Bonnette Pierre
Hôpital Foch, service de chirurgie thoracique, Suresnes, France.
Bull Cancer. 2012 Nov;99(11):1069-75. doi: 10.1684/bdc.2012.1654.
It has been proved that lobectomy for lung cancer of less than 3 cm is superior to sublobar resection (segmentectomy and wedge resection) in the Lung Cancer Study Group trial published in 1995. Lobectomy is therefore recommended, with lymph node resection. Nevertheless, some publications have shown identical or close results after segmentectomy for tumors of less than 2 cm, and after wedge resection for tumors of less than 1 cm. It is likely that local recurrences are avoided by respecting a macroscopic margin of more than 2 cm around the tumor. A new trial comparing lobectomy and sublobar resection has been ongoing since 2007 for tumors of less than 2 cm. Persistent ground glass opacities are now often discovered after screening, either pure or with a small solid component, and correspond to an in situ or a micro-invasive adenocarcinoma, that can be removed with sublobar resection without recurrence.
1995年发表的肺癌研究组试验证明,对于直径小于3厘米的肺癌,肺叶切除术优于肺段以下切除(肺段切除术和楔形切除术)。因此,建议行肺叶切除术并清扫淋巴结。然而,一些研究表明,对于直径小于2厘米的肿瘤,肺段切除术后的结果与之相同或相近;对于直径小于1厘米的肿瘤,楔形切除术后的结果也相近。通过在肿瘤周围保留超过2厘米的宏观切缘,有可能避免局部复发。自2007年以来,一项比较肺叶切除术和肺段以下切除术治疗直径小于2厘米肿瘤的新试验一直在进行。现在,在筛查后经常发现持续性磨玻璃影,可为纯磨玻璃影或伴有小实性成分,对应原位腺癌或微浸润腺癌,可通过肺段以下切除将其切除且不复发。