Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University Hospital, Fukuoka, Japan.
Breast and Endocrinological Surgery, Department of General Thoracic Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan.
Ann Thorac Surg. 2022 Sep;114(3):1073-1083. doi: 10.1016/j.athoracsur.2021.04.063. Epub 2021 May 5.
Completion pneumonectomy (CP) for second primary/primary lung cancer (SPLC) and local recurrence lung cancer (LRLC) is still controversial. Although several case series on such a practice exist, the oncological benefit is under debate. The purpose of this study was to review available literatures on CP for SPLC and LRLC and evaluate postoperative and long-term outcomes.
MEDLINE, SCOPUS, and Web of Science were reviewed for eligible studies in January 2021. Studies were included if they indicated outcomes of patients with lung cancer undergoing CP. Overall survival (OS) was defined as the primary endpoint; secondary endpoints included operative morbidity and 30-day mortality. Random-effects meta-analysis based on a binomial distribution was used to create pooled estimates.
Thirty-two eligible studies including 1157 patients were identified. These studies were uniformly retrospective reports. Pooled estimates for 3-year and 5-year OS were 50.6% (95% confidence interval [CI], 34.7%-66.5%) and 38.9% (95% CI, 32.2%-46.1%) in SPLC patients. When the SPLC was a stage I tumor, pooled 5-year OS was favorable with 60.7% (95% CI, 43.2%-75.9%). In LRLC, pooled 3-year and 5-year OS were 47.6% (95% CI, 36.1%-59.4%) and 33.8% (95% CI, 26.8%-41.5%), respectively. Pooled morbidity and 30-day mortality was reported in 38.2% (95% CI, 32.0%-44.9%), and 10.0% (95% CI, 8.1%-12.3%), respectively.
CP for SPLC and LRLC is a challenging procedure with significant perioperative morbimortality. However, published evidence indicates good long-term survival for selected patients. Further studies are needed to identify patient subgroups which benefit most from CP.
对于第二原发/原发性肺癌（SPLC）和局部复发性肺癌（LRLC），完成性肺切除术（CP）仍然存在争议。尽管有几项关于这种做法的病例系列，但肿瘤学获益仍存在争议。本研究的目的是回顾 SPLC 和 LRLC 接受 CP 治疗的可用文献，并评估术后和长期结果。
2021 年 1 月，检索 MEDLINE、SCOPUS 和 Web of Science 以获取符合条件的研究。如果研究表明接受 CP 的肺癌患者的结局，则将其纳入研究。总生存（OS）定义为主要终点；次要终点包括手术发病率和 30 天死亡率。基于二项式分布的随机效应荟萃分析用于创建汇总估计值。
共纳入 32 项符合条件的研究，共纳入 1157 例患者。这些研究均为回顾性报告。SPLC 患者的 3 年和 5 年 OS 汇总估计值分别为 50.6%（95%置信区间[CI]，34.7%-66.5%）和 38.9%（95% CI，32.2%-46.1%）。当 SPLC 为 I 期肿瘤时，5 年 OS 汇总结果较好，为 60.7%（95% CI，43.2%-75.9%）。在 LRLC 中，3 年和 5 年 OS 的汇总估计值分别为 47.6%（95% CI，36.1%-59.4%）和 33.8%（95% CI，26.8%-41.5%）。38.2%（95% CI，32.0%-44.9%）和 10.0%（95% CI，8.1%-12.3%）分别报告了汇总发病率和 30 天死亡率。
CP 治疗 SPLC 和 LRLC 是一种具有显著围手术期发病率和死亡率的挑战性手术。然而，已发表的证据表明，对于选定的患者，长期生存情况良好。需要进一步的研究来确定从 CP 中获益最多的患者亚组。
