Voltolini Luca, Gonfiotti Alessandro, Viggiano Domenico, Borgianni Sara, Farronato Arianna, Bongiolatti Stefano
Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy.
Thoracic Surgery Division, ASST Mantova-Cremona, Mantua, Italy.
J Thorac Dis. 2020 Aug;12(8):4090-4098. doi: 10.21037/jtd-20-1241.
The aim of this study was to report our Institutional experience with extended sleeve lobectomy (ESL) in centrally located non-small cell lung cancer (NSCLC), focusing on technical details, post-operative results, recurrence and survival, to determine whether ESL can be accepted as a favorable alternative procedure to pneumonectomy (PN).
Twenty-two consecutive patients undergoing ESL for centrally located tumors from January 2014 to June 2019 were prospectively enrolled.
Six (27.3%) patients had been preoperatively considered unfit for PN. Neo-adjuvant chemotherapy was administered in 7 (31.8%) out of the 10 patients that showed a cN2 disease. According to Okada classification, 8 cases of type A ESL (resection of right upper plus middle lobe ± segment 6), one case of type B (resection of left upper lobe + segment 6) and 13 cases of type C (resection of left lower lobe + lingulectomy) ESL were performed. Concomitant pulmonary angioplasty was done in 7 (31.8%) patients. Complete resection was achieved in all patients. There was no postoperative mortality. Major postoperative complications developed in 2 (9.1%) patients (one small anastomotic dehiscence healed in few weeks, one pulmonary embolism). Complete long-term patency of the reconstructed airway was documented in all patients by fiber-optic bronchoscopy. At the median follow-up of 21 months (4-57 months), the recurrence rate was 54.5%, with 4 (18.2%) patients developing a loco-regional recurrence but no endobronchial or perianastomotic recurrence occurred. The overall 3-year survival rate was 45% with a median survival of 33 months.
ESL is a safe and effective procedure that should be considered a favorable alternative to PN whenever it may guarantee a complete resection.
本研究的目的是报告我们机构在中心型非小细胞肺癌（NSCLC）中进行扩大袖状肺叶切除术（ESL）的经验，重点关注技术细节、术后结果、复发和生存情况，以确定ESL是否可被视为肺切除术（PN）的一种有利替代手术。
前瞻性纳入了2014年1月至2019年6月期间连续22例因中心型肿瘤接受ESL的患者。
6例（27.3%）患者术前被认为不适合进行PN。10例显示cN2疾病的患者中有7例（31.8%）接受了新辅助化疗。根据冈田分类，进行了8例A型ESL（右上叶加中叶切除±6段）、1例B型（左上叶加6段切除）和13例C型（左下叶切除加舌叶切除）ESL。7例（31.8%）患者同时进行了肺血管成形术。所有患者均实现了完全切除。无术后死亡。2例（9.1%）患者出现了主要术后并发症（1例小的吻合口裂开在几周内愈合，1例肺栓塞）。所有患者通过纤维支气管镜检查均记录到重建气道完全长期通畅。在中位随访21个月（4 - 57个月）时，复发率为54.5%，4例（18.2%）患者出现局部区域复发，但未发生支气管内或吻合口周围复发。3年总生存率为45%，中位生存期为33个月。
ESL是一种安全有效的手术，只要能保证完全切除，就应被视为PN的一种有利替代方法。
