Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15232, USA.
Ann Thorac Surg. 2012 Jun;93(6):1780-5; discussion 1786-7. doi: 10.1016/j.athoracsur.2011.11.074. Epub 2012 Apr 6.
Anatomic segmentectomy is a versatile sublobar resection approach that can be both diagnostic and therapeutic in the setting of the indeterminate pulmonary nodule (IPN), metastasectomy, as well as small, peripheral cancers. We analyzed the clinical indications and perioperative outcomes after anatomic segmentectomy and explored its utility in the diagnosis and treatment of IPNs and small stage IA lung cancers.
This study is a retrospective review of 785 consecutive patients undergoing anatomic segmentectomy from 2002 to 2010. Primary outcome variables include perioperative course, morbidity, mortality, recurrence patterns, and survival.
Surgical indications included IPN (62.4%), known lung cancer (27.6%), suspected metastasis (4.1%), bullous disease (3.7%), or other (2.2%). Video-assisted thoracic surgery was employed in 468 (59.6%) and open thoracotomy in 317 (40.4%) patients. Median length of stay was 6 days. Overall complication rate was 34.9%. Thirty-day mortality was 1.1%. Among 490 patients with an IPN, 381 (77.7%) were found to have lung cancer, 41 (8.4%) metastatic cancer, and 68 (13.9%) benign disease. Among patients with pathologic stage IA lung cancer, there was no difference in recurrence rates (14.5% vs 13.9%) or 5-year freedom from recurrence estimates (78% in each group, p=0.738) when comparing segmentectomy and lobectomy.
Anatomic segmentectomy provides acceptable morbidity and mortality when approaching the IPN. Cancer is identified in 86% of lesions. Complete surgical resection can be achieved with generous parenchymal margins and thorough nodal staging for small, peripheral stage IA non-small cell lung cancer. The use of anatomic segmentectomy should be considered in this era of competing image-guided diagnostic and therapeutic approaches to peripheral lung pathology.
解剖性肺段切除术是一种多用途的亚肺叶切除术方法，在不确定的肺结节（IPN）、转移瘤切除术以及小的、外周性癌症中既可以起到诊断作用，也可以起到治疗作用。我们分析了解剖性肺段切除术后的临床适应证和围手术期结果，并探讨了其在 IPN 和小 I 期非小细胞肺癌的诊断和治疗中的应用。
本研究是对 2002 年至 2010 年间连续 785 例接受解剖性肺段切除术的患者进行的回顾性分析。主要观察指标包括围手术期过程、发病率、死亡率、复发模式和生存情况。
手术适应证包括 IPN（62.4%）、已知肺癌（27.6%）、疑似转移（4.1%）、大疱性疾病（3.7%）或其他（2.2%）。468 例（59.6%）采用电视胸腔镜手术，317 例（40.4%）采用开胸手术。中位住院时间为 6 天。总并发症发生率为 34.9%。30 天死亡率为 1.1%。在 490 例 IPN 患者中，381 例（77.7%）发现肺癌，41 例（8.4%）发现转移性癌，68 例（13.9%）发现良性疾病。在病理 I 期非小细胞肺癌患者中，肺段切除术和肺叶切除术的复发率（14.5%比 13.9%）或 5 年无复发率估计值（两组均为 78%，p=0.738）均无差异。
在处理 IPN 时，解剖性肺段切除术具有可接受的发病率和死亡率。86%的病变可以明确诊断为癌症。对于小的、外周性 I 期非小细胞肺癌，可以通过充分的肺实质边缘切除和彻底的淋巴结分期来实现完全的外科切除。在这个竞争激烈的影像引导诊断和治疗外周肺疾病的时代，应考虑采用解剖性肺段切除术。
