Xie Ming-Ran, Zhang Xu, Lin Peng, Chen Jie-Xin, Ling Yong-Bin, Fu Jian-Hua, Rong Tie-Hua, Zeng Can-Guang, Huang Zhi-Fan
State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China.
Ai Zheng. 2009 Aug;28(8):868-71. doi: 10.5732/cjc.009.10028.
Pneumonectomy has been long term used as the standard surgical procedure for central type non-small cell lung cancer (NSCLC). Sleeve lobectomy has been performed in a small number of patients meeting the indications. This study was to compare the 5-year survival rate, operation related complications and mortality of sleeve lobectomy with pneumonectomy for NSCLC, and evaluate sleeve lobectomy in the surgical treatment for NSCLC.
Ninety-three patients with NSCLC undergoing sleeve lobectomy (group A) and 571 patients with NSCLC undergoing pneumonectomy (group B) from January 1997 to December 2007 in Sun Yat-sen University Cancer Center were reviewed. The 5-year survival rate, operation related complications and mortality between the two groups were analyzed.
The overall 5-year survival for group A and group B were 42.0% and 31.5%, respectively (P=0.015). In the subgroup analysis, the 5-year survival of N0 (P=0.007) and N1 (P=0.025) patients were significant higher in group A than in group B, while the survival were not significantly different between N2 patients (P=0.073). The 5-year survival rates for bronchial and pulmonary arterial sleeve resection (the subset of group A) and pneumonectomy were not significantly different (P=0.092). There was no significant difference in local recurrences between the groups (P=0.821). The postoperative complication rates were 11.8% in group A and 20.7% in group B (P=0.046). There was no statistically significant difference in mortality between the two groups (P=0.259).
The operative safety and long term efficacy of sleeve lobectomy are superior to pneumonectomy for NSCLC.
肺切除术长期以来一直是中央型非小细胞肺癌（NSCLC）的标准外科手术。少数符合适应证的患者接受了袖状肺叶切除术。本研究旨在比较NSCLC患者行袖状肺叶切除术与肺切除术的5年生存率、手术相关并发症及死亡率，并评估袖状肺叶切除术在NSCLC外科治疗中的价值。
回顾性分析1997年1月至2007年12月在中山大学肿瘤防治中心接受袖状肺叶切除术的93例NSCLC患者（A组）和接受肺切除术的571例NSCLC患者（B组）。分析两组患者的5年生存率、手术相关并发症及死亡率。
A组和B组的总体5年生存率分别为42.0%和31.5%（P = 0.015）。亚组分析显示，A组N0（P = 0.007）和N1（P = 0.025）患者的5年生存率显著高于B组，而N2患者的生存率在两组间无显著差异（P = 0.073）。支气管和肺动脉袖状切除术（A组的一个亚组）与肺切除术的5年生存率无显著差异（P = 0.092）。两组间局部复发率无显著差异（P = 0.821）。A组术后并发症发生率为11.8%，B组为20.7%（P = 0.046）。两组间死亡率无统计学显著差异（P = 0.259）。
对于NSCLC患者，袖状肺叶切除术的手术安全性和长期疗效优于肺切除术。
