Chamogeorgakis Themistokles, Ieromonachos Costas, Georgiannakis Emmanouil, Mallios Dimitrios
Department of Cardiothoracic Surgery, Attikon Hospital, University of Athens, Haidari, Greece.
Interact Cardiovasc Thorac Surg. 2009 Mar;8(3):364-72. doi: 10.1510/icvts.2008.178947. Epub 2008 Jul 18.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: 'Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients?' Altogether 225 papers were found using the reported search, of which nineteen represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A meta-analysis published in 2005 showed a 0.7% (P=0.3659) survival difference at one year, 1.9% (P=0.5088) at three years and 3.6% (P=0.3603) at five years. The largest study prior to the meta-analysis was a randomized controlled study of 247 patients with T1N0 tumors that showed eight locoregional recurrences in the lobectomy group compared to 21 in the sublobar group, which was statistically significant. Since the meta-analysis we identified three studies, two of which showed no difference in survival and recurrence between wedge resection and lobectomy for T1N0 tumors and one that showed improved survival after lobectomy compared to wedge resection for T1N0 tumors. We conclude that wedge resection is not comparable to lobectomy for stage IA NSCLC. The increased long-term mortality associated with wedge resection is mainly due to non-cancer deaths, reflecting a higher risk patient group with many comorbid conditions. Segmental resection is comparable to lobectomy for small peripheral tumors. Sublobar resection is associated with shorter hospital stay. For bronchioalveolar carcinoma sublobar resection is recommended provided intra-operative pathologic consultation confirms pure bronchioalveolar histology without evidence of invasion, and surgical margins are free of disease.
根据结构化方案撰写了一篇心脏外科的最佳证据主题文章。所探讨的问题是：“对于T1N0M0非小细胞肺癌患者，肺叶切除术在生存率和复发率方面是否比有限肺切除术更佳？”通过报告的检索共找到225篇论文，其中19篇代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、发表日期、国家、研究的患者组、研究类型、相关结局和结果制成表格。2005年发表的一项荟萃分析显示，一年时生存率差异为0.7%（P = 0.3659），三年时为1.9%（P = 0.5088），五年时为3.6%（P = 0.3603）。荟萃分析之前最大的一项研究是对247例T1N0肿瘤患者进行的随机对照研究，结果显示肺叶切除组有8例局部区域复发，而肺叶以下切除组有21例，具有统计学意义。自荟萃分析以来，我们确定了三项研究，其中两项显示T1N0肿瘤楔形切除术和肺叶切除术在生存率和复发率方面无差异，另一项显示T1N0肿瘤肺叶切除术后生存率优于楔形切除术。我们得出结论，对于IA期非小细胞肺癌，楔形切除术与肺叶切除术不可比。与楔形切除术相关的长期死亡率增加主要归因于非癌症死亡，这反映了一个合并症较多的高风险患者群体。对于小的周围型肿瘤，肺段切除术与肺叶切除术相当。肺叶以下切除术与住院时间较短相关。对于细支气管肺泡癌，若术中病理会诊确认组织学类型为纯细支气管肺泡癌且无浸润证据，手术切缘无病变，则建议行肺叶以下切除术。
