Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Thorac Cardiovasc Surg. 2010 Dec;140(6):1288-93. doi: 10.1016/j.jtcvs.2010.06.011. Epub 2010 Jul 14.
The objective of this study was to assess early and late outcomes of pathologic N1 or N2 disease unexpectedly detected in patients undergoing video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer.
We retrospectively reviewed the clinical and pathologic features of patients with unexpected N1 or N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I disease and their early and late outcomes, including survival and recurrence pattern.
Between 2004 and 2008, 547 patients with clinical stage I disease underwent video-assisted thoracic surgery lobectomy, and of these, 89 were found to have pathologic N1 (n = 49) or N2 (n = 40) disease. No in-hospital mortality was noted during the postoperative period. For patients receiving adjuvant treatment, the median time interval between discharge from surgical intervention and start of adjuvant treatment was 24 days. The median follow-up time was 21.3 months. The 3-year overall survival was 98% for patients with N1 disease and 89% for patients with N2 disease. During follow-up, 33 (37%) patients had a recurrence. The pattern of recurrence was locoregional in 7, distant in 21, and both in 5 patients. The 3-year disease-free survival was 59% for patients with N1 disease and 33% for patients with N2 disease.
For patients with pathologic N1 or N2 disease after video-assisted thoracic surgery lobectomy, survival was comparable with that after lobectomy through a thoracotomy. Even if lymph node metastasis is unexpectedly detected during video-assisted thoracic surgery lobectomy for clinical stage I disease, there is no need to convert to conventional thoracotomy.
本研究旨在评估因临床Ⅰ期非小细胞肺癌行电视辅助胸腔镜手术肺叶切除时意外发现病理 N1 或 N2 疾病的患者的早期和晚期结局。
我们回顾性分析了 547 例临床Ⅰ期疾病患者行电视辅助胸腔镜手术肺叶切除术后意外发现病理 N1（n=49）或 N2（n=40）疾病的患者的临床和病理特征及其早期和晚期结局，包括生存和复发模式。
2004 年至 2008 年，547 例临床Ⅰ期疾病患者接受了电视辅助胸腔镜手术肺叶切除术，其中 89 例患者被发现患有病理 N1 或 N2 疾病。术后无住院期间死亡。接受辅助治疗的患者，从手术干预出院到开始辅助治疗的中位时间间隔为 24 天。中位随访时间为 21.3 个月。N1 疾病患者的 3 年总生存率为 98%，N2 疾病患者为 89%。随访期间，33 例（37%）患者复发。复发模式为局部区域 7 例，远处转移 21 例，局部区域和远处转移各 5 例。N1 疾病患者的 3 年无病生存率为 59%，N2 疾病患者为 33%。
对于临床Ⅰ期疾病行电视辅助胸腔镜手术肺叶切除后病理 N1 或 N2 疾病的患者，生存情况与开胸肺叶切除相当。即使在临床Ⅰ期疾病行电视辅助胸腔镜手术肺叶切除时意外发现淋巴结转移，也无需转为常规开胸手术。
