Mizuguchi Shinjiro, Inoue Kiyotoshi, Iwata Takashi, Izumi Nobuhiro, Tsukioka Takuma, Morita Ryuhei, Nishida Tatsuya, Nishiyama Noritoshi, Shuto Taichi, Suehiro Shigefumi
Department of Thoracic Surgery, Osaka City University Hospital, Japan.
Jpn J Thorac Cardiovasc Surg. 2006 Mar;54(3):103-8. doi: 10.1007/BF02744871.
Impacts of mediastinal lymph node dissection on a patient's course after pulmonary resection is unclear in octogenarians with non-small cell lung cancer.
Retrospectively identified subjects included 39 octogenarians and 1 nonagenarian, with grades according to the Charlson Comorbidity Index ranging from only 0 to 2. We performed mediastinal lymph node dissection in 19 patients (D group), and just lymph node sampling biopsy in the other 21 (S group). We compared clinicopathologic features and outcome after surgery between both groups.
Deterioration of performance status at the time of discharge, evident in 17 patients overall, was significantly more frequent in the D group. Postoperative complications occurred in 27 patients overall and there was no significant difference between the two groups. Survival rates in younger patients at 1, 3, and 5 years were 86, 59, and 49%, respectively; in octogenarians these were 83, 58, and 42% (no significant difference). Nor did survival differ significantly by surgical management of mediastinal lymph nodes; 1-, 3-, and 5-year survival rates were 94, 63, and 40%, respectively in the D group and 78, 66, and 43%, respectively in the S group.
Octogenarians with non-small cell lung cancer should be treated by urgent pulmonary resection whenever possible. Since mediastinal lymph node dissection has little effect on long-term survival or the carried risk of worsening performance status at discharge, pulmonary resection without complete mediastinal lymph node dissection should be considered.
对于患有非小细胞肺癌的八旬老人，纵隔淋巴结清扫术对其肺切除术后病程的影响尚不清楚。
回顾性纳入的研究对象包括39名八旬老人和1名九旬老人，根据Charlson合并症指数分级，范围仅为0至2。我们对19例患者进行了纵隔淋巴结清扫术（D组），另外21例仅进行了淋巴结采样活检（S组）。我们比较了两组的临床病理特征和术后结局。
出院时总体有17例患者出现了体能状态恶化，在D组中更为常见。总体有27例患者发生了术后并发症，两组之间无显著差异。年轻患者1年、3年和5年生存率分别为86%、59%和49%；八旬老人分别为83%、58%和42%（无显著差异）。纵隔淋巴结的手术处理方式对生存率也无显著差异；D组1年、3年和5年生存率分别为94%、63%和40%，S组分别为78%、66%和43%。
患有非小细胞肺癌的八旬老人应尽可能紧急进行肺切除术。由于纵隔淋巴结清扫术对长期生存或出院时体能状态恶化风险影响不大，应考虑行不完全纵隔淋巴结清扫的肺切除术。
