Watanabe T, Okada A, Imakiire N, Hirono T
Division of Chest Surgery, Nishiniigata-Central Hospital, Niigata, Japan.
Kyobu Geka. 2004 Jan;57(1):25-9.
From 1996 to 2002, we performed intentional limited resection for small peripheral lung cancer using intraoperative pathologic examination. Wedge resection was performed in patients who had small peripheral adenocarcinoma (< or = 20 mm), suspected of being Noguchi type A or B, and confirmed by intraoperative pathologic examination. Extended segmentectomy was performed in the rest of patients (tumor diameter < or = 20 mm), and not suspected of being Noguchi type A or B. Hilar and mediastinal lymph nodes sampling was performed in this group. If lymph node metastasis was detected by the intraoperative pathologic examination, the surgical procedures was converted into a lobectomy with lymph node dissection. Limited resection was performed in 27 patients, wedge resection in 8, and extended segmentectomy in 19. All patients received wedge resection are alive without sign of recurrence. In extended segmentectomy, 17 patients are alive with no evidence of disease, 1 patient died of non-pulmonary disease, and 1 patient is alive with recurrent disease. The overall survival rate at 5 years was 100% in wedge resection, 91% in extended segmentectomy, and 79% in standard lobectomy. We conclude that limited resection for small peripheral lung cancer using intraoperative pathologic examination may be safe and effective procedure.
1996年至2002年期间，我们采用术中病理检查对周围型小肺癌实施了意向性局限性切除术。对于周围型小腺癌（直径≤20 mm）、怀疑为Noguchi A或B型且经术中病理检查确诊的患者，实施楔形切除术。其余患者（肿瘤直径≤20 mm），且不怀疑为Noguchi A或B型，实施扩大肺段切除术，并对该组患者进行肺门和纵隔淋巴结采样。如果术中病理检查发现淋巴结转移，则将手术方式转为肺叶切除加淋巴结清扫术。27例患者接受了局限性切除术，其中8例行楔形切除术，19例行扩大肺段切除术。所有接受楔形切除术的患者均存活，无复发迹象。在扩大肺段切除术中，17例患者存活且无疾病证据，1例患者死于非肺部疾病，1例患者存活但有复发病灶。楔形切除术的5年总生存率为100%，扩大肺段切除术为91%，标准肺叶切除术为79%。我们得出结论，采用术中病理检查对周围型小肺癌进行局限性切除术可能是一种安全有效的手术方法。
