Divisi Duilio, De Vico Andrea, Zaccagna Gino, Crisci Roberto
Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy.
J Thorac Dis. 2020 Jun;12(6):3357-3362. doi: 10.21037/jtd.2020.02.54.
Surgery is the gold standard treatment of lung cancer. The minimally invasive technique does not only concern access to the chest but also the limits of parenchymal resection. The study debates on the safety and oncological adequacy of sublobar resections in bronchogenic carcinoma patients. A systematic analysis of the data in the literature was carried out, comparing the outcomes of patients with resectable non-small lung cancer (NSCLC) who underwent lobectomy or sublobar resection. These last interventions include both segmentectomies and wedge resections taking into consideration the following parameters: complications, relapse rate and overall survival. The complication rate is higher in patients underwent lobectomy compared to sublobar resection, especially in presence of high comorbidity index or octogenarian patients (overall values respectively between 0 and 48% and 0 and 46.6%). Contrarily, the relapse rate (6.2% to 32% 3.6% to 53.4%) and overall survival (50.2% to 93.8% 38.6% to 100%) are more favorable in patients undergoing lobectomy. Sublobar resections are particularly indicated in elderly patients and in patients with high comorbidity index or reduced respiratory functional reserve. However, pulmonary lobectomy still remains the safest and oncologically correct method in patients with good performance status or higher risk of recurrence.
手术是肺癌的金标准治疗方法。微创技术不仅涉及进入胸腔的方式，还涉及实质切除的范围。该研究探讨了支气管源性癌患者亚肺叶切除的安全性和肿瘤学适宜性。对文献中的数据进行了系统分析，比较了接受肺叶切除术或亚肺叶切除术的可切除非小细胞肺癌（NSCLC）患者的结局。这些最后的干预措施包括节段切除术和楔形切除术，同时考虑以下参数：并发症、复发率和总生存率。与亚肺叶切除术相比，接受肺叶切除术的患者并发症发生率更高，尤其是在合并症指数高的患者或八十岁以上的患者中（总体发生率分别在0至48%和0至46.6%之间）。相反，接受肺叶切除术的患者复发率（6.2%至32%对3.6%至53.4%）和总生存率（50.2%至93.8%对38.6%至100%）更有利。亚肺叶切除术特别适用于老年患者以及合并症指数高或呼吸功能储备降低的患者。然而，对于身体状况良好或复发风险较高的患者，肺叶切除术仍然是最安全且肿瘤学上正确的方法。
