Lung Clinic, Hospital of Cologne, Thoracic Surgery, University of Witten Herdecke, Cologne.
Lung Clinic, Hospital of Cologne, Thoracic Surgery, University of Witten Herdecke, Cologne.
Ann Thorac Surg. 2020 Mar;109(3):879-886. doi: 10.1016/j.athoracsur.2019.10.049. Epub 2019 Dec 13.
Preoperative radiotherapy and/or chemotherapy of lung cancer in patients with locally advanced disease is an option in multimodal treatment. Sleeve lobectomy has an important part in decreasing complications and sparing lung function. We present our experience in a large cohort of patients after sleeve lobectomy with or without neoadjuvant treatment and standardized assessment of bronchial anastomotic healing.
The data used for this study were collected in a prospective database in our hospital. Anastomotic healing was documented by bronchoscopy on the seventh postoperative day and thereafter only when necessary, using a standardized scoring system. From 2006 to 2017, we performed 501 sleeve lobectomies representing 19% of all lung cancer resections. A total of 365 of patients had no preoperative treatment (73%), 41 had neoadjuvant chemotherapy (8%), and 95 had radiochemotherapy (19%).
Using our scoring system of the bronchial anastomosis from 1 (excellent) to 5 (insufficient), we found the anastomosis was worse than grade 2 after no treatment, chemotherapy, or radiochemotherapy in 17%, 10%, and 30%, respectively (P = .002). The rate of anastomotic insufficiency was equally low after no pretreatment and chemotherapy (2.7% and 2.4%) and rose to 10.4% after radiotherapy (P = .002). Similarly, the risk for pulmonary complications was higher after radiochemotherapy (39%) compared with no pretreatment (29%) or chemotherapy (27%), respectively (P = .382).
Neoadjuvant radiotherapy is associated with worse wound healing of the anastomosis after sleeve lobectomy in lung cancer. There seems to be a higher risk for anastomotic insufficiency and complications.
对于局部晚期疾病的肺癌患者，术前放疗和/或化疗是多模式治疗的一种选择。袖状肺叶切除术在减少并发症和保留肺功能方面起着重要作用。我们报告了在接受新辅助治疗和标准化支气管吻合口愈合评估的大量患者中进行袖状肺叶切除术后的经验。
本研究使用的数据来自我们医院的前瞻性数据库。术后第 7 天和必要时使用标准化评分系统通过支气管镜检查记录吻合口愈合情况。2006 年至 2017 年，我们进行了 501 例袖状肺叶切除术，占所有肺癌切除术的 19%。共有 365 例患者未行术前治疗（73%），41 例接受新辅助化疗（8%），95 例接受放化疗（19%）。
使用我们的支气管吻合口评分系统（从 1 级（优秀）到 5 级（不足）），我们发现无治疗、化疗或放化疗后吻合口分别为 2 级以下的患者比例为 17%、10%和 30%（P =.002）。无预处理和化疗后吻合口不足的发生率相似（分别为 2.7%和 2.4%），而放疗后上升至 10.4%（P =.002）。同样，放化疗后肺部并发症的风险较高（39%），与无预处理（29%）或化疗（27%）相比（P =.382）。
新辅助放疗与肺癌袖状肺叶切除术后吻合口愈合不良有关。吻合口不足和并发症的风险似乎更高。
