Department of General Thoracic Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2012 Apr;143(4):820-4. doi: 10.1016/j.jtcvs.2011.10.045. Epub 2011 Nov 20.
To examine the role of radical segmentectomy, defined as a segmentectomy with extensive hilar/mediastinal lymph node dissection and a sufficient surgical margin, for local control in cT1 N0 M0/pN1-2 non-small cell lung cancer (NSCLC), we examined the following: (1) whether metastases were observed in specimens additionally resected by completion lobectomy undertaken after segmentectomy because of pN1-2 disease and (2) prognostic outcome in patients whose operations were completed with segmentectomy regardless of pN1-2.
Of 275 patients with cT1 N0 M0 NSCLC who were scheduled to undergo radical segmentectomy, 15 (6%) had a diagnosis of pN1 or N2 disease. Of these patients, 10 were additionally treated with completion lobectomy, whereas the operations of the remaining 5 were completed with segmentectomy.
None of the 10 patients who underwent completion lobectomy showed residual metastases in the specimens additionally resected by completion lobectomy. Two of the 5 patients whose operations were completed with segmentectomy, regardless of N1 or N2 disease, had tumor recurrence, but their first recurrence was not local.
Radical segmentectomy, with extensive hilar/mediastinal lymph node dissection and a sufficient surgical margin, may play a role in local control in patients with cT1 N0 M0/pN1-2 NSCLC.
研究广泛的肺门/纵隔淋巴结清扫和足够的手术切缘的根治性节段切除术（定义为节段切除术伴广泛的肺门/纵隔淋巴结清扫和足够的手术切缘）在 cT1N0M0/pN1-2 非小细胞肺癌（NSCLC）局部控制中的作用，我们研究了以下内容：（1）是否在因 pN1-2 疾病而行节段切除术之后行完成性肺叶切除术额外切除的标本中观察到转移；（2）无论 pN1-2 如何，节段切除术完成后患者的预后结局。
在 275 例计划行根治性节段切除术的 cT1N0M0 NSCLC 患者中，有 15 例（6%）诊断为 pN1 或 N2 疾病。这些患者中有 10 例额外接受了完成性肺叶切除术治疗，而其余 5 例的手术则完成了节段切除术。
在接受完成性肺叶切除术的 10 例患者中，没有 1 例在额外切除的标本中发现残留转移。5 例无论 N1 或 N2 疾病均完成节段切除术的患者中有 2 例出现肿瘤复发，但首次复发并非局部复发。
广泛的肺门/纵隔淋巴结清扫和足够的手术切缘的根治性节段切除术可能在 cT1N0M0/pN1-2 NSCLC 患者的局部控制中发挥作用。
