Kanayama Masatoshi, Ichiki Yoshinobu, Mori Masataka, Matsumiya Hiroki, Nabe Yusuke, Taira Akihiro, Shinohara Shinji, Kuwata Taiji, Takenaka Masaru, Hirai Ayako, Imanishi Naoko, Yoneda Kazue, Ikushima Eigo, Yasutsune Toru, Nishimura Yosuke, Tanaka Fumihiro
Second Department of Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Cardiovascular Surgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Surg Case Rep. 2019 Jul 22;5(1):114. doi: 10.1186/s40792-019-0675-9.
Recent retrospective studies have shown that salvage surgery can improve survival with acceptable adverse events, and this procedure has been adapted for lung cancer. However, there are no reports demonstrating the efficacy of salvage surgery combined with aortic resection.
A 73-year-old man had received definitive concurrent chemoradiotherapy (carboplatin/paclitaxel, 70 Gy) for lung cancer originated from the left upper lobe and infiltrating the thoracic aorta (cT4N1M0 stage IIIA). Although the tumor has shrunk significantly (ycT4N0M0 stage IIIA), radiation pneumonitis occurred. Due to the steroid therapy, radiation pneumonitis was relieved; however, re-enlargement of the primary tumor was observed during steroid tapering. Nonetheless, the lymphatic and distant metastases were controlled. Moreover, aortic invasion was localized to the periphery of the third branch, and the tumor was considered to be resectable. Intraoperatively, we observed macroscopic evidence of aortic invasion in the periphery of the third branch; thus, left upper lobectomy combined with descending aorta resection was performed under partial extracorporeal circulation. The patient is currently active without any recurrence 21 months post-surgery.
No clear consensus exists regarding salvage surgery combined with aortic resection for primary lung cancer. However, we believe that this surgery may improve the survival of carefully selected patients.
近期的回顾性研究表明，挽救性手术可提高生存率，且不良事件在可接受范围内，该手术已应用于肺癌治疗。然而，尚无报告证明挽救性手术联合主动脉切除术的疗效。
一名73岁男性因源于左上叶并侵犯胸主动脉的肺癌（cT4N1M0 IIIA期）接受了根治性同步放化疗（卡铂/紫杉醇，70 Gy）。尽管肿瘤显著缩小（ycT4N0M0 IIIA期），但发生了放射性肺炎。由于采用了类固醇治疗，放射性肺炎得到缓解；然而，在逐渐减少类固醇用量期间，观察到原发肿瘤再次增大。尽管如此，淋巴和远处转移得到了控制。此外，主动脉侵犯局限于第三分支的周边，肿瘤被认为可切除。术中，我们观察到第三分支周边存在主动脉侵犯的宏观证据；因此，在部分体外循环下进行了左上叶切除术联合降主动脉切除术。患者术后21个月目前情况良好，无任何复发迹象。
对于原发性肺癌的挽救性手术联合主动脉切除术，目前尚无明确共识。然而，我们认为这种手术可能会提高经过精心挑选的患者的生存率。
