Schreiner Waldemar, Dudek Wojciech, Sirbu Horia
Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany
Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.
Interact Cardiovasc Thorac Surg. 2015 Nov;21(5):682-4. doi: 10.1093/icvts/ivv243. Epub 2015 Aug 30.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether salvage pulmonary resection is possible and worthwhile for patients with recurrence of non-small-cell lung cancer (NSCLC) after prior definitive non-operative therapy. A total of nine reports were identified using the reported search, of which four represented the best available evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All studies were retrospective. In total, 48 pulmonary salvage resections were performed in 47 patients after prior definitive radiation, chemoradiation or stereotactic body radiation therapy, of which 28 were lobectomies (including 1 sleeve lobectomy), 12 pneumonectomies, 4 bilobectomies and 4 sublobar resections (2 segmentectomies and 2 wedge resections). Postoperative complications ranged from 0 to 58% (mean from four studies 42.5%). Only one study reported any mortality (4%), the other three had zero mortality. Median postoperative survival was reported in two studies and ranged from 9 to 30 months. Experience with salvage lung resection for locally recurrent NSCLC, after prior definitive non-surgical treatment, remains limited. Therefore, this analysis was based on only 48 resections in 47 patients from four retrospective studies. Nevertheless, the published data suggest that salvage lung surgery for recurrent, previously non-operatively managed non-small-cell lung cancer is a worthwhile treatment option with good survival, acceptable morbidity and low mortality.
根据结构化方案撰写了一篇胸外科最佳证据主题文章。所探讨的问题是，对于先前接受过确定性非手术治疗后非小细胞肺癌（NSCLC）复发的患者，挽救性肺切除是否可行且值得。通过报告的检索共识别出9篇报告，其中4篇代表了回答该临床问题的最佳现有证据。现将这些论文的作者、期刊、出版日期和国家、所研究的患者群体、研究类型、相关结局和结果制成表格。所有研究均为回顾性研究。共有47例患者在先前接受确定性放疗、放化疗或立体定向体部放疗后进行了48例挽救性肺切除，其中28例为肺叶切除术（包括1例袖式肺叶切除术），12例为全肺切除术，4例为双肺叶切除术，4例为肺段以下切除术（2例肺段切除术和2例楔形切除术）。术后并发症发生率为0%至58%（四项研究的平均发生率为42.5%）。只有一项研究报告了任何死亡病例（4%），其他三项研究的死亡率为零。两项研究报告了术后中位生存期，范围为9至30个月。对于先前接受确定性非手术治疗后局部复发的NSCLC进行挽救性肺切除的经验仍然有限。因此, 本分析仅基于四项回顾性研究中47例患者的48例切除术。尽管如此，已发表的数据表明，对于复发的、先前未接受手术治疗的非小细胞肺癌进行挽救性肺手术是一种值得的治疗选择，具有良好的生存率、可接受的发病率和低死亡率。
