Iwasaki A, Hamatake D, Hamanaka W, Hamada T, Shirakusa T, Yamamoto S, Shiraishi T
Department of Thoracic Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan.
Thorac Cardiovasc Surg. 2008 Feb;56(1):37-41. doi: 10.1055/s-2007-965057.
The therapeutic role of systematic node dissection (SND) for early lung cancer remains controversial. Elderly patients have a background of insufficient physiological function and comorbidity, and a shorter life expectancy than that of younger patients. Therefore, we have evaluated the impact on survival, local recurrence, and complications of not performing systematic lymph node dissection in the elderly.
A retrospective analysis of 126 patients, including the elderly (75 - 89 years), who underwent a lobectomy for clinical stage I was performed. The patients were grouped according to node dissection numbers after surgery, and finally separated into two groups (SG: sufficient group, dissections of more than 10 nodes and 3 or more mediastinal stations; IG: insufficient group, less than 10 nodes and one or two mediastinal stations). Postoperative morbidity and sites of recurrence were evaluated between the two groups, and the survival rates were analyzed at 5 years.
Upstage was identified in 12.6% of patients: 7.3% in IG (n = 45), 15.2% in SG (n = 86). Postoperative mortality occurred in 2 cases (1.58%). The incidence of postoperative respiratory or cardiac complications was more frequent in the SG, while there were fewer complications in the IG. There was no significant difference in recurrence rates between the two groups. Both local and distant recurrence was observed in the two groups. The 5-year survival rates were 61.5% for the SG and 59.4% for the IG. There was no significant difference in the survival rate between the IG and SG patients.
Proper staging and the avoidance of nontherapeutic lymph node dissection seems acceptable for clinical stage I lung cancer in the group of elderly patients.
系统性淋巴结清扫术（SND）对早期肺癌的治疗作用仍存在争议。老年患者存在生理功能不足和合并症的背景，预期寿命比年轻患者短。因此，我们评估了不对老年患者进行系统性淋巴结清扫对生存、局部复发和并发症的影响。
对126例临床I期接受肺叶切除术的老年患者（75 - 89岁）进行回顾性分析。根据术后淋巴结清扫数量对患者进行分组，最终分为两组（SG：充分组，清扫淋巴结超过10个且纵隔站数为3个或更多；IG：不充分组，清扫淋巴结少于10个且纵隔站数为1个或2个）。评估两组之间的术后发病率和复发部位，并分析5年生存率。
12.6%的患者出现分期上调：IG组（n = 45）为7.3%，SG组（n = 86）为15.2%。术后死亡2例（1.58%）。SG组术后呼吸或心脏并发症的发生率更高，而IG组并发症较少。两组之间的复发率无显著差异。两组均观察到局部和远处复发。SG组的5年生存率为61.5%，IG组为59.4%。IG组和SG组患者的生存率无显著差异。
对于老年患者中的临床I期肺癌，适当分期并避免进行非治疗性淋巴结清扫似乎是可以接受的。
