Matsui Takuya, Takahashi Yusuke, Nakada Takeo, Sugita Yusuke, Shinohara Shuichi, Suzuki Ayumi, Sakakura Noriaki, Takano Takatsugu, Chiba Kensuke, Nakamura Ryuji, Oda Risa, Tatematsu Tsutomu, Yokota Keisuke, Mizuno Kotaro, Haneda Hiroshi, Okuda Katsuhiro, Kuroda Hiroaki
Department of Thoracic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Japan.
Department of Thoracic and Pediatric Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
World J Surg. 2023 Aug;47(8):2065-2075. doi: 10.1007/s00268-023-07002-8. Epub 2023 May 9.
Among anatomical sublobar resection techniques for non-small cell lung cancer (NSCLC), the clinical benefit of subsegmentectomy remains unclear. We investigated whether anatomical sublobar resection including subsegmentectomy-segmental resection with subsegmental additional resection or subsegmental resection alone-is an effective and feasible surgical procedure for NSCLC.
We retrospectively reviewed data of 285 patients with clinical stage I NSCLC who underwent anatomical sublobar resection at our institution from January 2013 to March 2021 and compared surgical outcomes between patients who underwent anatomical sublobar resection including (IS; n = 50) and excluding (ES; n = 235) subsegmentectomy.
No significant intergroup differences were noted in terms of age, sex, smoking, comorbidities, tumor size or location, consolidation tumor ratio, and preoperative pulmonary function. The IS group had more preoperative computed tomography-guided markings (34 vs. 15%; p = .004) and smaller resected lung volumes converted to the total subsegment number [3 (2-4) vs. 3 (3-6); p = .02] than the ES group. No significant differences in margin distance [mm, 20 (15-20) vs. 20 (20-20); p = .93], readmission rate (2% vs. 3%; p > .99), and intraoperative (8% vs. 7%; p = .77) or postoperative (8% vs. 10%; p = .80) complication rates were observed, and the 5-year local recurrence-free survival (91% vs. 90%; p = .92) or postoperative pulmonary function change were comparable between both groups.
Although further investigations are required, anatomical sublobar resection including subsegmentectomy for clinical stage I NSCLC could be an acceptable therapeutic option.
在非小细胞肺癌（NSCLC）的解剖性肺叶下切除技术中，亚段切除术的临床获益仍不明确。我们研究了包括亚段切除术（亚段附加切除的节段性切除）或单独亚段切除术在内的解剖性肺叶下切除对于NSCLC是否是一种有效且可行的手术方法。
我们回顾性分析了2013年1月至2021年3月在我院接受解剖性肺叶下切除的285例临床I期NSCLC患者的数据，并比较了接受包括亚段切除术（IS组；n = 50）和不包括亚段切除术（ES组；n = 235）的解剖性肺叶下切除患者的手术结果。
两组在年龄、性别、吸烟、合并症、肿瘤大小或位置、实性肿瘤比例和术前肺功能方面无显著差异。与ES组相比，IS组术前计算机断层扫描引导下的标记更多（34%对15%；p = 0.004），切除肺体积转换为亚段总数更小[3（2 - 4）对3（3 - 6）；p = 0.02]。切缘距离[mm，20（15 - 20）对20（20 - 20）；p = 0.93]、再入院率（2%对3%；p > 0.99）以及术中（8%对7%；p = 0.77）或术后（8%对10%；p = 0.80）并发症发生率均无显著差异，两组的5年局部无复发生存率（91%对90%；p = 0.92）或术后肺功能变化相当。
尽管需要进一步研究，但对于临床I期NSCLC，包括亚段切除术在内的解剖性肺叶下切除可能是一种可接受的治疗选择。
