Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan; Department of General Thoracic Surgery, Kagoshima University Graduate School of Medicine, Kagoshima, Japan.
Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Ann Thorac Surg. 2020 Jun;109(6):1750-1756. doi: 10.1016/j.athoracsur.2019.12.061. Epub 2020 Feb 10.
Previous reports suggest that lung cancer in the lower lobe is associated with a poorer prognosis than upper lobe disease. However, the reason remains controversial. We evaluated the relationship among the affected lobe, postoperative infectious complications, and cancer recurrence in patients who underwent lobectomy for clinical stage I lung cancer.
We retrospectively reviewed 422 cases of resected lung cancer. We recorded the postoperative complications that developed within 30 days after surgery. The covariates included in the outcome analysis were patient demographic variables, surgical approach, laterality, affected lobe, tumor size, histologic type, tumor grade, pleural lavage cytology, pleural invasion, lymphovascular invasion, and lymph node metastasis.
Lower lobectomy was associated with significantly poorer recurrence-free (excluding nonspecific death) and overall survival than upper lobectomy. According to a stepwise multiple Cox proportional hazards analysis, lower lobectomy, lymph node metastasis, tumor grade, and pleural invasion were independent predictors of recurrence. The following postoperative complications were significantly associated with cancer recurrence and predominantly developed after lower lobectomy: any grade ≥3 complications (n = 61), space/organ surgical site infection of any grade (n = 55), and any infection requiring antibiotics (n = 61).
The current study revealed a significant relationship among the site of resection (upper or lower lobe), cancer recurrence, and occurrence of infectious complications. We must clarify the role of preventing infectious complications in improving the early- and long-term outcomes of lower lobe cancer.
先前的报告表明，相较于上叶病变，下叶肺癌与预后较差相关。然而，其原因仍存在争议。我们评估了行肺叶切除术的Ⅰ期肺癌患者中，受累肺叶、术后感染性并发症与癌症复发之间的关系。
我们回顾性分析了 422 例接受肺切除术的肺癌病例。我们记录了术后 30 天内发生的术后并发症。结局分析中的协变量包括患者的人口统计学变量、手术方法、病变侧、受累肺叶、肿瘤大小、组织学类型、肿瘤分级、胸腔灌洗细胞学、胸膜侵犯、脉管侵犯和淋巴结转移。
下叶切除术与明显较差的无复发生存（排除非特异性死亡）和总生存相关。根据逐步多元 Cox 比例风险分析，下叶切除术、淋巴结转移、肿瘤分级和胸膜侵犯是复发的独立预测因素。以下术后并发症与癌症复发显著相关，且主要在下叶切除术后发生：任何分级≥3 级的并发症（n=61）、任何分级的胸腔/器官手术部位感染（n=55）和需要抗生素治疗的任何感染（n=61）。
本研究揭示了切除部位（上叶或下叶）、癌症复发和感染性并发症之间的显著关系。我们必须明确预防感染性并发症在改善下叶癌症的早期和长期结局中的作用。
