Fukui Mariko, Takamochi Kazuya, Suzuki Kazuhiro, Hotta Akihiro, Ando Katsutoshi, Matsunaga Takeshi, Oh Shiaki, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2020 Aug;68(8):812-819. doi: 10.1007/s11748-019-01277-2. Epub 2020 Feb 10.
Idiopathic interstitial pneumonias (IIPs) are predominantly encountered in the lower lobe, and frequently with concomitant emphysema that is predominantly in the upper lobe. However, the impact of the resection site on surgical outcomes of lung cancer with IIPs remains unclear. This study was conducted to evaluate the surgical outcome between patients undergoing upper or lower lobe resection.
This retrospective study was performed on 1972 patients who underwent surgical resection for lung cancer at our institute between 2009 and 2018. Review of CT findings revealed that 337 (14.1%) patients had IIPs. Morbidity, mortality, and postoperative pulmonary function test (PFT) were compared between patients who underwent upper or lower lobectomy and stratified by presence or absence of emphysema (CPFE and non-CPFE).
Surgical mortality and morbidity were not statistically different between the two groups regardless of CPFE. The difference between actual and predicted postoperative PFTs was statistically larger in the upper lobectomy compared to the lower lobectomy among the non-CPFE patients. (FVC: p = 0.019, FEV: p = 0.001, %DLCO: p = 0.090) CONCLUSIONS: Site of the resected lobe in lung cancer is not a prognostic factor of surgical mortality and morbidity in patients with IIPs. However, the impact of upper lobectomy on postoperative respiratory function reduction is larger than lower lobectomy in non-CPFE patients.
特发性间质性肺炎（IIP）主要出现在下叶，且常伴有主要位于上叶的肺气肿。然而，切除部位对合并IIP的肺癌手术结局的影响仍不明确。本研究旨在评估接受上叶或下叶切除的患者的手术结局。
本回顾性研究对2009年至2018年间在我院接受肺癌手术切除的1972例患者进行。CT检查结果显示，337例（14.1%）患者患有IIP。比较接受上叶或下叶切除术的患者的发病率、死亡率和术后肺功能测试（PFT），并根据是否存在肺气肿（合并肺气肿-肺纤维化综合征和非合并肺气肿-肺纤维化综合征）进行分层。
无论是否合并肺气肿-肺纤维化综合征，两组之间的手术死亡率和发病率在统计学上均无差异。在非合并肺气肿-肺纤维化综合征的患者中，上叶切除术后实际与预测的PFT差异在统计学上比下叶切除术后更大。（用力肺活量：p = 0.019，第一秒用力呼气容积：p = 0.001，一氧化碳弥散量百分比：p = 0.090）结论：肺癌切除叶的部位不是IIP患者手术死亡率和发病率的预后因素。然而，在非合并肺气肿-肺纤维化综合征的患者中，上叶切除术对术后呼吸功能降低的影响大于下叶切除术。
