Division of Cardiovascular and Thoracic Surgery, Department of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.
Semin Respir Crit Care Med. 2020 Jun;41(3):335-345. doi: 10.1055/s-0039-3401991. Epub 2020 May 25.
Lung carcinoma widely affects men and women in the sixth and seventh decades of life. Thorough workup with radiographic imaging, pathologic diagnosis, and cardiopulmonary functional assessment is key to successful treatment. Accurate staging is essential for both assessing prognosis and directing therapy. Early-stage lung cancer is most often treated with anatomic lobectomy; locally advanced cancers may require induction or adjuvant therapies. Any nonnodal metastases will require definitive systemic therapy. Traditionally, surgery was performed with a posterolateral thoracotomy incision, division of the hilar vessels, removal of affected lung parenchyma, and a complete mediastinal and hilar lymph node dissection for accurate pathologic staging. In recent years, however, video-assisted thoracoscopic (VATS) or other minimally invasive approaches have emerged as the standard of care for early-stage disease. Compared with standard thoracotomy, VATS lobectomy offers improved postoperative outcomes as well as potential survival benefit. Thoracoscopic lobectomy is also cost-effective. This article focuses on the technique, outcomes, adaptation, and evolution of thoracoscopic lobectomy and other minimally invasive techniques in the treatment of lung cancer.
肺癌广泛影响六、七十岁的男性和女性。彻底的影像学检查、病理诊断和心肺功能评估是成功治疗的关键。准确的分期对于评估预后和指导治疗都至关重要。早期肺癌通常采用解剖性肺叶切除术治疗；局部晚期癌症可能需要诱导或辅助治疗。任何非淋巴结转移都需要明确的全身治疗。传统上，手术采用后外侧开胸切口，分离肺门血管，切除受累的肺实质，并进行完整的纵隔和肺门淋巴结清扫以进行准确的病理分期。然而，近年来，电视辅助胸腔镜（VATS）或其他微创方法已成为早期疾病的标准治疗方法。与标准开胸相比，VATS 肺叶切除术可改善术后结果，并可能带来生存获益。胸腔镜肺叶切除术也具有成本效益。本文重点介绍胸腔镜肺叶切除术和其他微创技术在肺癌治疗中的技术、结果、适应性和演变。
