Sezen Celal Bugra, Kocaturk Celalettin Ibrahim, Bilen Salih, Kalafat Cem Emrah, Cansever Levent, Dincer Seyyit Ibrahim, Bedirhan Mehmet Ali
Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey.
Department of Thoracic Surgery, Istinye University Medical Faculty, Liv Hospital Ulus, Istanbul, Turkey.
Thorac Cardiovasc Surg. 2020 Mar;68(2):190-198. doi: 10.1055/s-0039-1679959. Epub 2019 Feb 26.
Carinal resections for non-small cell lung cancer (NSCLC) invading the carina are challenging cases that require a therapeutic strategy. The aim of this study was to compare the oncologic outcomes and complications of patients who underwent carinal resection.
Sixty-four patients who underwent carinal resection between 2005 and 2016 were evaluated. Data were retrospectively reviewed for indications, complications, and factors influencing long-term survival.
The study included 51 patients (79.7%) who underwent sleeve pneumonectomy (sP) and 13 patients who underwent carinal sleeve lobectomy (csL) as a curative therapy. Nine patients (14.1%) received induction chemotherapy. Complications were observed in 31 patients (48.8%), including 24 patients (47.1%) in the sP group and 7 patients (53.8%) in the csL group ( = 0.662). Six patients (9.4%) developed bronchopleural fistula. The 30-day mortality rate was 10.9% ( = 7). The 5- and 10-year survival rates were 42.2 and 23.1%, respectively. N2 and R1 were identified as factors affecting survival ( = 0.029 and = 0.047).
Carinal resections have acceptable morbidity, mortality, and long-term survival outcomes in central NSCLC. The main factors affecting survival are complete resection and nodal status. The results of csL were similar to those of sP. Therefore, we believe that csL should be performed in all eligible patients.
对于侵犯隆突的非小细胞肺癌（NSCLC）进行隆突切除是具有挑战性的病例，需要一种治疗策略。本研究的目的是比较接受隆突切除患者的肿瘤学结局和并发症。
对2005年至2016年间接受隆突切除的64例患者进行评估。回顾性分析数据，包括手术指征、并发症以及影响长期生存的因素。
该研究纳入了51例（79.7%）接受袖状肺叶切除术（sP）和13例接受隆突袖状肺叶切除术（csL）作为根治性治疗的患者。9例（14.1%）患者接受了诱导化疗。31例（48.8%）患者出现并发症，其中sP组24例（47.1%），csL组7例（53.8%）（P = 0.662）。6例（9.4%）患者发生支气管胸膜瘘。30天死亡率为10.9%（n = 7）。5年和10年生存率分别为42.2%和23.1%。N2和R1被确定为影响生存的因素（P = 0.029和P = 0.047）。
对于中央型NSCLC，隆突切除具有可接受的发病率、死亡率和长期生存结局。影响生存的主要因素是完整切除和淋巴结状态。csL的结果与sP相似。因此，我们认为所有符合条件的患者均应行csL。
