Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Ann Thorac Surg. 2012 Jan;93(1):251-7; discussion 257-8. doi: 10.1016/j.athoracsur.2011.08.086. Epub 2011 Nov 23.
Bilobectomy for lung cancer is considered a high-risk procedure for the increased postoperative complication rate and the negative impact on survival. We analyzed the safety and the oncologic results of this procedure.
We retrospectively reviewed patients who underwent bilobectomy for lung cancer between October 1998 and August 2009. Age, gender, bilobectomy type and indication, complications, pathology, stage, and survival were analyzed.
Bilobectomy was performed on 146 patients (101 men; mean age, 62 years). There were 77 upper-middle and 69 middle-lower bilobectomies. Indications were tumor extending across the fissure in 27 (18.5%) patients, endobronchial tumor in 39 (26.7%), extrinsic tumor or nodal invasion of bronchus intermedius in 66 (45.2%), and vascular invasion in 14 (9.6%). An extended resection was performed in 24 patients (16.4%). Induction therapy was performed in 43 patients (29.4%). Thirty-day mortality was 1.4% (n=2). Overall morbidity was 47.2%. Mean chest tube persistence was 7 days (range, 6 to 46 days). Overall 5-year survival was 58%. Significance differences in survival were observed among different stages (stage I, 70%; stage II, 55%; stage III, 40%; p=0.0003) and the N status (N0, 69%; N1, 56%; N2, 40%; p=0.0005). Extended procedure (p=0.0003) and superior bilobectomy (p=0.0008) adversely influenced survival. Multivariate analysis demonstrated that an extended resection (p=0.01), an advanced N disease (p=0.02), and an upper-mild lobectomy (p=0.02) adversely affected prognosis.
Bilobectomy is associated with a low mortality and an increased morbidity. Survival relates to disease stage and N factor. Optimal prognosis is obtained in patients with lower-middle lobectomy without extension of the resection.
肺癌行肺叶切除术被认为是一种高风险的手术，其术后并发症发生率较高，对生存有负面影响。我们分析了这种手术的安全性和肿瘤学结果。
我们回顾性分析了 1998 年 10 月至 2009 年 8 月期间行肺叶切除术治疗肺癌的患者。分析了年龄、性别、肺叶切除术类型和适应证、并发症、病理学、分期和生存情况。
146 例患者行肺叶切除术（男性 101 例；平均年龄 62 岁）。其中中上叶肺叶切除术 77 例，中下叶肺叶切除术 69 例。适应证为：裂区肿瘤侵犯 27 例（18.5%），支气管内肿瘤 39 例（26.7%），中间支气管外肿瘤或淋巴结侵犯 66 例（45.2%），血管侵犯 14 例（9.6%）。24 例患者行扩大切除术（16.4%）。43 例患者行诱导治疗（29.4%）。30 天死亡率为 1.4%（n=2）。总体并发症发生率为 47.2%。胸腔引流管留置时间平均为 7 天（6~46 天）。总体 5 年生存率为 58%。不同分期（Ⅰ期 70%，Ⅱ期 55%，Ⅲ期 40%，p=0.0003）和 N 状态（N0 69%，N1 56%，N2 40%，p=0.0005）之间的生存差异有统计学意义。扩展手术（p=0.0003）和上叶肺叶切除术（p=0.0008）对生存有不利影响。多因素分析表明，扩大切除术（p=0.01）、进展期 N 疾病（p=0.02）和中上叶肺叶切除术（p=0.02）对预后有不利影响。
肺叶切除术死亡率低，发病率高。生存与疾病分期和 N 因素有关。不扩展切除的中下叶肺叶切除术患者可获得最佳预后。
