非小细胞肺癌的肺切除术能否避免？肺实质保留手术的审计。

Can pneumonectomy for non-small cell lung cancer be avoided? An audit of parenchymal sparing lung surgery.

作者信息

Martin-Ucar A E, Chaudhuri N, Edwards J G, Waller D A

机构信息

Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.

出版信息

Eur J Cardiothorac Surg. 2002 Apr;21(4):601-5. doi: 10.1016/s1010-7940(02)00028-3.

DOI:10.1016/s1010-7940(02)00028-3

PMID:11932153

Abstract

BACKGROUND

Lung cancer resection rates are suboptimal in the UK. Pneumonectomy has a higher perioperative mortality risk than lobectomy. To increase resection rates and improve outcomes we have implemented a policy of parenchymal sparing surgery for tumours involving a main stem bronchus.

METHODS

In a prospective 4 year study of 119 consecutive patients operated upon by a single surgeon the perioperative course, pathology and survival were compared for 81 patients undergoing pneumonectomy and 38 patients in whom pneumonectomy was avoided by bronchoplastic+/-angioplastic procedures.

RESULTS

The rate of pneumonectomy decreased significantly with increasing experience with parenchymal sparing surgery (R(2)=0.98, P<0.001) with 21 of the last 30 patients (70%) avoiding pneumonectomy. There were no significant inter-group differences in patient characteristics, perioperative course or outcome. One-year survival was 64% after pneumonectomy and 73% after sleeve lobectomy. However the perioperative loss of respiratory function was significantly lower in the patients in whom pneumonectomy was avoided (P=0.0003).

CONCLUSIONS

Pneumonectomy can be avoided in a large proportion of patients with non-small cell lung cancer of a main stem bronchus without adversely affecting outcome but with preservation of lung function

摘要

背景

在英国，肺癌切除率并不理想。全肺切除术的围手术期死亡风险高于肺叶切除术。为了提高切除率并改善治疗效果，我们对累及主支气管的肿瘤实施了保留实质组织手术的政策。

方法

在一项由单一外科医生进行的为期4年的前瞻性研究中，对119例连续接受手术的患者进行了研究，比较了81例行全肺切除术的患者和38例通过支气管成形术+/-血管成形术避免行全肺切除术的患者的围手术期过程、病理情况和生存率。

结果

随着保留实质组织手术经验的增加，全肺切除术的比例显著下降（R²=0.98，P<0.001），在最后30例患者中有21例（70%）避免了全肺切除术。两组在患者特征、围手术期过程或结局方面没有显著差异。全肺切除术后1年生存率为64%，袖状肺叶切除术后为73%。然而，避免行全肺切除术的患者围手术期呼吸功能的损失显著更低（P=0.0003）。