Casillas M, Paris F, Tarrazona V, Padilla J, Paniagua M, Galan G
Thoracic Surgery Services, Hospital La Paz, Madrid, Spain.
Eur J Cardiothorac Surg. 1989;3(5):425-9. doi: 10.1016/1010-7940(89)90052-3.
From 1969 to 1986, 97 patients with chest wall invasion by lung carcinoma (excluding superior sulcus tumours) underwent surgical resection in two hospitals, La Paz (Madrid) and La Fé (Valencia). The same surgical policy was used in both thoracic surgical units: extrapleural pulmonary resection when tumour involved only the parietal pleura (N = 36), and en bloc chest wall resection when the carcinoma extended into the ribs and intercostal muscles (N = 61). The tumour histology was classified according the WHO criteria. Lobectomy or bilobectomy was carried out in 72%, pneumonectomy in 18% and segmentectomy or wedge resection in 10% of the patients. The perioperative mortality was higher in the en bloc resection group 9/61 (15%) versus 2/36 (6%) for extrapleural dissection. The node staging was NO in 58/97 (60%), N1 in 16/97 (16%) and N2 in 23/97 (24%). The probability of survival was calculated by the Kaplan-Meier method collecting data from the perioperative survivors only. The overall 5-year survival was 23% with no significant differences between the en bloc resection and the extrapleural lung resection groups. The most important predictor of survival was the node stage. The 5-year survival for N1 and N2 were 8% and 6%, respectively. These percentages increased to 34% when N0 patients were considered. Other predictors of survival were not significant. The authors conclude that either extrapleural or en bloc chest wall resection are both valid procedures which may be used depending on the depth of local invasion.
1969年至1986年期间，拉巴斯（马德里）和拉费（巴伦西亚）两家医院对97例肺癌侵犯胸壁（不包括肺上沟瘤）的患者进行了手术切除。两个胸外科单位采用相同的手术策略：肿瘤仅累及壁层胸膜时行胸膜外肺切除术（N = 36），癌肿延伸至肋骨和肋间肌时行胸壁整块切除术（N = 61）。肿瘤组织学根据世界卫生组织标准分类。72%的患者行肺叶切除术或双肺叶切除术，18%行全肺切除术，10%行肺段切除术或楔形切除术。胸壁整块切除组的围手术期死亡率较高，分别为9/61（15%）和2/36（6%）。淋巴结分期为NO的患者有58/97（60%），N1的患者有16/97（16%），N2的患者有23/97（24%）。仅收集围手术期幸存者的数据，采用Kaplan-Meier法计算生存率。总体5年生存率为23%，胸壁整块切除组和胸膜外肺切除组之间无显著差异。生存的最重要预测因素是淋巴结分期。N1和N2患者的5年生存率分别为8%和6%。当考虑N0患者时，这些百分比增至34%。其他生存预测因素不显著。作者得出结论，胸膜外或胸壁整块切除术都是有效的手术方法，可根据局部侵犯深度选用。
