Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, Washington.
Ann Thorac Surg. 2021 Jan;111(1):231-236. doi: 10.1016/j.athoracsur.2020.05.082. Epub 2020 Jul 9.
When a resectable lung cancer that invades across the fissure into an adjacent lobe is encountered, options include a bilobectomy on the right or a pneumonectomy on the left vs a parenchymal-sparing resection combined with a lobectomy. Although parenchymal-sparing combinations are technically possible, the available literature reporting on the related oncologic outcomes is limited. We sought to examine the influence of resection extent on overall survival and recurrence patterns in this scenario.
A single-center retrospective medical record review from 2006 to 2018 was performed on all preoperative computed tomography and operative reports of resections greater than a lobectomy. Patients were grouped into maximal resection: bilobectomy or pneumonectomy, and parenchymal-sparing resection: lobectomy with en bloc segment or nonanatomic wedge. Overall survival and cumulative incidence of recurrence were calculated.
The size of our cohort was 54 patients; 19 maximal and 35 parenchymal-sparing resections. All resections were reported as complete (R0). The parenchymal-sparing group had lower odds of immediate surgical morbidity (odds ratio, 0.13; 95% confidence interval, 0.02-0.74; P = .02). Parenchymal-sparing resection was not associated with an increased cumulative incidence of recurrence (P = .98). Postresection estimated overall survival between the 2 cohorts was not significantly different (P = .30).
When technically feasible, a parenchymal-sparing resection is a good option for the resection of tumors that invade across the fissure. R0 parenchymal-sparing resections do not appear to compromise the oncologic outcomes of overall survival or cumulative incidence of recurrence and also seem to carry less morbidity.
当遇到可切除的肺癌侵犯裂并延伸至相邻肺叶时，可选择行右侧全肺切除术或左侧肺叶切除术，也可选择行保留肺实质的肺段切除术联合肺叶切除术。虽然保留肺实质的联合切除术在技术上是可行的，但相关的肿瘤学结果的文献报道有限。我们旨在研究在此情况下，切除范围对总生存率和复发模式的影响。
对 2006 年至 2018 年所有大于肺叶切除术的术前 CT 和手术报告进行了单中心回顾性病历审查。患者被分为最大程度的切除术组：全肺切除术或肺叶切除术，以及保留肺实质的切除术组：肺叶切除术联合整块肺段切除术或非解剖楔形切除术。计算总生存率和复发的累积发生率。
我们的队列大小为 54 例患者；19 例最大程度的切除术和 35 例保留肺实质的切除术。所有切除均报告为完全切除（R0）。保留肺实质的组的即时手术发病率较低（优势比，0.13；95%置信区间，0.02-0.74；P =.02）。保留肺实质的切除术与复发的累积发生率增加无关（P =.98）。两组之间的术后估计总生存率无显著差异（P =.30）。
在技术上可行的情况下，对于侵犯裂的肿瘤，保留肺实质的切除术是一种很好的选择。R0 保留肺实质的切除术似乎不会影响总生存率或复发的累积发生率的肿瘤学结果，而且似乎发病率也较低。
