Seguin-Givelet A, Lutz J, Brian E, Grigoroiu M, Gossot D
Département thoracique, institut mutualiste Montsouris, institut du Thorax-Curie-Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Sorbonne Paris Cité, UFR SMBH Université Paris 13, 93000 Bobigny, France.
Département thoracique, institut mutualiste Montsouris, institut du Thorax-Curie-Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Division of General Thoracic Surgery, University Hospital Bern, Bern, Suisse.
Rev Mal Respir. 2018 May;35(5):521-530. doi: 10.1016/j.rmr.2018.02.004. Epub 2018 May 18.
The rate of segmental resection for early stage non-small cell lung carcinoma (NSCLC) is increasing. However, the indications remain controversial. The aim of this study is to analyze the preliminary results of thoracoscopic segmental resection in early stage NSCLC in terms of morbidity, oncological validity and survival. We report the preliminary results of a consecutive series of 226 thoracoscopic segmentectomies for suspicion of early stage NSCLC.
Between 2007 and 2016, we performed 322 thoracoscopic anatomical sublobar resections (ASLR). Two hundred and twenty six of these were for suspicion of early stage NSCLC in 222 patients. Data were recorded prospectively and analysed retrospectively on an intent-to-treat basis. Overall and disease-free survivals were estimated on a Kaplan-Meier curve and differences were calculated by a log-rank test.
Twenty-two patients were upstaged (10.4%), in 10 cases to T3 or T4, in 6 cases to N1 and in 6 others to N2 for metastasis. Out of the 6 N1 cases, 3 were discovered at frozen section and resulted in a switch from segmentectomy to lobectomy. There were 10 conversions to thoracotomy (3.9%). Seventeen patients had a more extensive resection than initially planned (7.5%), most often for oncological reasons: invasion of intersegmental lymph nodes (n=3) or insufficient resection margin at frozen section (n=7). Morbidity and mortality were 25.7% and 1.3 % respectively. For pT1aN0 carcinomas, overall and disease-free survivals were 87.1% and 80.6%, respectively. For pT1bN0 carcinomas, overall and disease-free survivals were 88.8 %, and 75.3% respectively.
For early stage NSCLC, thoracoscopic ASLR allows reduced perioperative morbidity while offering satisfactory survival. However, a rigorous technique must be applied to reduce the rates of conversion to thoracotomy and extension to lobectomy when required for oncological reasons.
早期非小细胞肺癌（NSCLC）的肺段切除术比例正在上升。然而，其适应证仍存在争议。本研究的目的是从发病率、肿瘤学有效性和生存率方面分析早期NSCLC胸腔镜肺段切除术的初步结果。我们报告了连续226例因怀疑早期NSCLC而行胸腔镜肺段切除术的初步结果。
2007年至2016年期间，我们进行了322例胸腔镜解剖性肺亚段切除术（ASLR）。其中226例是对222例怀疑早期NSCLC的患者进行的。数据前瞻性记录，并在意向性治疗基础上进行回顾性分析。通过Kaplan-Meier曲线估计总生存率和无病生存率，并通过对数秩检验计算差异。
22例患者分期上调（10.4%），其中10例升至T3或T4期，6例升至N1期，另外6例因转移升至N2期。在6例N1期病例中，3例在冰冻切片时被发现，导致手术从肺段切除术改为肺叶切除术。有10例转为开胸手术（3.9%）。17例患者的切除范围比最初计划的更广泛（7.5%），最常见的原因是肿瘤学方面的：节段间淋巴结侵犯（n = 3）或冰冻切片时切除边缘不足（n = 7）。发病率和死亡率分别为25.7%和
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