Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology-Oncology-DIPO, University of Milan, Milan, Italy.
Ann Thorac Surg. 2018 Apr;105(4):1017-1023. doi: 10.1016/j.athoracsur.2017.11.052. Epub 2017 Dec 23.
The role of induction therapy (IT) and its effects on morbidity and mortality of patients receiving tracheal sleeve pneumonectomy (TSP) are unclear. We evaluated early and long-term outcomes of patients who underwent TSP after IT.
From 1998 to 2015, 32 patients (26 men; median age, 63 years) underwent TSP. Twenty-two patients (69%) received IT (cisplatin-based chemotherapy). The TSPs were all right sided and included three completion pneumonectomies. Superior vena cava resection was combined with TSP in 15 cases. Diaphragmatic and vertebral resection was also associated in 1 case each.
Operative mortality was nil. Thirty-day mortality was 9% (n = 3). Major complications occurred in 7 patients (21.8%): bronchopleural fistulas in 3; acute respiratory distress syndrome in 2; cardiac hernia in 1; and empyema in 1. The IT had no significant effects on morbidity and mortality. Resection was complete in 31 patients (97%). Pathologic N status was N0 in 2 cases, N1 in 17, and N2 in 13. Nodal downstaging was diagnosed in 13 of 22 patients (59.1%) who received IT (11 passed from N2 to N1, and 2 to N0). Mean survival was 36 months (range, 1 to 181). Overall 5-year survival and disease-free survival were 30.3% and 27.7%, respectively. Patients receiving IT had a poor survival (p = 0.03). At multivariate analysis, nodal downstaging and adjuvant treatment significantly affected survival (p = 0.035 and p = 0.007, respectively).
Tracheal sleeve pneumonectomy is a feasible but technically challenging surgical procedure and provides acceptable results in terms of early and long-term outcomes. Induction therapy did not significantly affect morbidity and mortality.
诱导治疗（IT）的作用及其对接受气管袖状切除术（TSP）患者发病率和死亡率的影响尚不清楚。我们评估了接受 IT 后行 TSP 的患者的早期和长期结果。
1998 年至 2015 年，32 例患者（26 例男性；中位年龄 63 岁）接受了 TSP。22 例（69%）接受了 IT（顺铂为基础的化疗）。TSP 均为右侧，包括 3 例完成性肺切除术。15 例合并上腔静脉切除术，1 例合并膈肌和椎体切除术。
手术死亡率为零。30 天死亡率为 9%（n=3）。7 例患者（21.8%）发生重大并发症：3 例支气管胸膜瘘；2 例急性呼吸窘迫综合征；1 例心脏疝；1 例脓胸。IT 对发病率和死亡率没有显著影响。31 例（97%）患者的切除完全。2 例病理 N 状态为 N0，17 例为 N1，13 例为 N2。接受 IT 的 22 例患者中有 13 例（59.1%）发生淋巴结降期，11 例从 N2 降至 N1，2 例降至 N0。平均生存时间为 36 个月（1 至 181）。总 5 年生存率和无病生存率分别为 30.3%和 27.7%。接受 IT 的患者生存状况较差（p=0.03）。多因素分析显示，淋巴结降期和辅助治疗显著影响生存（p=0.035 和 p=0.007）。
气管袖状切除术是一种可行但技术上具有挑战性的手术方法，在早期和长期结果方面提供了可接受的结果。诱导治疗对发病率和死亡率没有显著影响。
