Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Thorac Cardiovasc Surg. 2012 Sep;144(3):S23-6. doi: 10.1016/j.jtcvs.2012.05.071.
Despite a trend toward sublobar resections for lung cancers, some question the adequacy of limited resections in the treatment of lung cancer and questions remain about performing these procedures by video-assisted thoracoscopic surgery (VATS). We compared the survival for lung cancers treated with VATS segmentectomy versus VATS lobectomy.
VATS segmentectomy and lobectomy for both malignant and benign lung pathology are reviewed from a single institution.
Between 1998 and 2010, 73 VATS trisegmentectomies were performed in 49 women and 24 men (mean age, 72 years). Diagnoses included primary lung cancer (91%), benign disease (4%), and metastatic disease (5%). Primary lung cancers were 68% for stage IA, 17% for stage IB, and 15% for stage II-IV. Seventy-three left upper lobe (LUL) trisegmentectomies were performed. Mean hospital stay after VATS trisegmentectomy was 3.8 days, versus 5.5 days after VATS LUL lobectomy (P = .0736). Complication rates for trisegmentectomy group (37%) and lobectomy (17%; P > .05) were not statistically different. Survival after VATS trisegmentectomy and LUL lobectomy for either stage IA lung cancer or stage IB lung cancer was not statistically significant.
Segmentectomy can be performed by VATS with no greater morbidity and mortality than with VATS lobectomy. LUL trisegmentectomy provides the same survival as lobectomy for stage IA and IB tumors. Our experience supports the use of lingular-sparing trisegmentectomy in the treatment of stage IA and IB lung cancer.
尽管肺肿瘤切除术有向亚肺叶切除术发展的趋势，但仍有人对有限切除术治疗肺肿瘤的充分性提出质疑，而且对于电视辅助胸腔镜手术（VATS）施行此类手术仍存在疑问。我们比较了 VATS 节段切除术与 VATS 肺叶切除术治疗肺肿瘤的生存率。
对单一机构施行的 VATS 节段切除术和肺叶切除术治疗肺良、恶性病变的病例进行了回顾性研究。
1998 年至 2010 年间，49 例女性和 24 例男性共施行 73 例 VATS 三区段切除术（平均年龄 72 岁）。诊断包括原发性肺癌（91%）、良性疾病（4%）和转移性疾病（5%）。原发性肺癌中ⅠA 期占 68%，ⅠB 期占 17%，Ⅱ~Ⅳ期占 15%。共施行 73 例左上叶（LUL）三区段切除术。VATS 三区段切除术后平均住院时间为 3.8 天，而 VATS LUL 肺叶切除术后为 5.5 天（P =.0736）。三区段切除术组（37%）和肺叶切除术组（17%；P >.05）的并发症发生率无统计学差异。VATS 三区段切除术与 LUL 肺叶切除术治疗ⅠA 期或ⅠB 期肺癌的生存率无统计学差异。
VATS 节段切除术的发病率和死亡率与 VATS 肺叶切除术相同。对于ⅠA 期和ⅠB 期肿瘤，LUL 三区段切除术与肺叶切除术的生存率相同。我们的经验支持在治疗ⅠA 期和ⅠB 期肺癌时采用保留舌段的三区段切除术。
