Sherwood J Timothy, Brock Malcolm V
Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Respirology. 2007 May;12(3):326-32. doi: 10.1111/j.1440-1843.2007.01083.x.
Over the past two decades, many surgical specialties have seen a dramatic shift from large, open operations with wide incisions towards more-minimal incisions and less-invasive procedures. Surgical techniques for lung cancer are no exception, and today, video-assisted thoracic surgical lobectomies are being performed with increasing frequency in large-volume thoracic practices. Despite these new surgical techniques, however, the most substantial innovations that have changed surgical outcomes occurred away from the operative theatre. In lung cancer, in particular, the last 20 years have witnessed the clinical debut of more sophisticated, more elegant and more accurate imaging modalities for improved screening, diagnostic and staging, such as the spiral CT scan, PET scan, PET/CT and the endobronchial ultrasound machine. This technology has been complimented by more targeted chemotherapeutic regimens, novel methods of administering more accurate and more concentrated doses of radiation therapy, and innovative local excisional methods, such as the Cyberknife and radiofrequency ablation. The result has been that surgical excision, although remaining the most effective local therapeutic modality in early-stage lung cancer, is no longer the 'lone ranger' treatment, but rather is part of a complex mosaic of multimodality therapy. As scientific advances continue to be translated into the clinic, this trend will inexorably continue with the advent of a molecular staging system using molecular markers and tumour profiling, which ultimately could enhance our ability to predict tumour chemosensitivity. In this brave new world, however, complete surgical resection of the lung cancer will continue to be critical.
在过去二十年中，许多外科专业领域都经历了显著转变，从需要做大切口的大型开放性手术转向切口更小、侵入性更低的手术。肺癌的手术技术也不例外，如今，在大型胸外科手术中，电视辅助胸腔镜肺叶切除术的开展频率越来越高。然而，尽管有这些新的手术技术，但对外科手术结果产生重大影响的最实质性创新却并非发生在手术室。特别是在肺癌领域，过去20年见证了更先进、更精巧、更精确的成像模式在临床的首次应用，用于改进筛查、诊断和分期，如螺旋CT扫描、PET扫描、PET/CT以及支气管内超声仪。这项技术得到了更具针对性的化疗方案、给予更精确、更集中剂量放射治疗的新方法以及创新的局部切除方法（如射波刀和射频消融）的补充。结果是，手术切除虽然仍是早期肺癌最有效的局部治疗方式，但不再是“唯一”的治疗方法，而是多模式治疗复杂组合的一部分。随着科学进步不断转化为临床应用，随着使用分子标记和肿瘤分析的分子分期系统的出现，这一趋势将不可避免地持续下去，这最终可能会提高我们预测肿瘤化疗敏感性的能力。然而，在这个全新的世界里，肺癌的完整手术切除仍将至关重要。
