Bao Tong, Xiao Fei, Liu Deruo, Guo Yongqing, Liang Chaoyang
Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China.
Zhongguo Fei Ai Za Zhi. 2018 Jan 20;21(1):24-31. doi: 10.3779/j.issn.1009-3419.2018.01.04.
Non-small cell lung cancer with left atrial tumor thrombus accounts for a small proportion of local advanced lung cancer. Whether surgery could bring benefits, as well as surgical options are still controversial, and have always been hot spots in surgical research. We report a single center experience of surgical treatment to non-small cell lung cancer with left atrial tumor thrombus, aim to figure out more reasonable treatment strategy.
From August 2006 to July 2017, a total of 11 cases of non-small cell lung cancer with left atrial tumor thrombus underwent surgery in Thoracic Surgery Department of China-Japan Friendship Hospital. Clinical data, treatment options, pathological types and prognosis of these patients were collected to perform a retrospective study.
Of the 11 patients (mean age of 57.9), 7 were men and 4 were women. Six of them received neoadjuvant radiotherapy and/or chemotherapy. All patients underwent smooth operation, including 3 cases with cardiopulmonary bypass, 1 case of posterolateral approach under extracorporeal membrane oxygenation, 6 cases of conventional posterolateral approach and 1 case of video-assisted minithoracotomy. Nine patients were evaluated as R0 resection while 2 cases were evaluated as R1 resection. The Surgeries cost an average of 292 min (210 min-380 min), with an average of 436 mL (100 mL-1,600 mL) blood loss. One patient (9.1%) died within 90 days after surgery, and another 4 cases (36.4%) suffered postoperative complications such as arrhythmia, cerebral infarction or hypoxemia. Six cases of squamous cell carcinoma, 4 cases of adenocarcinoma and 1 case of sarcomatoid carcinoma were identified by pathology. Seven cases were staged as pT4N0M0 while 4 cases were staged as pT4N1M0. Nine patients underwent adjuvant chemotherapy, and two patients underwent radiotherapy during follow-up. The overall follow-up time was 2 to 53 months, the 3-year disease-free survival rate was 30.7%, the median disease-free survival time was 31 months, the 3-year overall survival rate was 49.1% and the median overall survival time was 33 months.
For selected patients of non-small cell lung cancer complicated with left atrial tumor thrombus, choose a reasonable surgical approach to resect both the tumor and the thrombus, strengthen the perioperative management and apply neoadjuvant/adjuvant radiotherapy and/or chemotherapy, might obtain satisfying prognosis.
伴有左心房肿瘤血栓的非小细胞肺癌在局部晚期肺癌中占比小。手术是否能带来益处以及手术方式仍存在争议，一直是外科研究的热点。我们报告了单中心对伴有左心房肿瘤血栓的非小细胞肺癌的手术治疗经验，旨在找出更合理的治疗策略。
2006年8月至2017年7月，共有11例伴有左心房肿瘤血栓的非小细胞肺癌患者在中国-日本友好医院胸外科接受手术。收集这些患者的临床资料、治疗方案、病理类型和预后情况进行回顾性研究。
11例患者（平均年龄57.9岁）中，男性7例，女性4例。其中6例接受了新辅助放疗和/或化疗。所有患者手术均顺利，包括3例体外循环手术、1例体外膜肺氧合下后外侧入路手术、6例传统后外侧入路手术和1例电视辅助小切口开胸手术。9例患者评估为R0切除，2例评估为R1切除。手术平均用时292分钟（210分钟 - 380分钟），平均失血436毫升（100毫升 - 1600毫升）。1例患者（9.1%）术后90天内死亡，另外4例（36.4%）出现心律失常、脑梗死或低氧血症等术后并发症。病理检查确诊为鳞状细胞癌6例、腺癌4例、肉瘤样癌1例。7例分期为pT4N0M0，4例分期为pT4N1M0。9例患者接受辅助化疗，2例患者在随访期间接受放疗。总随访时间为2至53个月，3年无病生存率为30.7%，无病生存时间中位数为31个月，3年总生存率为49.1%，总生存时间中位数为33个月。
对于选择的伴有左心房肿瘤血栓的非小细胞肺癌患者，选择合理的手术方式切除肿瘤和血栓，加强围手术期管理并应用新辅助/辅助放疗和/或化疗，可能获得满意的预后。
