Dal Agnol Guilherme, Oliveira Ricardo, Ugalde Paula A
Divison of Thoracic Surgery, Americas-Centro de Oncologia Integrado, Rio de Janeiro, Brazil.
Division of Thoracic Surgery, Santa Casa de Misericórdia da Bahia, University-affiliated hospital, Quebec, Canada.
J Thorac Dis. 2018 Aug;10(Suppl 22):S2656-S2663. doi: 10.21037/jtd.2018.04.72.
Lung cancer presents with chest wall invasion in 5-8% of patients, which imparts some treatment challenges. Surgical resection is currently the standard of care, and there are some controversies regarding the best approach. Published series and case reports confirm the safety and feasibility of video-assisted thoracoscopic surgery (VATS) in highly complex surgical cases including lobectomy with chest wall resection of locally advanced lung cancer. In this article, we present the clinical indications of locally advanced lung cancer that infiltrates the chest wall, the modalities for and importance of accurately staging lung cancers with chest wall invasion, and the technical aspects of accomplishing a safe and oncologically sound extended resection through VATS.
5%-8%的肺癌患者会出现胸壁侵犯，这带来了一些治疗挑战。手术切除是目前的标准治疗方法，关于最佳手术方式存在一些争议。已发表的系列研究和病例报告证实了电视辅助胸腔镜手术（VATS）在高度复杂手术病例中的安全性和可行性，这些病例包括局部晚期肺癌的肺叶切除并胸壁切除。在本文中，我们阐述了侵犯胸壁的局部晚期肺癌的临床指征、准确分期伴有胸壁侵犯肺癌的方式及重要性，以及通过VATS完成安全且肿瘤学合理的扩大切除的技术要点。
