Kilic Arman, Schuchert Matthew J, Pettiford Brian L, Pennathur Arjun, Landreneau James R, Landreneau Joshua P, Luketich James D, Landreneau Rodney J
Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
Ann Thorac Surg. 2009 Jun;87(6):1662-6; discussion 1667-8. doi: 10.1016/j.athoracsur.2009.02.097.
Anatomic segmentectomy for stage I non-small cell lung cancer (NSCLC) offers the potential of surgical cure with preservation of lung function. This may be of particular importance in elderly NSCLC patients with declining cardiopulmonary status and a limited life expectancy.
The study compared outcomes of 78 elderly patients (aged > 75 years) with stage I NSCLC undergoing segmentectomy and 106 undergoing lobectomy for stage I NSCLC from 2002 to 2007. Primary outcome variables included perioperative morbidity and mortality, hospital course, recurrence patterns, and survival.
Age, gender, tumor histology, and surgical approach were similar between groups. Comorbidities were similar except for a higher incidence of chronic obstructive pulmonary disease and diabetes in segmentectomy patients. The tumors in the lobectomy group were significantly larger (3.5 vs 2.5 cm, p = 0.0001). Operative mortality was 1.3% for segmentectomy and 4.7% for lobectomy. Segmentectomy patients had fewer major complications (11.5% vs 25.5%, p = 0.02). There were no differences in median hospitalization (7 vs 6 days). The estimated overall survival at 2, 3, and 5 years was 76%, 69%, and 46% for segmentectomy patients and 68%, 59%, and 47% for lobectomy patients (p = 0.28). The 5-year disease-free survival was equivalent (segmentectomy, 49.8%; lobectomy, 45.5%; p = 0.80).
Anatomic segmentectomy can be performed safely in elderly patients with early-stage NSCLC. This approach is associated with reduced perioperative complications and comparable oncologic efficacy compared with lobectomy in older patients with a limited life expectancy.
对于Ⅰ期非小细胞肺癌（NSCLC），解剖性肺段切除术有望实现手术治愈并保留肺功能。这对于心肺功能逐渐下降且预期寿命有限的老年NSCLC患者可能尤为重要。
该研究比较了2002年至2007年间78例接受肺段切除术的Ⅰ期NSCLC老年患者（年龄>75岁）和106例接受肺叶切除术的Ⅰ期NSCLC老年患者的治疗结果。主要结局变量包括围手术期发病率和死亡率、住院过程、复发模式和生存率。
两组患者的年龄、性别、肿瘤组织学和手术方式相似。合并症情况相似，但肺段切除术患者慢性阻塞性肺疾病和糖尿病的发病率较高。肺叶切除术组的肿瘤明显更大（3.5 vs 2.5 cm，p = 0.0001）。肺段切除术的手术死亡率为1.3%，肺叶切除术为4.7%。肺段切除术患者的主要并发症较少（11.5% vs 25.5%，p = 0.02）。中位住院时间无差异（7天 vs 6天）。肺段切除术患者2年、3年和5年的估计总生存率分别为76%、69%和46%，肺叶切除术患者分别为68%、59%和47%（p = 0.28）。5年无病生存率相当（肺段切除术，49.8%；肺叶切除术，45.5%；p = 0.80）。
解剖性肺段切除术可在老年早期NSCLC患者中安全进行。与肺叶切除术相比，这种方法在预期寿命有限的老年患者中与围手术期并发症减少以及相当的肿瘤学疗效相关。
