de Leyn P, Decker G
Hôpital universitaire de Leuven, Herestraat 49, 3000 Leuven, Belgium.
Rev Mal Respir. 2004 Nov;21(5 Pt 1):971-82. doi: 10.1016/s0761-8425(04)71479-5.
Surgery remains the best option for curative treatment of early stages Non-small cell lung cancer (NSCLC). In this article we review the current status and future perspectives of surgical treatment of NSCLC.
An important part of the surgical procedure is the final determination of the staging with evaluation of the resectability of the tumor and its nodal status. This requires a systematic hilar and mediastinal nodal dissection and a complete resection that remains a major prognostic factor.
In order to preserve pulmonary function, lobectomies with the use of broncho- or arterioplasty have been developed with reduction in the number of pneumonectomies. For peripheral T1N0 NSCLC, video-assisted (VATS) lobectomy has become technically feasible with survival, in non-randomised studies, at least as good as the survival after open resection. While VATS has a clear role in staging of lung cancer, its role in the treatment of lung cancer however remains debatable. In case of involved mediastinal nodes (N2 disease) induction therapy is given in many centers and patients with mediastinal downstaging have a significantly better survival than non-responders. Restaging of the mediastinum is at the moment far from accurate. In case of locally advanced tumour (cT4), new surgical techniques and approaches make resection of carina, vena cava superior, vertebrae feasible with acceptable morbidity and mortality but additional studies are required.
Surgery remains the treatment of choice for curative treatment of NSCLC. The evolution of surgical techniques and the use of multimodality treatment further improve the results of surgical management. Rigorous patient selection, meticulous surgical technique and adequate peri- and postoperative management can keep operative morbidity and morbidity acceptable.
手术仍然是早期非小细胞肺癌（NSCLC）根治性治疗的最佳选择。在本文中，我们回顾了NSCLC手术治疗的现状和未来前景。
手术过程的一个重要部分是通过评估肿瘤的可切除性及其淋巴结状态来最终确定分期。这需要系统的肺门和纵隔淋巴结清扫以及完整切除，而完整切除仍然是一个主要的预后因素。
为了保留肺功能，已开发出使用支气管或血管成形术的肺叶切除术，从而减少了全肺切除术的数量。对于周围型T1N0 NSCLC，电视辅助（VATS）肺叶切除术在技术上已变得可行，在非随机研究中，其生存率至少与开放切除术后的生存率一样好。虽然VATS在肺癌分期中具有明确作用，但其在肺癌治疗中的作用仍存在争议。在纵隔淋巴结受累（N2期疾病）的情况下，许多中心会进行诱导治疗，纵隔分期降低的患者比无反应者的生存率明显更高。目前纵隔重新分期远不准确。对于局部晚期肿瘤（cT4），新的手术技术和方法使隆突、上腔静脉、椎体的切除可行，且发病率和死亡率可接受，但还需要更多研究。
手术仍然是NSCLC根治性治疗的首选方法。手术技术的发展和多模式治疗的应用进一步改善了手术治疗的效果。严格的患者选择、细致的手术技术以及充分的围手术期和术后管理可以使手术发病率和死亡率保持在可接受范围内。
