Mun Mingyon, Nakao Masayuki, Matsuura Yosuke, Ichinose Junji, Nakagawa Ken, Okumura Sakae
Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Koto-ku, Tokyo, Japan.
J Thorac Dis. 2018 Jun;10(6):3738-3744. doi: 10.21037/jtd.2018.05.163.
Lung segmentectomy is a therapeutic option in containing pathological diagnosis and radical cure for small-sized peripheral lung cancer. We retrospectively investigated the results of thoracoscopic segmentectomy (TS-S).
From April 2008 to December 2016, 191 patients who underwent TS-S for small-sized peripheral lung cancer were reviewed retrospectively. Intentional indication of TS-S is peripheral radiologically noninvasive lung cancer whose tumor size is less than 2 cm in size with consolidation to tumor (C/T) ratio less than 0.5. Compromised indication is radiologically invasive lung cancer (C/T ration more than 0.5) which we can keep sufficient surgical margin.
We performed TS-S in 191 patients (81 males and 110 females, median age 66 years). The mean diameter of the nodules was 15 mm (range, 6-46 mm), and clinical IA/IB was 184/7, respectively. Intentional indication was 145 (76%) and compromised one was 46 (24%). The mean operation time was 169 min (range, 73-319 min) and the mean blood loss was 42 g (range, 0-2,900 g). One procedure was converted to open thoracotomy due to bleeding of pulmonary artery (conversion rate, 0.5%). The median chest drainage duration was 1 day (range, 1-9 days), and the median postoperative hospital stay was 7 days (range, 3-30 days). Postoperative complications occurred in 19 patients (10%), including air leak lasting more than 7 days in 3 patients, and late phase air leak in 1 patient. There was no 30-day mortality. Median follow-up was 52 months. The 5-year overall survival (OS) rates and relapse free survival rates, including deaths from all causes, were 93.4% and 90.8%, respectively. During this period, there were 4 distal recurrences after TS-S. However, there was no local recurrence.
Our result of TS-S was an acceptable. Appropriate selection of patient and surgical procedure in TS-S is important issue.
肺段切除术是对小型周围型肺癌进行病理诊断和根治性治疗的一种选择。我们回顾性研究了电视胸腔镜肺段切除术（TS-S）的结果。
回顾性分析2008年4月至2016年12月期间191例行TS-S治疗小型周围型肺癌的患者。TS-S的意向性指征为影像学表现为外周非浸润性肺癌，肿瘤大小小于2 cm，实性成分与肿瘤（C/T）比值小于0.5。折衷指征为影像学表现为浸润性肺癌（C/T比值大于0.5），但我们能够保留足够的手术切缘。
我们对191例患者（81例男性和110例女性，中位年龄66岁）实施了TS-S。结节的平均直径为15 mm（范围6-46 mm），临床ⅠA/ⅠB期分别为184/7例。意向性指征为145例（76%），折衷指征为46例（24%）。平均手术时间为169分钟（范围73-319分钟），平均失血量为42克（范围0-2900克）。1例手术因肺动脉出血转为开胸手术（转换率0.5%）。中位胸腔引流持续时间为1天（范围1-9天），中位术后住院时间为7天（范围3-30天）。19例患者（10%）发生术后并发症，包括3例漏气持续超过7天，1例发生迟发性漏气。无30天死亡率。中位随访时间为52个月。5年总生存率（OS）和无复发生存率（包括各种原因导致的死亡）分别为93.4%和90.8%。在此期间，TS-S术后有4例远处复发。然而，无局部复发。
我们的TS-S结果是可接受的。在TS-S中合理选择患者和手术方式是重要问题。
