Kawahara Katsunobu, Shiraishi Takeshi, Iwasaki Akinori, Yoshinaga Yasuteru, Yamamoto Satoshi, Yoneda Satoshi, Shirakusa Takayuki
Second Department of Surgery, Fukuoka University School of Medicine, 7-45-1 Jyonannku, Nanakuma, Fukuoka 814-0180, Japan.
Jpn J Thorac Cardiovasc Surg. 2002 Oct;50(10):418-23. doi: 10.1007/BF02913175.
In left lung cancer, left and right mediastinum lymphatic spread occur equally frequently. We evaluated the safety and effectiveness of thoracoscopic right upper mediastinal dissection, implemented prior to left lung resection for left lung cancer.
Between January 1999 and May 2000, 17 patients with left lung cancer underwent thoracoscopic right upper mediastinal dissection prior to resection of the left lung and left mediastinal dissection for left lung cancer. These patients had either enlarged left hilar or bilateral mediastinal nodes, or either a tumor at least 3 cm in diameter or tumor extension to the hilum, mediastinum, or chest wall. Tumor and lymph nodes were examined with hematoxylin and eosin and immunohistochemical staining of cytokeratin for micrometastasis.
In 3 patients (17.6%), metastasis occurred in right paratracheal nodes. The 30-day mortality was 0% and morbidity 35.3% (6/17). Postoperative complications occurred in 3 of 4 patients (75%) undergoing induction chemotherapy, but none were lethal.
Thoracoscopic right upper mediastinal dissection is safe and feasible in treating advanced left lung cancer.
在左肺癌中，左右纵隔淋巴结转移的发生率相同。我们评估了在左肺癌左肺切除术前进行胸腔镜右上纵隔清扫术的安全性和有效性。
1999年1月至2000年5月，17例左肺癌患者在左肺切除及左肺癌左纵隔清扫术前接受了胸腔镜右上纵隔清扫术。这些患者有左肺门或双侧纵隔淋巴结肿大，或肿瘤直径至少3 cm，或肿瘤侵犯肺门、纵隔或胸壁。对肿瘤和淋巴结进行苏木精-伊红染色及细胞角蛋白免疫组化染色以检测微转移。
3例患者（17.6%）右气管旁淋巴结发生转移。30天死亡率为0%，发病率为35.3%（6/17）。4例接受诱导化疗的患者中有3例（75%）发生术后并发症，但均无致命性。
胸腔镜右上纵隔清扫术治疗晚期左肺癌安全可行。
