Ichinokawa Hideomi, Takamochi Kazuya, Hayashi Takuo, Fukui Mariko, Hattori Aritoshi, Matsunaga Takeshi, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University Hospital, Tokyo, Japan.
Department of Human Pathology, School of Medicine, Juntendo University, Tokyo, Japan.
Transl Cancer Res. 2023 Feb 28;12(2):359-366. doi: 10.21037/tcr-22-1945. Epub 2023 Jan 9.
Pulmonary artery intimal sarcoma (PAIS) is a rare but aggressive malignancy. This study clarified the problems and countermeasures of surgical treatment by examining surgical cases of PAIS.
Between January 2007 and October 2020, 10 patients with PAIS who underwent surgery at our hospital were retrospectively examined.
The surgical procedure that aimed at complete resection was pulmonary resection only (three cases), along with pulmonary artery vascular replacement (six cases) and pulmonary endarterectomy (PE) (one case). The positive rate of vascular stumps was 7/10. In all cases, chest computed tomography scan showed positive margins of ≤20 mm between the tumor and surgical dissection (6/6). In addition, the distance between the location of the tumor on computed tomography and the dissection line during surgery needed to be at least 20 mm (2/3). However, even at a distance of 25 mm, one case with a positive margin was observed. Postoperative recurrence was 8/9 cases, and the median recurrence period was as short as 10 months (range, 3-19 months). Postoperative treatment was required in 7/9 cases (operation/chemotherapy/radiotherapy/chemoradiotherapy/heavy ion radiotherapy =1/2/2/1/1). The median survival was 15 months (range, 0.5-36 months).
Extended surgery should be performed as much as possible, with a distance of at least 20 mm between the location of the tumor on computed tomography scan and the incision line during surgery. The median postoperative recurrence period was as short as 10 months. Therefore, intensive care for intrathoracic recurrence follow-up is required for 1 year after surgery.
肺动脉内膜肉瘤（PAIS）是一种罕见但侵袭性强的恶性肿瘤。本研究通过检查PAIS的手术病例，阐明了手术治疗的问题及对策。
回顾性研究2007年1月至2020年10月在我院接受手术的10例PAIS患者。
旨在完全切除的手术方式为单纯肺切除术（3例）、肺动脉血管置换术（6例）和肺动脉内膜剥脱术（PE）（1例）。血管残端阳性率为7/10。所有病例中，胸部计算机断层扫描显示肿瘤与手术切缘之间的阳性切缘≤20 mm（6/6）。此外，计算机断层扫描上肿瘤位置与手术中解剖线之间的距离至少需要20 mm（2/3）。然而，即使距离为25 mm，仍观察到1例切缘阳性病例。术后复发率为8/9例，中位复发期短至10个月（范围3 - 19个月）。9例中有7例需要术后治疗（手术/化疗/放疗/放化疗/重离子放疗=1/2/2/1/1）。中位生存期为15个月（范围0.5 - 36个月）。
应尽可能进行扩大手术，计算机断层扫描上肿瘤位置与手术切口线之间的距离至少为20 mm。术后中位复发期短至10个月。因此，术后1年内需要对胸腔内复发进行密切随访。
