Kobayashi Aki K, Horinouchi Hidehito, Nakayama Yuko, Ohe Yuichiro, Yotsukura Masaya, Uchida Shinsuke, Asakura Keisuke, Yoshida Yukihiro, Nakagawa Kazuo, Watanabe Shun-Ichi
Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Lung Cancer. 2020 Jul;145:105-110. doi: 10.1016/j.lungcan.2020.04.013. Epub 2020 Apr 21.
Local recurrence after definitive chemoradiation therapy, chemotherapy or radiotherapy with curative intent is often seen in patients with advanced non-small cell lung cancer. We evaluated the feasibility of salvage pulmonary resection after definitive non-surgical treatments and the postoperative morbidity and mortality rates.
We retrospectively analyzed the characteristics and medical courses of patients who had undergone salvage pulmonary resections after local relapse or progression between January 2000 and March 2018 at the National Cancer Centre Hospital, Tokyo, Japan. All the candidates were evaluated, and curability by surgical resection was assessed by a multidisciplinary tumor board.
A total of 38 patient received salvage surgery: 26 of the patients were men, and the median age was 64.5 years (range, 20-78 years). Among these 38 patients, salvage lung resection was performed after chemoradiotherapy in 23 patients, after chemotherapy in 9 patients, and after radiotherapy with curative intent in 6 patients. The surgical resection methods were as follows: 26 lobectomies (2 bilobectomy, 15 right upper, 5 right lower, 1 right middle, 2 left lower and 1 left upper), 8 pneumonectomies (5 left and 3 right), and 4 segmentectomies. A complete resection (R0 resection) was achieved in 35 cases (92.1 %). Postoperative complications were observed in 3 patients (prolonged air leakage, bronchopleural fistula and surgical site infection in 1 patient each). No postoperative deaths occurred within 30 days after surgery.
Along with better outcomes after definitive chemoradiotherapy, chemotherapy, and radiotherapy, the frequency of salvage surgery has been increasing in recent years. Salvage pulmonary resections after definitive non-surgical treatments with curative intent are feasible with an acceptable morbidity rate and oncological outcomes in thoroughly assessed patients.
在晚期非小细胞肺癌患者中，根治性放化疗、化疗或根治性放疗后局部复发较为常见。我们评估了根治性非手术治疗后挽救性肺切除的可行性以及术后发病率和死亡率。
我们回顾性分析了2000年1月至2018年3月在日本东京国立癌症中心医院接受局部复发或进展后挽救性肺切除患者的特征和病程。对所有候选患者进行评估，并由多学科肿瘤委员会评估手术切除的可治愈性。
共有38例患者接受了挽救性手术：其中26例为男性，中位年龄为64.5岁（范围20 - 78岁）。在这38例患者中，23例在放化疗后进行了挽救性肺切除，9例在化疗后进行，6例在根治性放疗后进行。手术切除方法如下：26例肺叶切除术（2例双叶切除，15例右上叶，5例右下叶，1例右中叶，2例左下叶，1例左上叶），8例全肺切除术（5例左全肺，3例右全肺），4例肺段切除术。35例（92.1%）实现了完整切除（R0切除）。3例患者出现术后并发症（各1例出现持续漏气、支气管胸膜瘘和手术部位感染）。术后30天内无死亡病例。
随着根治性放化疗、化疗和放疗后疗效的提高，近年来挽救性手术的频率不断增加。对于经过全面评估的患者，根治性非手术治疗后进行挽救性肺切除是可行的，发病率和肿瘤学结局均可接受。
