Department of General Thoracic Surgery, Juntendo University Hospital, Tokyo, Japan.
Thorac Cancer. 2022 Jul;13(14):2024-2030. doi: 10.1111/1759-7714.14481. Epub 2022 May 30.
The initial surgery for lung cancer with interstitial lung disease (ILD) is often followed by passive treatment due to the surgery-induced deterioration in respiratory function, and only a few studies have summarized the findings associated with a second surgery for lung cancer patients with ILD.
Of the 3932 lung cancer patients who underwent surgery at our hospital from August 2008 to July 2019, 404 (10%) patients (1) underwent preoperative computed tomography for imaging of interstitial pneumonia and (2) underwent initial surgery. We analyzed 45 cases (11%) suspected of showing metachronous lung cancer during the postoperative course.
Thirty-four patients (76%) underwent a second surgery. The group that underwent a second surgery showed a significantly better prognosis than the group that did not (p = 0.0009). The surgical procedure was wide-wedge resection/segmentectomy/lobectomy and above in 15/7/12 cases, respectively. Postoperative complications were observed in nine cases (26%) (prolonged pulmonary fistula in five cases, ILD acute exacerbation in two cases, and wound dissection in two cases). Mortality within 30 days occurred in one case (ILD acute exacerbation at postoperative day 15). Twelve patients (35%) experienced recurrence. In the wide-wedge resection group, 2/15 (13%) patients showed stump recurrence. The 1-, 2-, 3-, and 5-year survival rates after surgery for secondary lung cancer were 80.4, 72.5, 68.2, and 39.4%, respectively.
Surgery can be considered an effective treatment method for secondary lung cancer with ILD if the cases are carefully selected.
由于手术导致呼吸功能恶化，患有间质性肺病 (ILD) 的肺癌患者的初始手术通常会接受被动治疗，仅有少数研究总结了针对这些患者进行二次肺癌手术的结果。
在我院 2008 年 8 月至 2019 年 7 月接受手术的 3932 例肺癌患者中，404 例（10%）患者 (1) 术前进行了间质性肺炎的 CT 成像，以及 (2) 进行了初始手术。我们分析了术后过程中疑似出现肺癌的 45 例（11%）病例。
34 例患者（76%）接受了二次手术。与未接受二次手术的患者相比，接受手术的患者预后明显更好（p = 0.0009）。二次手术的手术方式分别为广泛楔形切除术/节段切除术/肺叶切除术及以上术式，分别为 15/7/12 例。9 例（26%）出现术后并发症（5 例出现迁延性肺瘘，2 例出现 ILD 急性加重，2 例出现切口裂开）。1 例患者（ILD 急性加重，术后第 15 天）术后 30 天内死亡。12 例（35%）患者出现复发。在广泛楔形切除术组中，15 例中有 2 例（13%）患者出现残端复发。二次肺癌手术后的 1、2、3 和 5 年生存率分别为 80.4%、72.5%、68.2%和 39.4%。
如果仔细选择病例，手术可以被认为是患有 ILD 的肺癌的有效治疗方法。
