Chadeyras J-B, Mazel C, Grunenwald D
Service de Chirurgie Générale à Orientation Thoracique, CHU Gabriel-Montpied, 58, rue Montalembert, 63000 Clermont-Ferrand, France.
Ann Chir. 2006 Dec;131(10):616-22. doi: 10.1016/j.anchir.2006.06.012. Epub 2006 Jul 5.
To report a single-institution retrospective study of radical en bloc resection for lung cancer invading the spine.
Between 1993 and 2004, 32 patients underwent partial or total vertebrectomy for non-small cells lung cancer with spinal extension. Twenty-one received induction treatment (chemotherapy, N=16; radiation, N=1 and chemoradiotherapy, N=4). Pneumonectomy was performed in 3 patients, lobectomy in 26 patients and wedge resection in 3 patients. Partial vertebrectomy was performed in 26 patients and total vertebrectomy was performed in 6 patients. Tumor stage was IIb in 9 patients, IIIa in 2 patients and IIIb in 21 patients.
There was no immediate postoperative mortality. Major morbidity was observed in 10 patients (31%), including 4 complications related to spinal surgery. For 28 patients, a completed resection was achieved (87%). 2-years survival was 65% and 5-years survival was 24%. Completed resection and induction chemotherapy appear to be determinant prognostics factors (respectively p=0,01 and p=0,04 in univariate analysis).
Radical en bloc resection with vertebrectomy for lung cancer is technically demanding. Encouraging long-term survival suggest that this surgical approach could be a valid option for selected patients with vertebral involvement of lung cancer.
报告一项关于肺癌侵犯脊柱行整块根治性切除术的单机构回顾性研究。
1993年至2004年间，32例患者因非小细胞肺癌脊柱侵犯接受了部分或全椎体切除术。21例接受了诱导治疗（化疗，16例；放疗，1例；放化疗，4例）。3例行全肺切除术，26例行肺叶切除术，3例行楔形切除术。26例行部分椎体切除术，6例行全椎体切除术。肿瘤分期为IIb期9例，IIIa期2例，IIIb期21例。
术后无即刻死亡。10例患者（31%）出现严重并发症，其中4例与脊柱手术相关。28例患者（87%）实现了完整切除。2年生存率为65%，5年生存率为24%。完整切除和诱导化疗似乎是决定性的预后因素（单因素分析中分别为p=0.01和p=0.04）。
肺癌行椎体整块根治性切除术技术要求高。令人鼓舞的长期生存率表明，这种手术方法对于选定的肺癌侵犯椎体患者可能是一种有效的选择。
