Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve School of Medicine, Cleveland, Ohio.
Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):293-298. doi: 10.1053/j.semtcvs.2021.03.005. Epub 2021 Mar 10.
Current guidelines recommend anatomic lung resection of typical bronchopulmonary carcinoids. Typical carcinoid tumors have excellent prognosis and sublobar resection has been associated with noninferior long-term survival. It's unclear whether wedge resection is acceptable for small typical carcinoid tumors. We hypothesize there is no difference in survival between wedge resection and segmentectomy for Stage I typical bronchopulmonary carcinoid tumors. Using the National Cancer Database from 2010 to 2016, we identified clinical T1N0M0 typical bronchopulmonary carcinoid tumors by wedge resection or segmentectomy. Short-term outcomes included length of stay, lymph nodes evaluated, pathologic node status, positive margin status, and 90-day mortality. Primary outcome was overall survival and estimated using Kaplan-Meier survival analysis. 821 patients were identified: 677 receiving wedge resection, 144 receiving segmentectomy. Segmentectomy was more commonly performed in an academic setting (70.0% vs 57.3%, P = 0.005). The mean tumor size for segmentectomy was 1.7 cm versus 1.4 cm for wedge resection (P < 0.001). There was no difference in LOS, positive margin status, and 90-day mortality between groups. There were significantly more lymph nodes evaluated in segmentectomy patients (median 4 vs 0, P < 0.001), but there was no difference in positive lymph node status (5.3% vs 2.6%, P = 0.165). The OS was similar between wedge and segmental resection (P = 0.613): 3-year survival (93.5% vs 92.8%) and 5-year survival (83.8% vs 84.9%). Wedge resection and segmentectomy have similar survival for Stage I typical bronchopulmonary carcinoids in a large national database. This analysis suggests nonanatomic, parenchymal-sparing resection should be considered an appropriate alternative for Stage I typical bronchopulmonary carcinoids.
目前的指南建议对典型的支气管类癌进行解剖性肺切除术。典型类癌肿瘤的预后极好，亚肺叶切除术与非劣效的长期生存相关。对于小的典型类癌肿瘤，楔形切除术是否可行尚不清楚。我们假设对于 I 期典型支气管类癌肿瘤，楔形切除术和节段切除术之间的生存无差异。本研究使用 2010 年至 2016 年国家癌症数据库，通过楔形切除术或节段切除术确定了临床 T1N0M0 期的典型支气管类癌肿瘤。短期结果包括住院时间、评估的淋巴结数量、病理淋巴结状态、阳性切缘状态和 90 天死亡率。主要结果是总生存时间，并通过 Kaplan-Meier 生存分析进行估计。共确定了 821 例患者：677 例行楔形切除术，144 例行节段切除术。节段切除术更常见于学术机构（70.0%比 57.3%，P = 0.005）。节段切除术的肿瘤平均直径为 1.7cm，而楔形切除术为 1.4cm（P<0.001）。两组间的 LOS、阳性切缘状态和 90 天死亡率无差异。节段切除术患者评估的淋巴结数量明显更多（中位数 4 个比 0 个，P<0.001），但阳性淋巴结状态无差异（5.3%比 2.6%，P = 0.165）。楔形切除术和节段切除术的 OS 相似（P = 0.613）：3 年生存率（93.5%比 92.8%）和 5 年生存率（83.8%比 84.9%）。在大型国家数据库中，I 期典型支气管类癌的楔形切除术和节段切除术具有相似的生存。该分析表明，对于 I 期典型支气管类癌，非解剖性、保留实质的切除术可作为一种合适的替代方法。
