Sekine Yasuo, Saitoh Yukio, Chiyo Masako, Yasufuku Kazuhiro, Iyoda Akira, Shibuya Kiyoshi, Iizasa Toshihiko, Fujisawa Takehiko
Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Surg Today. 2006;36(6):491-8. doi: 10.1007/s00595-006-3190-0.
The characteristics of tumor extension determine whether pneumonectomy or lobectomy with bronchoplasty should be performed for central lung cancer. We investigated how the characteristics of tumor extension determined the operative methods and the surgical outcomes.
We conducted a retrospective chart review of 151 patients with positive bronchoscopic findings who underwent lung cancer operations between January 1995 and March 2002. Twenty-five patients underwent pneumonectomy, 88 underwent lobectomy/segmentectomy (Lob/Seg), and 38 underwent Lob/Seg with bronchoplasty.
Pathologic staging was higher in the pneumonectomy group than in the Lob/Seg groups, with or without bronchoplasty (P = 0.002). Interlobar extension and hilar lymph node involvement were more frequent, and mucosal invasion was less frequent, in the pneumonectomy group than in the Lob/Seg with bronchoplasty group. The frequencies of all specific pulmonary complications and 30-day mortality were similar among the three groups. The 5-year overall survival rates were 23.7%, 51.5%, and 72.8% for the pneumonectomy, Lob/Seg, and Lob/Seg with bronchoplasty groups, respectively (P = 0.0004). There was a significant difference in survival between patients with mucosal and those with submucosal types of lung cancer (P = 0.0114).
Lob/Seg with bronchoplasty was feasible without a higher risk of operative complications or poorer long-term survival. The nature of tumor extension was important in the selection of operative methods and in predicting survival.
肿瘤扩展特征决定了中央型肺癌应行肺切除术还是支气管成形肺叶切除术。我们研究了肿瘤扩展特征如何决定手术方式及手术效果。
我们对1995年1月至2002年3月间151例支气管镜检查阳性且接受肺癌手术的患者进行了回顾性病历分析。25例行肺切除术，88例行肺叶/肺段切除术（Lob/Seg），38例行支气管成形肺叶/肺段切除术。
肺切除术组的病理分期高于行或未行支气管成形术的Lob/Seg组（P = 0.002）。肺切除术组叶间扩展和肺门淋巴结受累更为常见，而黏膜侵犯较支气管成形Lob/Seg组少见。三组间所有特定肺部并发症的发生率和30天死亡率相似。肺切除术组、Lob/Seg组和支气管成形Lob/Seg组的5年总生存率分别为23.7%、51.5%和72.8%（P = 0.0004）。黏膜型和黏膜下型肺癌患者的生存率存在显著差异（P = 0.0114）。
支气管成形肺叶/肺段切除术可行，且手术并发症风险不高，长期生存率也不低。肿瘤扩展的性质在手术方式选择和生存预测中很重要。
