De Leyn Paul, Moons Johnny, Vansteenkiste Johan, Verbeken Eric, Van Raemdonck Dirk, Nafteux Philippe, Decaluwe Herbert, Lerut Tony
Department of Thoracic Surgery, University Hospitals and Leuven Lung Cancer Group, Herestraat 49, 3000 Leuven, Belgium.
Eur J Cardiothorac Surg. 2008 Dec;34(6):1215-22. doi: 10.1016/j.ejcts.2008.07.069. Epub 2008 Oct 1.
Due to recent advances in imaging, the incidence of patients presenting with bilateral lung lesions is increasing. A single contralateral lung lesion can be an isolated metastasis or a synchronous second primary lung cancer. For the revision of the TNM in 2009, the International Association for the Study of Lung Cancer Staging Committee proposes that patients with contralateral lung nodules remain classified as M1 disease. In this retrospective study, the survival after resection of synchronous bilateral lung cancer is evaluated.
From our database of bronchial carcinoma, all patients with bilateral synchronous lung lesions between 1990 and 2007 were retrieved. We analysed 57 patients in which, after functional assessment and thorough staging, the decision was taken to treat the disease with bilateral resection. All these files were retrospectively reviewed. Twenty-one patients were excluded from this analysis because only one side was resected (n=15) or one of the lesions was non-neoplastic on final pathology (n=6).
Thirty-six patients underwent bilateral resection for synchronous multiple primary lung cancer. All resections were performed as sequential procedures. In 23 patients, one side was anatomically resected (2 pneumonectomies) and the contralateral side was resected by limited resection. In 10 patients a bilateral lobectomy was performed, and 3 patients had bilateral limited resections. Postoperative mortality was 2.8%. Eighteen patients had a tumour with a different histological pattern, confirmed by comparing both specimens by an experienced senior pathologist. The median survival after resection of synchronous bilateral lung cancer in our series was 25.4 months with a 5-year survival rate of 38%. There was no significant difference in survival between patients with different versus same histology. This survival is much higher compared to the survival of assumed stage IV disease.
Our study shows that selected patients with bilateral lung cancer may benefit from an aggressive approach, with acceptable morbidity and mortality, and rewarding long-term survival. Patients with a single contralateral lung lesion should not be treated as disseminated disease (stage IV). After extensive searching for metastatic spread, bilateral surgical resection should be considered in fit patients.
由于近期影像学的进展，双侧肺病变患者的发病率正在上升。单个对侧肺病变可能是孤立性转移瘤或同步性第二原发性肺癌。在2009年修订TNM时，国际肺癌研究协会分期委员会提议，对侧肺结节患者仍归类为M1期疾病。在这项回顾性研究中，评估了同步性双侧肺癌切除术后的生存率。
从我们的支气管癌数据库中，检索出1990年至2007年间所有双侧同步性肺病变患者。我们分析了57例患者，这些患者在经过功能评估和全面分期后，决定采用双侧切除术治疗该疾病。所有这些病例均进行了回顾性审查。21例患者被排除在本分析之外，原因是仅切除了一侧（n = 15）或其中一个病变在最终病理检查中为非肿瘤性（n = 6）。
36例患者因同步性多原发性肺癌接受了双侧切除术。所有切除均按序贯程序进行。23例患者中，一侧进行了解剖性切除（2例全肺切除术），对侧通过局限性切除。10例患者进行了双侧肺叶切除术，3例患者进行了双侧局限性切除。术后死亡率为2.8%。18例患者的肿瘤具有不同的组织学类型，经经验丰富的资深病理学家对两个标本进行比较得以证实。我们系列中同步性双侧肺癌切除术后的中位生存期为25.4个月，5年生存率为38%。不同组织学类型与相同组织学类型患者的生存率无显著差异。与假定的IV期疾病生存率相比，该生存率要高得多。
我们的研究表明，部分双侧肺癌患者可能从积极的治疗方法中获益，其发病率和死亡率可接受，且长期生存效果良好。单个对侧肺病变患者不应被视为播散性疾病（IV期）。在广泛寻找转移扩散后，适合的患者应考虑双侧手术切除。
