Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
Divisions of Thoracic Surgery and Respiratory Medicine, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
Semin Thorac Cardiovasc Surg. 2021 Autumn;33(3):873-881. doi: 10.1053/j.semtcvs.2021.02.003. Epub 2021 Feb 18.
In recent years, there has been a shift from extrapleural pneumonectomy (EPP) toward pleurectomy/decortication (P/D) as the preferred surgical technique. However, we occasionally encounter difficult cases wherein visceral pleurectomy requires conversion to EPP from P/D. We sought to clarify the preoperative risk factors and clinical outcomes associated with conversion to EPP. We compared and analyzed conversion to EPP and P/D between September 2012 and December 2019. Conversion to EPP was decided in case of diffuse tumor invasion to the pulmonary parenchyma or due to failure of decortication. Univariable regression analysis was performed to determine the association of preoperative variables with conversion to EPP. Survival was analyzed by the Kaplan-Meier method and log-rank test. Of the 181 patients who underwent intended P/D, 145 (80.1%) patients underwent P/D and 18 (9.9%) patients underwent conversion to EPP. The sum of 3-level pleural thickness (P < 0.001), maximum of 3-level pleural thickness (P = 0.006), and clinical T stage (P < 0.001) demonstrated association with conversion to EPP. Overall survival and progression-free survival were significantly worse in the conversion to EPP group (median overall survival, 29.2 months vs 57.0 months [P = 0.008]; median progression-free survival, 15.3 months vs 23.2 months [P = 0.005]. Our data show that approximately 1 of every 10 patients with P/D intention converted to EPP. Preoperative pleural thickness and clinical T stage may be risk factors associated with conversion to EPP. The survival rate of conversion to EPP was worse than that of P/D.
近年来，人们已从施行胸膜外全肺切除术（EPP）转向施行胸膜切除术/剥除术（P/D），将其作为首选的手术技术。然而，我们偶尔会遇到困难的病例，这些病例中的内脏胸膜切除术需要从 P/D 转为 EPP。我们旨在阐明与转为 EPP 相关的术前风险因素和临床结局。我们比较和分析了 2012 年 9 月至 2019 年 12 月期间转为 EPP 和 P/D 的病例。如果肿瘤广泛侵犯肺实质或剥除术失败，则决定转为 EPP。使用单变量回归分析来确定与转为 EPP 相关的术前变量的关联。使用 Kaplan-Meier 方法和对数秩检验分析生存情况。在 181 例行计划 P/D 的患者中，145 例（80.1%）患者接受了 P/D，18 例（9.9%）患者转为 EPP。3 级胸膜厚度总和（P<0.001）、3 级胸膜最大厚度（P=0.006）和临床 T 分期（P<0.001）与转为 EPP 相关。转为 EPP 组的总生存和无进展生存明显较差（中位总生存，29.2 个月比 57.0 个月[P=0.008]；中位无进展生存，15.3 个月比 23.2 个月[P=0.005]）。我们的数据显示，约每 10 例计划行 P/D 的患者中就有 1 例转为 EPP。术前胸膜厚度和临床 T 分期可能是与转为 EPP 相关的风险因素。转为 EPP 的生存率比 P/D 差。
