Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.
Eur J Cardiothorac Surg. 2013 Mar;43(3):568-72. doi: 10.1093/ejcts/ezs323. Epub 2012 Jun 1.
A sleeve lobectomy is a widely accepted procedure for enabling the pulmonary parenchyma to be spared. Induction chemoradiotherapy (CRT) followed by surgery is one treatment option for locally advanced non-small cell lung cancer (NSCLC), but CRT is considered to have a negative effect on subsequent surgery, especially for anastomotic healing. In this study, we describe our experience performing sleeve lobectomies and the associated anastomotic complications after induction CRT.
The medical records of NSCLC patients who underwent surgery after receiving CRT were reviewed. The relationships between anastomotic complications and clinicopathological factors were examined.
Between December 1998 and October 2011, a total of 104 patients received CRT followed by surgery. Among them, 14 NSCLC patients underwent a bronchial sleeve resection: nine patients underwent a right upper lobe resection, two patients underwent a left lingular division and lower lobe resection and one patient each underwent a right lower lobe, a right upper and middle lobe and a right middle and lower lobe resection. A bronchopleural fistula at the anastomosis occurred in two patients. A pulmonary arterial (PA) branch to the spared lobe had been sacrificed in both of these patients because of tumour involvement. In contrast, the PA branches to the spared lobes were preserved in 11 of the 12 patients who did not exhibit anastomotic complications (P = 0.033).
Our experience strongly suggests that the sacrifice of the PA branch to the spared lobe is a possible risk factor for anastomotic complications for a sleeve lobectomy after induction CRT.
袖状肺叶切除术被广泛认为是一种能够保留肺实质的手术方法。诱导放化疗（CRT）后再进行手术是局部晚期非小细胞肺癌（NSCLC）的一种治疗选择，但 CRT 被认为对随后的手术有负面影响，尤其是对吻合口愈合。在这项研究中，我们描述了我们在接受 CRT 后进行袖状肺叶切除术和相关吻合口并发症的经验。
回顾了接受 CRT 后接受手术的 NSCLC 患者的病历。检查了吻合口并发症与临床病理因素之间的关系。
1998 年 12 月至 2011 年 10 月期间，共有 104 例患者接受 CRT 后接受手术。其中，14 例 NSCLC 患者接受了支气管袖状切除术：9 例接受了右上叶切除术，2 例接受了左下舌叶和下叶切除术，1 例接受了右下叶、右上叶和中叶以及右中叶和下叶切除术。两名患者在吻合处发生支气管胸膜瘘。由于肿瘤累及，这两名患者的保留肺叶的肺动脉（PA）分支被牺牲。相比之下，在 12 例未出现吻合口并发症的患者中，有 11 例保留了保留肺叶的 PA 分支（P = 0.033）。
我们的经验强烈表明，在接受 CRT 后进行袖状肺叶切除术中，牺牲保留肺叶的 PA 分支可能是吻合口并发症的一个危险因素。
