Pricopi C, Rivera C, Abdennadher M, Arame A, Foucault C, Dujon A, Le Pimpec Barthes F, Riquet M
Service de chirurgie thoracique, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
Service de chirurgie thoracique, centre médico-chirurgical du Cèdre, Bois-Guillaume, France.
Rev Pneumol Clin. 2015 Aug;71(4):207-16. doi: 10.1016/j.pneumo.2014.09.005. Epub 2015 Mar 18.
Results of surgery for non-small-cell lung cancer (NSCLC) are poorer after limited resection, wedge and segmentectomy, than after lobectomy. Guidelines recommend avoiding wedge-resection, which new techniques (radiofrequency ablation and cyberknife) tend to replace. This work aimed to study the wedge-resection carcinological value.
NSCLC without previous other cancer history and neoadjuvant therapy measuring less than 31 millimetres and operated from 1980 to 2009 were reviewed. Analyzed variables were: location, gender, age, FEVS, type of resection, histology, pT and pN.
There were 66 wedge-resections (10.9%), 32 segmentectomies (5.3%), 507 lobectomies (83.8%), nine postoperative deaths (1.5%), 136 complications (22.5%), 557 complete resections (R0=92%); 72.2% of NSCLC upper lobe location (437/605). Age was more advanced in wedge-resection and segmentectomy, FEVS lower and NSCLC most often a squamous cell pN0 and pStage I carcinoma than in lobectomy. Lymphadenectomy was not performed in half the wedge-resections. Five-year survival rates were poorer after wedge-resection: 50% versus segmentectomy 59.8% (P=0.09), and lobectomy 66% (P=0.0035), but the number of recurrences was similar. Multivariate analysis demonstrated that age, FEVS, type of surgery and lymphadenectomy, pN in pTNM were the only prognosis factors.
Wedge-resection is less carcinological than segmentectomy when the patient-status and NSCLC location allow performing the latter, but more than the new techniques, because of its pathological yield, when the patient-status and nodule peripheral location allow wedging.
非小细胞肺癌（NSCLC）行局限性切除（楔形切除和肺段切除）后的手术效果比肺叶切除术后差。指南建议避免楔形切除，而新技术（射频消融和射波刀）似乎正逐渐取而代之。本研究旨在探讨楔形切除的肿瘤学价值。
回顾性分析1980年至2009年间接受手术治疗的NSCLC患者，这些患者无其他癌症病史，未接受新辅助治疗，肿瘤直径小于31毫米。分析的变量包括：肿瘤位置、性别、年龄、第一秒用力呼气容积（FEV1）、切除类型、组织学类型、pT和pN。
共有66例楔形切除（10.9%）、32例肺段切除（5.3%）、507例肺叶切除（83.8%）；9例术后死亡（1.5%），136例并发症（22.5%），557例完整切除（R0=92%）；72.2%的NSCLC位于上叶（437/605）。与肺叶切除相比，楔形切除和肺段切除患者年龄更大，FEV1更低，NSCLC最常见为鳞状细胞癌，pN0且为pⅠ期癌。半数楔形切除未行淋巴结清扫。楔形切除术后5年生存率较低：50%，而肺段切除为59.8%（P=0.09），肺叶切除为66%（P=0.0035），但复发数量相似。多因素分析表明，年龄、FEV1、手术类型和淋巴结清扫、pTNM中的pN是唯一的预后因素。
当患者情况和NSCLC位置允许行肺段切除时，楔形切除的肿瘤学效果不如肺段切除，但当患者情况和结节位于周边允许楔形切除时，由于其病理收获，楔形切除比新技术更具优势。
