Baltayiannis Nikolaos, Chandrinos Michail, Anagnostopoulos Dimitrios, Zarogoulidis Paul, Tsakiridis Kosmas, Mpakas Andreas, Machairiotis Nikolaos, Katsikogiannis Nikolaos, Kougioumtzi Ioanna, Courcoutsakis Nikolaos, Zarogoulidis Konstantinos
Department of Thoracic Surgery, Metaxa Hospital, Piraeus, Greece;
J Thorac Dis. 2013 Sep;5 Suppl 4(Suppl 4):S425-39. doi: 10.3978/j.issn.2072-1439.2013.09.17.
According to the International Agency for Research on Cancer (IARC) GLOBOCAN World Cancer Report, lung cancer affects more than 1 million people a year worldwide. In Greece according to the 2008 GLOBOCAN report, there were 6,667 cases recorded, 18% of the total incidence of all cancers in the population. Furthermore, there were 6,402 deaths due to lung cancer, 23.5% of all deaths due to cancer. Therefore, in our country, lung cancer is the most common and deadly form of cancer for the male population. The most important prognostic indicator in lung cancer is the extent of disease. The Union Internationale Contre le Cancer (UICC) and the American Joint Committee for Cancer Staging (AJCC) developed the tumour, node, and metastases (TNM) staging system which attempts to define those patients who might be suitable for radical surgery or radical radiotherapy, from the majority, who will only be suitable for palliative measures. Surgery has an important part for the therapy of patients with lung cancer. "Lobectomy is the gold standard treatment". This statement may be challenged in cases of stage Ia cancer or in patients with limited pulmonary function. In these cases an anatomical segmentectomy with lymph node dissection is an acceptable alternative. Chest wall invasion is not a contraindication to resection. En-bloc rib resection and reconstruction is the treatment of choice. N2 disease represents both a spectrum of disease and the interface between surgical and non-surgical treatment of lung cancer Evidence from trials suggests that multizone or unresectable N2 disease should be treated primarily by chemoradiotherapy. There may be a role for surgery if N2 is downstaged to N0 and lobectomy is possible, but pneumonectomy is avoidable. Small cell lung cancer (SCLC) is considered a systemic disease at diagnosis, because the potential for hematogenous and lymphogenic metastases is very high. The efficacy of surgical intervention for SCLC is not clear. Lung cancer resection can be performed using several surgical techniques. Video-assisted thoracoscopic surgery (VATS) lobectomy is a safe, efficient, well accepted and widespread technique among thoracic surgeons. The 5-year survival rate following complete resection of lung cancer is stage dependent. Incomplete resection rarely is useful and cures the patient.
根据国际癌症研究机构（IARC）的《全球癌症报告》，全球每年有超过100万人受肺癌影响。在希腊，根据2008年的《全球癌症报告》，记录了6667例病例，占该国所有癌症总发病率的18%。此外，有6402人死于肺癌，占癌症死亡总数的23.5%。因此，在我国，肺癌是男性人群中最常见、最致命的癌症形式。肺癌最重要的预后指标是疾病的程度。国际抗癌联盟（UICC）和美国癌症联合委员会（AJCC）制定了肿瘤、淋巴结和转移（TNM）分期系统，该系统试图从大多数仅适合姑息治疗的患者中，界定出那些可能适合根治性手术或根治性放疗的患者。手术在肺癌患者的治疗中起着重要作用。“肺叶切除术是金标准治疗方法”。在Ia期癌症病例或肺功能有限的患者中，这一说法可能会受到质疑。在这些情况下，解剖性肺段切除术加淋巴结清扫术是一种可接受的替代方法。胸壁侵犯并非手术切除的禁忌证。整块肋骨切除及重建是首选的治疗方法。N2期疾病代表了一系列疾病情况以及肺癌手术治疗与非手术治疗的交界点。试验证据表明，多区域或不可切除的N2期疾病应主要采用放化疗。如果N2期降期为N0期且可能进行肺叶切除术，但可避免全肺切除术，则手术可能会发挥作用。小细胞肺癌（SCLC）在诊断时被认为是一种全身性疾病，因为其血行和淋巴转移的可能性非常高。手术干预对SCLC的疗效尚不清楚。肺癌切除可采用多种手术技术。电视辅助胸腔镜手术（VATS）肺叶切除术是一种安全、高效、广受认可且在胸外科医生中广泛应用的技术。肺癌完全切除后的5年生存率取决于分期。不完全切除很少能起到有效治疗并治愈患者的作用。
