Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
Department of Thoracic Surgery, Iwate Medical University, Yahaba-cho, Japan.
Thorac Cancer. 2023 Mar;14(9):827-833. doi: 10.1111/1759-7714.14813. Epub 2023 Feb 2.
Sleeve lobectomy is recommended to avoid pneumonectomy and preserve pulmonary function in patients with central lung cancer. However, the relationship between postoperative pulmonary functional loss and resected lung parenchyma volume has not been fully characterized. The aim of this study was to evaluate the relationship between pulmonary function and lung volume in patients undergoing sleeve lobectomy or pneumonectomy.
A total of 61 lung cancer patients who had undergone pneumonectomy or sleeve lobectomy were analyzed retrospectively. Among them, 20 patients performed pulmonary function tests, including vital capacity (VC) and forced expiratory volume in 1 s (FEV1) tests, preoperatively and then about 6 months after surgery. VC and FEV1 ratios were calculated (measured postoperative respiratory function/predicted postoperative respiratory function) as the standardized pulmonary functional loss ratio.
Thirty-day operation-related mortality was significantly lower after sleeve lobectomy (3.2%) than pneumonectomy (9.6%). The 5-year relapse-free survival rate was 46.67% versus 29.03%, and the 5-year overall survival rate was 63.33% versus 38.71% in patients receiving sleeve lobectomy versus pneumonectomy. The VC ratio in the pneumonectomy group was better than in the sleeve lobectomy group (1.003 ± 0.117 vs. 0.779 ± 0.12; p = 0.0008), as was the FEV1 ratio (1.132 ± 0.226 vs. 0.851 ± 0.063; p = 0.0038).
Both short-term and long-term outcomes were better with sleeve lobectomy than pneumonectomy. However, actual postoperative pulmonary function after pneumonectomy may be better than clinicians expect, and pneumonectomy should still be considered a treatment option for patients with sufficient pulmonary reserve and in whom sleeve lobectomy is less likely to be curative.
对于中央型肺癌患者，推荐行袖状肺叶切除术以避免全肺切除术，并保留肺功能。然而，术后肺功能丧失与切除的肺实质体积之间的关系尚未完全阐明。本研究旨在评估行袖状肺叶切除术或全肺切除术的患者肺功能与肺容积之间的关系。
回顾性分析了 61 例接受全肺切除术或袖状肺叶切除术的肺癌患者。其中 20 例患者术前和术后约 6 个月进行了肺功能检查，包括肺活量（VC）和 1 秒用力呼气量（FEV1）检查。计算 VC 和 FEV1 的比值（实测术后呼吸功能/预测术后呼吸功能）作为标准化肺功能丧失比。
袖状肺叶切除术的 30 天手术相关死亡率（3.2%）明显低于全肺切除术（9.6%）。袖状肺叶切除术组 5 年无复发生存率为 46.67%，全肺切除术组为 29.03%；5 年总生存率分别为 63.33%和 38.71%。全肺切除术组的 VC 比值优于袖状肺叶切除术组（1.003±0.117 比 0.779±0.12；p=0.0008），FEV1 比值也优于袖状肺叶切除术组（1.132±0.226 比 0.851±0.063；p=0.0038）。
袖状肺叶切除术在短期和长期结果上均优于全肺切除术。然而，全肺切除术后实际的肺功能可能优于临床医生的预期，且对于有足够肺储备且袖状肺叶切除术不太可能治愈的患者，全肺切除术仍应被视为一种治疗选择。
