Uramoto Hidetaka, Nakajima Yuki, Kinoshita Hiroyasu, Akiyama Hirohiko
Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan Division of Thoracic Surgery, Kanazawa Medical University, Uchinada, Japan
Division of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan.
Anticancer Res. 2016 Aug;36(8):4243-7.
There have, so far, been few previous reports concerning the use of salvage surgery in small number of patients with primary lung cancer and there are no reports currently available regarding salvage surgery compared to other treatments.
The postoperative complications and long-term survival of patients with non-small cell lung cancer (NSCLC) who received salvage surgery compared to induction chemotherapy followed by surgery from 2000 and 2013, were evaluated.
During the study period, 1,847 consecutive patients with lung cancer underwent pulmonary resection at our Institution. Salvage operations were performed in 16 (0.9%) patients. The clinical stages were diagnosed as stage IIB in 1, IIIA in 8, IIIB in 6 and stage IV in 1 patient. The mean interval between initial treatment and surgery was 31.4 months. The surgical procedures were lobectomy in 9, pneumonectomy in 4 and partial resection in 3 patients. The operation was performed during a mean of 303 min; no case required blood transfusion. Complete resection was performed in 81% of the patients. Thus, the morbidity was 31.3% and the mortality rate was 0%. The five-year overall survival (OS) rates in the patients with induction chemotherapy followed by surgery and salvage surgery were 65.2 and 62.2%, respectively, (p=0.460) when OS was calculated from the date of registration to the date of initial treatment. The median survival for patients receiving salvage surgery was 64.4 months at any rate when OS was calculated from the date of registration for initial treatment or surgery.
Salvage surgery can be performed safely with no mortality and is associated with a reasonable long-term survival, equivalent to the outcome of induction chemotherapy followed by surgical resection.
迄今为止，关于少数原发性肺癌患者采用挽救性手术治疗的报道较少，目前也没有关于挽救性手术与其他治疗方法对比的报道。
对2000年至2013年期间接受挽救性手术的非小细胞肺癌（NSCLC）患者与先进行诱导化疗后手术的患者的术后并发症及长期生存率进行评估。
在研究期间，我院共有1847例连续性肺癌患者接受了肺切除术。其中16例（0.9%）患者接受了挽救性手术。临床分期为IIB期1例，IIIA期8例，IIIB期6例，IV期1例。初始治疗至手术的平均间隔时间为31.4个月。手术方式为肺叶切除术9例，全肺切除术4例，部分切除术3例。手术平均时长为303分钟；无一例需要输血。81%的患者实现了完全切除。因此，发病率为31.3%，死亡率为0%。从登记日期至初始治疗日期计算总生存率（OS）时，先进行诱导化疗后手术的患者和接受挽救性手术的患者的五年OS率分别为65.2%和62.2%（p = 0.460）。无论从初始治疗或手术登记日期计算OS，接受挽救性手术患者的中位生存期均为64.4个月。
挽救性手术可安全实施，无死亡病例，且具有合理的长期生存率，与先进行诱导化疗后手术切除的结果相当。
