier).
The cytologic results of lavage were positive for malignant cells in eight of 85 patients (9.4%). The existence of cancer cells in the pleural cavity can be the result of their exfoliation or surgical manipulations. The mechanical irrigation subdivides the percentage of positive samples. Our study supports that the positive findings on pleural lavage cytology is an essential prognostic factor.
在肺癌分期中，经细胞学检查为恶性的胸腔积液被视为T4期疾病，无法进行根治性切除。我们开展本研究以确定胸腔内无胸腔积液时是否存在癌细胞，探讨导致这种情况发生的因素，并评估其预后意义。
85例患者（77例男性，8例女性），中位年龄60.1±7.9岁（31 - 74岁），因肺癌在我科接受了肺大部切除术。1998年1月至1999年12月，进行了30例全肺切除术、7例双叶切除术、46例肺叶切除术和2例楔形切除术。4例患者进行了胸壁切除术。在进行后外侧开胸和肺切除并扩大纵隔淋巴结清扫后，向胸腔内注入1升生理盐水（PSS）并摇晃液体。吸出灌洗液（S1）。灌洗后立即向胸腔内再注入3升PSS。外科医生手动冲洗胸腔1分钟后吸出液体。最后，向胸腔内再注入1升PSS并吸出新的灌洗液（S2）。对每个样本进行细胞学检查。
病理报告显示有39例腺癌、33例鳞状细胞癌、2例腺鳞癌、4例大细胞癌、2例神经内分泌癌和5例未分化癌。8例患者（9.4%）的S1呈阳性，4例患者（4.7%）的S2呈阳性。阳性胸腔灌洗与浸润淋巴结的相关性表明，N2期疾病的存在与S2样本阳性之间存在统计学显著关系（P = 0.049）。灌洗样本阳性（S1或S2）与TNM分期、T水平、肿瘤侵犯范围、手术类型、癌症组织学类型或分化之间不存在显著相关性（卡方检验）。平均随访时间为11.3±6.2个月（4 - 22个月）。有78例患者存活。S1阳性患者（P = 0.0081）和S2阳性患者（P = 0.0251）的生存率存在显著差异（Kaplan - Meier）。
85例患者中有8例（9.4%）灌洗的细胞学结果显示恶性细胞呈阳性。胸腔内癌细胞的存在可能是其脱落或手术操作的结果。机械冲洗使阳性样本的比例细分。我们的研究支持胸腔灌洗细胞学的阳性结果是一个重要的预后因素。
