Otsuki Yuji, Kuwahara Hiroaki, Konn Hirofumi
Department of Thoracic Surgery, KKR Sapporo Medical Center, 6-3-40, Hiragishi 1-jo, Toyohira-ku Sapporo-shi, Hokkaido, 062-0931, Japan.
Department of Dialysis, KKR Sapporo Medical Center, 6-3-40, Hiragishi 1-jo, Toyohira-ku Sapporo-shi, Hokkaido, 062-0931, Japan.
Gen Thorac Cardiovasc Surg. 2018 Jan;66(1):48-53. doi: 10.1007/s11748-017-0847-0. Epub 2017 Oct 9.
The rate of surgical resection of lung cancer in patients on hemodialysis is expected to increase due to the development of hemodialysis, improved diagnosis of lung cancer, and increases in the number and age of patients. However, studies assessing outcomes of lung resection in these patients are limited. In this retrospective case series, we investigated the safety and efficacy of video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy for lung cancer in patients on hemodialysis.
Between January 2010 and January 2017, lobectomy or segmentectomy using VATS was performed for seven lung cancer cases in six patients receiving hemodialysis at our institution. There were two female and five male patients, with a median age of 61 years (range 53-76 years). Six patients underwent lobectomy, and segmentectomy and wedge resection were performed in each one case, respectively; systematic mediastinal lymph node dissection (ND2a-2) was performed in six patients.
There were no perioperative deaths in this case series. Median recurrence-free and overall survival rates were 20 months (range 3-82 months) and 31 months (range 3-82 months), respectively.
Video-assisted thoracic surgery (VATS) is a safe and effective procedure for resection of lung cancer in hemodialysis patients and should be considered after accurate determination of surgical indications and careful perioperative management.
由于血液透析技术的发展、肺癌诊断的改善以及患者数量和年龄的增加，预计接受血液透析的肺癌患者的手术切除率将会提高。然而，评估这些患者肺切除术后结局的研究有限。在这个回顾性病例系列中，我们调查了电视辅助胸腔镜手术（VATS）用于接受血液透析的肺癌患者肺叶切除术或肺段切除术的安全性和有效性。
2010年1月至2017年1月期间，在我们机构对6例接受血液透析的患者中的7例肺癌病例进行了VATS肺叶切除术或肺段切除术。有2例女性和5例男性患者，中位年龄为61岁（范围53 - 76岁）。6例患者接受了肺叶切除术，分别有1例患者接受了肺段切除术和楔形切除术；6例患者进行了系统性纵隔淋巴结清扫（ND2a - 2）。
该病例系列中无围手术期死亡。无复发生存率和总生存率的中位数分别为20个月（范围3 - 82个月）和31个月（范围3 - 82个月）。
电视辅助胸腔镜手术（VATS）是一种用于接受血液透析的肺癌患者切除手术的安全有效的方法，在准确确定手术指征并进行仔细的围手术期管理后应予以考虑。
