Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania 15232, USA.
Ann Thorac Surg. 2012 Mar;93(3):929-35; discussion 935-6. doi: 10.1016/j.athoracsur.2011.09.047.
Anatomic segmentectomy has been proposed as a reasonable alternative to lobectomy in the management of small early-stage non-small cell lung cancers. We reviewed our outcomes with anatomic segmentectomy versus lobectomy for stages IA and IB non-small cell lung cancer stratified by age and stage.
We conducted a retrospective review of prospectively-collected data analyzing outcomes after anatomic segmentectomy (n=305) for stage IA (n=187) or IB (n=118) NSCLC from 1999 to 2010. Lobectomy was performed in 594 patients for stage IA (n=290) and IB (n=304) disease during the same period. Surgical approach was stratified by stage and by the following age groups: less than 70, 70 to 79, and 80 or greater. Primary outcome variables included complications, mortality, recurrence patterns, and survival. Mean follow-up was 37 months.
Segmentectomy was associated with reduced complications (43.6% vs 58.7%) and mortality (0% vs 7.8%) in patients greater than 80 years old, without a difference in recurrence rates. There was no difference in complications or mortality in the younger age groups. Freedom from recurrence was similar between segmentectomy and lobectomy for stage IA tumors across all age groups. A reduced recurrence-free survival was seen with segmentectomy for stage IB tumors, especially with visceral pleural invasion (median 22.7 vs 29.6 months), p=0.048).
Segmentectomy appears to be a reasonable approach for early-stage NSCLC in patients 80 years of age or greater due to reduced morbidity and mortality with equivalent freedom from recurrence. Although equivalent survival was seen in all age groups for stage IA, these data further support the use of lobectomy for resection of stage IB tumors.
解剖性肺段切除术已被提议作为小的早期非小细胞肺癌的治疗方法，以替代肺叶切除术。我们对解剖性肺段切除术（n=305）与肺叶切除术（n=594）治疗 I 期和 II 期非小细胞肺癌（NSCLC）的结果进行了回顾性研究，这些病例根据年龄和分期进行分层。
我们对 1999 年至 2010 年期间前瞻性收集的资料进行了回顾性分析，这些资料包括 305 例接受解剖性肺段切除术治疗的 I 期（n=187）或 II 期（n=118）NSCLC 患者。同期，有 594 例患者接受肺叶切除术治疗 I 期（n=290）和 II 期（n=304）疾病。手术方式根据分期和以下年龄组进行分层：<70 岁、70-79 岁和≥80 岁。主要的观察变量包括并发症、死亡率、复发模式和生存情况。平均随访时间为 37 个月。
对于年龄大于 80 岁的患者，肺段切除术与并发症（43.6% vs 58.7%）和死亡率（0% vs 7.8%）的降低相关，而复发率没有差异。在年轻的年龄组中，并发症或死亡率没有差异。在所有年龄组中，IA 期肿瘤的段切除术与肺叶切除术的无复发生存率相似。对于 IB 期肿瘤，段切除术的无复发生存率降低，尤其是合并脏层胸膜侵犯时（中位 22.7 与 29.6 个月），p=0.048）。
对于 80 岁或以上的早期 NSCLC 患者，肺段切除术似乎是一种合理的方法，因为它可以降低发病率和死亡率，同时具有相当的无复发率。虽然 IA 期所有年龄组的生存情况相同，但这些数据进一步支持使用肺叶切除术切除 IB 期肿瘤。
