Nitanda Hiroyuki, Taguchi Ryo, Yanagihara Akitoshi, Sakaguchi Hirozo, Ishida Hironori, Kaneko Koichi
Department of General Thoracic Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Kyobu Geka. 2019 Jan;72(1):17-22.
Pulmonary lobectomy is the standard surgical procedure for resectable non-small cell lung cancer (NSCLC), while sublobar resection is an important surgical alternative for high-risk patients with comorbidities. We evaluated the treatment outcome and prognostic factors of sublobar resection in high-risk patients with NSCLC.
Eighty three high-risk patients who underwent compromised sublobar resection for clinical-N0 NSCLC with a solid appearance were retrospectively reviewed. A total of 47 wedge resections and 36 segmentectomies performed.
Poor pulmonary function and synchronous or metachronous multiple lung cancer were found in 56.7% and 20.5% of patients respectively, all requiring sublobar resection. There were 21 instances of tumor recurrence and 24 deaths during a mean follow-up of 1,500 days. There was no local recurrence in the segmentectomy group. The 3-year recurrence free survival (RFS) and overall survival (OS) were 72.6% and 73.8% respectively. A multivariate analysis indicated that resection type and lymphatic invasion were independent prognostic factors for RFS. In the wedge resection group, a ratio of surgical margin to clinical tumor size greater than 1 (MT ratio≥1) was an independent prognostic factor for RFS( 87.1%,p=0.001).
Segmentectomy leads to a favorable prognosis. MT ratio was independently associated with a longer RFS in the wedge resection group.
肺叶切除术是可切除非小细胞肺癌（NSCLC）的标准手术方式，而亚肺叶切除术是合并症高危患者的重要手术替代方案。我们评估了NSCLC高危患者亚肺叶切除术的治疗效果和预后因素。
回顾性分析83例因临床N0期实性外观NSCLC接受亚肺叶切除术的高危患者。共进行了47例楔形切除术和36例肺段切除术。
分别有56.7%和20.5%的患者存在肺功能差以及同步或异时性多发肺癌，均需行亚肺叶切除术。在平均1500天的随访期间，有21例肿瘤复发和24例死亡。肺段切除术组无局部复发。3年无复发生存率（RFS）和总生存率（OS）分别为72.6%和73.8%。多因素分析表明，切除类型和淋巴侵犯是RFS的独立预后因素。在楔形切除术组中，手术切缘与临床肿瘤大小之比大于1（MT比≥1）是RFS的独立预后因素（87.1%，p=0.001）。
肺段切除术预后良好。在楔形切除术组中，MT比与更长的RFS独立相关。
