Hattori Aritoshi, Matsunaga Takeshi, Watanabe Yukio, Fukui Mariko, Takamochi Kazuya, Oh Shiaki, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2021 Nov;162(5):1389-1398.e2. doi: 10.1016/j.jtcvs.2020.06.124. Epub 2020 Jul 16.
We investigated the surgical outcomes of repeated pulmonary resection for metachronous ipsilateral second non-small cell lung cancer (NSCLC).
A retrospective review identified 104 (3.6%) patients who underwent surgical resection for ipsilateral metachronous second NSCLC. Repeated anatomical (reanatomical) resection was defined as a metachronous anatomical surgery for secondary NSCLC after ipsilateral primary major lung resection for NSCLC. Operative morbidity or other clinicopathologic factors were analyzed by a multivariable model. Overall survival (OS) was evaluated using Cox proportional hazard model.
Seventy-seven (74%) patients were diagnosed as second primary cases. The 3-year OS after metachronous surgery for ipsilateral second NSCLC was 80.1%, and that of reanatomical resection was equivalent to the other procedures (reanatomical: 81.8%, others: 78.2%, P = .816), whereas reanatomical resection (n = 56) was a significant predictor of postoperative severe morbidity after ipsilateral second pulmonary resection (P = .036) that was found in 23 (41%) patients. When this procedure was classified into 2 groups, ie, completion pneumonectomy (CP; n = 26) and other reanatomical resection to avoid CP (non-CP; n = 32), non-CP was significant on the right side (P = .011), whereas intrapericardial procedure was employed frequently for both (CP: 85%, non-CP: 47%). In contrast, the oncologic outcome (3-year OS; 75.8% vs 87.1%, P = .881) and several surgical outcomes including morbidities were similar between CP and non-CP.
Reanatomical pulmonary resection showed acceptable oncologic outcomes for metachronous ipsilateral second NSCLC. The non-CP procedure was technically challenging; however, both oncologic and surgical results were feasible compared with the CP. This procedure might be a promising novel strategy for properly selected ipsilateral second NSCLC.
我们研究了异时性同侧第二原发性非小细胞肺癌（NSCLC）重复肺切除的手术效果。
一项回顾性研究确定了104例（3.6%）接受同侧异时性第二原发性NSCLC手术切除的患者。重复解剖性（再解剖性）切除定义为在同侧原发性NSCLC肺叶切除术后对继发性NSCLC进行的异时性解剖手术。通过多变量模型分析手术并发症或其他临床病理因素。使用Cox比例风险模型评估总生存期（OS）。
77例（74%）患者被诊断为第二原发性病例。同侧第二原发性NSCLC异时性手术后的3年总生存率为80.1%，再解剖性切除的生存率与其他手术相当（再解剖性：81.8%，其他：78.2%，P = 0.816），而在23例（41%）患者中，再解剖性切除（n = 56）是同侧第二次肺切除术后严重并发症的重要预测因素（P = 0.036）。当将该手术分为两组时，即全肺切除术（CP；n = 26）和为避免CP的其他再解剖性切除（非CP；n = 32），非CP在右侧具有显著性（P = 0.011），而心包内手术在两者中均频繁使用（CP：85%，非CP：47%）。相比之下，CP和非CP之间的肿瘤学结果（3年总生存率；75.8%对87.1%，P = 0.881）以及包括并发症在内的几种手术结果相似。
再解剖性肺切除对异时性同侧第二原发性NSCLC显示出可接受的肿瘤学结果。非CP手术在技术上具有挑战性；然而，与CP相比，肿瘤学和手术结果都是可行的。该手术可能是对适当选择的同侧第二原发性NSCLC的一种有前景的新策略。
