Elia S, Griffo S, Gentile M, Costabile R, Ferrante G
Department of Thoracic Surgery, Medical Faculty, University Federico II, Naples, Italy.
Eur J Cardiothorac Surg. 2001 Aug;20(2):356-60. doi: 10.1016/s1010-7940(01)00735-7.
To retrospectively assess the results of surgical treatment in a consecutive series of 110 patients with Stage IIb and IIIa non small cell lung cancer (NSCLC) invading chest wall.
A series of 110 patients underwent surgery for Stage IIb and IIIa NSCLC with involvement of chest wall. There were 101 male and 9 female patients, mean age was 61.4 (range 32--74), 52 (47.3%) of them complaining for chest pain. Surgical procedures were pneumonectomy in seven patients (6.4%), lobectomy in 73 (66.4%), bi-lobectomy in six (5.4%) and wedge resection in 24 (21.8%). In 63 patients (57.3%) an extrapleural resection was performed while in the other 47 (42.7%) an 'en bloc' resection of tumor with chest wall was required. In 22 patients (76.3%) repair was achieved by muscle flap while in 8 (26.7%) a prosthesis was required. Five-year survival was computed using the Kaplan--Meier method; P values correspond to the log-rank test.
There were neither intraoperative nor postoperative deaths. Postoperative staging revealed 83 T3N0M0, 17 T3N1M0 and 10 T3N2M0. Mean postoperative hospital stay was 17.7 days (range 5--40). For N0 patients 5 year survival was 47% (39/83) and no significant difference was noted when extrapleural and 'en bloc' resection groups were compared (P = 0.08). In N1/N2 patients no survival was observed (0/27) and comparison between surgical procedures was not statistically significant (P = 0.41). Moreover when N0 patients were compared with N1 patients the difference in survival was significant for both extrapleural (P = 0.02) and 'en bloc' (P = 0.04) groups. No difference was noted when the two surgical procedures were compared independently form N status (P = 0.94). Within the group of patients undergone 'en bloc' resection survival was significantly better for N0 patients as in the group of extrapleural resection.
Surgical treatment of Stage IIb and IIIa NSCLC invading chest wall by extrapleural or 'en bloc' resection is widely adopted and justified by the good results in terms of morbidity and relief of pain. Survival is always depending on the N status.
回顾性评估110例侵犯胸壁的IIb期和IIIa期非小细胞肺癌（NSCLC）患者的手术治疗结果。
110例侵犯胸壁的IIb期和IIIa期NSCLC患者接受了手术。其中男性101例，女性9例，平均年龄61.4岁（范围32 - 74岁），52例（47.3%）患者有胸痛症状。手术方式为7例（6.4%）全肺切除术，73例（66.4%）肺叶切除术，6例（5.4%）双肺叶切除术，24例（21.8%）楔形切除术。63例（57.3%）患者行胸膜外切除术，另外47例（42.7%）患者需要将肿瘤与胸壁整块切除。22例（76.3%）患者通过肌瓣修复，8例（26.7%）患者需要使用假体。采用Kaplan - Meier法计算5年生存率；P值对应对数秩检验。
术中及术后均无死亡病例。术后分期显示83例T3N0M0，17例T3N1M0，10例T3N2M0。术后平均住院时间为17.7天（范围5 - 40天）。N0患者5年生存率为47%（39/83），胸膜外切除术组与整块切除术组比较无显著差异（P = 0.08）。N1/N2患者无生存病例（0/27），不同手术方式比较无统计学意义（P = 0.41）。此外，N0患者与N1患者比较，胸膜外切除术组（P = 0.02）和整块切除术组（P = 0.04）的生存率差异均有统计学意义。不考虑N状态独立比较两种手术方式时无差异（P = 0.94）。在整块切除术组患者中，N0患者的生存率与胸膜外切除术组一样明显更好。
胸膜外切除术或整块切除术治疗侵犯胸壁的IIb期和IIIa期NSCLC被广泛采用，且在发病率和疼痛缓解方面效果良好，证明了其合理性。生存率始终取决于N状态。
