Misthos P, Papagiannakis G, Kokotsakis J, Lazopoulos G, Skouteli E, Lioulias A
Sismanogleio General Hospital, Thoracic Surgery Department, Athens, Greece.
Lung Cancer. 2007 May;56(2):223-7. doi: 10.1016/j.lungcan.2006.12.008. Epub 2007 Jan 16.
Invasion of mediastinal structures (T4) is considered as an absolute contraindication to surgical management of non-small cell lung cancer (NSCLC). The authors studied the role of surgical treatment in case of direct aortic and superior venous caval involvement.
From 1995 to 2000, 13 patients with left lung NSCLC invading descending aorta and 9 patients with right upper lobe NSCLC and superior vena cava (SVC) invasion were subjected to thoracotomy for lung resection. Surgery was indicated in case of absence of intraluminal extension. All patients were cN2 negative. The pathology results and 5-year survival were recorded and analyzed.
In three cases (23%) the tumor was adhered to the parietal pleura overlying descending aorta, which was resected en block with tumor-associated lung parenchyma. Aortic adventitia invasion by tumor led to local resection of adventitia (<1cm(2)) in nine patients (69%). Invasion deeper than adventitia was encountered in one case (8%), which was managed with aortic partial occlusion, resection of aortic wall and repair of the defect with Gore graft patch. In three patients (33%) the SVC wall was involved by the tumor 1-3cm in length and 2-4mm of the circumference. The defect was repaired with direct suturing. In five patients (56%) the area of SVC wall that was invaded was 3cmx2cm. The defect was repaired with Dacron patch. In 1 patient (11%) an arterial 14 graft was end-to-end interposed. All resections were radical (R0). Neither associated postoperative complications nor operative mortality was recorded. Five-year survival was 30.7% for the cases with aortic invasion and 11% for the ones with SVC involvement.
Radical surgical resection of lung tumors with localized aortic invasion can be considered after exclusion of N2 involvement.
纵隔结构侵犯（T4）被视为非小细胞肺癌（NSCLC）手术治疗的绝对禁忌证。作者研究了在主动脉和上腔静脉直接受累情况下手术治疗的作用。
1995年至2000年，13例左肺NSCLC侵犯降主动脉以及9例右上叶NSCLC侵犯上腔静脉（SVC）的患者接受了开胸肺切除术。若不存在腔内扩展则考虑手术。所有患者cN2均为阴性。记录并分析病理结果和5年生存率。
3例（23%）肿瘤与覆盖降主动脉的脏层胸膜粘连，与肿瘤相关的肺实质一并整块切除。9例（69%）患者肿瘤侵犯主动脉外膜，导致外膜局部切除（<1cm²）。1例（8%）患者侵犯深度超过外膜，采用主动脉部分阻断、主动脉壁切除并用戈尔补片修复缺损处理。3例（33%）患者SVC壁受肿瘤侵犯，长度为1 - 3cm，圆周范围为2 - 4mm。缺损采用直接缝合修复。5例（56%）患者SVC壁受侵犯面积为3cm×2cm。缺损采用涤纶补片修复。1例（11%）患者行端端插入动脉移植物。所有切除均为根治性（R0）。未记录到相关术后并发症及手术死亡率。主动脉侵犯病例的5年生存率为30.7%，SVC受累病例为11%。
排除N2受累后，可考虑对局限性主动脉侵犯的肺肿瘤进行根治性手术切除。
