Saito Hiroshi, Takata Munehisa, Yashiki Noriyoshi
Department of Thoracic Surgery, Koseiren Takaoka Hospital, Takaoka, Japan.
Kyobu Geka. 2013 May;66(5):351-7.
The purpose of this study was to evaluate the characteristics of solitary pulmonary lesion developed after the resection of primary lung cancer and the outcome. Between 1990 and 2011, 1,004 patients underwent complete resection for primary lung cancer in our hospital and we retrospectively analyzed 53 patients with a history of primary lung cancer resection who had a solitary pulmonary lesion. Pulmonary resections were performed in 43 patients. Wedge resection and segmentectomy were performed in 42( 98%) of them. There was no operative death. The diagnosis was 2nd primary lung cancer in 28 patients, recurrent lesion in 9, and benign lesions in 6. Malignant tumor ratio of resected cases was 86%.Other unresected 10 cases were not diagnosed historogically and 9 of them underwent radiation therapy. The 5-year survival rate was 57.3% in those with 2nd primary lung cancer, 55.5% in those with recurrent lesion, and 64.3% in those with undiagnosed-unresected lesions( no significant difference). It is important to take a surgical approach for a diagnosis and to treat with standard therapy for both 2nd primary lung cancer and recurrent lesion. Sublobar resection may be adequate. In patients with a undiagnosed nodule who were not able to have 2nd surgery, radiation therapy may be permitted and effective.
本研究旨在评估原发性肺癌切除术后出现的孤立性肺病变的特征及预后。1990年至2011年间，我院1004例患者接受了原发性肺癌的根治性切除，我们回顾性分析了53例有原发性肺癌切除史且伴有孤立性肺病变的患者。43例患者接受了肺切除术。其中42例（98%）行楔形切除术和肺段切除术。无手术死亡病例。诊断为第二原发性肺癌28例，复发病变9例，良性病变6例。切除病例的恶性肿瘤比例为86%。其他10例未切除病例未得到组织学诊断，其中9例接受了放射治疗。第二原发性肺癌患者的5年生存率为57.3%，复发病变患者为55.5%，未诊断未切除病变患者为64.3%（无显著差异）。采取手术方法进行诊断，并对第二原发性肺癌和复发病变采用标准治疗很重要。肺叶下切除可能足够。对于无法进行二次手术的未诊断结节患者，放射治疗可能是可行且有效的。
