Rami-Porta Ramón, Wittekind Christian, Goldstraw Peter
Complete Resection Subcommittee of the IASLC Staging Committee, Thoracic Surgery Service, Hospital Mutua de Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221 Terrassa, Barcelona, Spain.
Lung Cancer. 2005 Jul;49(1):25-33. doi: 10.1016/j.lungcan.2005.01.001.
To propose an internationally accepted definition of complete resection in lung cancer surgery.
The International Association for the Study of Lung Cancer (IASLC) Staging Committee created the Complete Resection Subcommittee in 2001 to work on an international definition of complete resection in lung cancer surgery. The previous definitions of complete resection and the rules of the International Union Against Cancer regarding the TNM residual tumor classification, together with a thorough review of the pertinent literature, and the input of the members of the IASLC Staging Committee were considered in order to get an international consensus on the definition of complete resection in lung cancer surgery.
Complete resection requires all of the following: free resection margins proved microscopically; systematic nodal dissection or lobe-specific systematic nodal dissection; no extracapsular nodal extension of the tumor; and the highest mediastinal node removed must be negative. Whenever there is involvement of resection margins, extracapsular nodal extension, unremoved positive lymph nodes or positive pleural or pericardial effusions, the resection is defined as incomplete. When the resection margins are free and no residual tumor is left, but the resection does not fulfill the criteria for complete resection, there is carcinoma in situ at the bronchial margin or positive pleural lavage cytology, the term uncertain resection is proposed.
The proposed definitions of complete, incomplete and uncertain resections are clear and reproducible in an international setting to study their prognostic impact prospectively.
提出肺癌手术中完全切除的国际公认定义。
国际肺癌研究协会（IASLC）分期委员会于2001年成立了完全切除小组委员会，致力于制定肺癌手术中完全切除的国际定义。考虑了既往完全切除的定义、国际抗癌联盟关于TNM残留肿瘤分类的规则，同时对相关文献进行了全面回顾，并参考了IASLC分期委员会成员的意见，以便就肺癌手术中完全切除的定义达成国际共识。
完全切除需要满足以下所有条件：显微镜下证实切缘阴性；系统性淋巴结清扫或肺叶特异性系统性淋巴结清扫；肿瘤无包膜外淋巴结转移；切除的最高纵隔淋巴结必须为阴性。只要存在切缘受累、包膜外淋巴结转移、未切除的阳性淋巴结或阳性胸腔或心包积液，该切除即定义为不完全切除。当切缘阴性且无残留肿瘤，但切除不符合完全切除标准、支气管切缘存在原位癌或胸腔灌洗细胞学阳性时，建议使用“不确定切除”这一术语。
所提出的完全、不完全和不确定切除的定义在国际环境中清晰且可重复，以便前瞻性地研究其对预后的影响。
