肺叶切除术治疗未经诊断的疑似肺癌。
Lobectomy for Suspected Lung Cancer Without Prior Diagnosis.
机构信息
Division of Thoracic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Georgetown University School of Medicine, Washington, DC.
出版信息
Ann Thorac Surg. 2023 Oct;116(4):694-701. doi: 10.1016/j.athoracsur.2023.05.017. Epub 2023 Jun 2.
BACKGROUND
We describe use, patients, and outcome of diagnostic lobectomy for suspected lung cancer without pathologic confirmation.
METHODS
A retrospective review of consecutive lobectomy or bilobectomy for suspected or confirmed primary pulmonary malignancy was conducted using our participant's sample of The Society of Thoracic Surgeons database. Surgeons performed lobectomy based on clinical diagnosis or confirmation on a biopsy specimen. Lung cancer confirmed by biopsy specimen was compared with cases clinically suspected. Univariate and multivariate analyses identified variables associated with lobectomy without biopsy specimen confirmation.
RESULTS
Among 2651 lobectomies performed between 2006 and 2019 in 2617 patients, lung cancer was confirmed by preoperative biopsy specimen in 51.6% (1368 of 2651) or was clinically suspected before the operation in 48.4% (1283 of 2651). The intraoperative biopsy specimen in 585 of 1283 cases (45.6%) proved lung cancer before lobectomy, whereas lobectomy proceeded in 698 cases (54.4%) without a diagnosis. Final pathology proved lung cancer in 90% (628 of 698) without a diagnosis before lobectomy and nonmalignant disease in 10% (70 of 698). Nonneoplastic pathology included granulomas (30 of 70 [43%]), pneumonia (12 of 70 [17%]), bronchiectasis (7 of 70 [10%]), and other lesions (21 of 70 [30%]). Operative mortality was 0.94% (25 of 2651) for the cohort and 1.0% (7 of 698) for diagnostic lobectomy only. Multivariate analysis identified patient age, type of lobectomy (right middle lobe), and the intermediate study tercile as associated with diagnostic lobectomy.
CONCLUSIONS
Lobectomy for suspected lung cancer without diagnosis is common, represents practice variation, and infrequently (10% diagnostic, 2.6% all lobectomies) removes nonmalignant disease. Tissue confirmation before lobectomy is preferred, particularly when operative risk is increased. Diagnostic lobectomy is acceptable in carefully selected patients and lesions.
背景
我们描述了在没有病理证实的情况下，对疑似肺癌患者进行诊断性肺叶切除术的使用情况、患者特征和结局。
方法
使用我们参与的胸外科医生协会数据库中的参与者样本，对连续行肺叶切除术或双肺叶切除术治疗疑似或确诊原发性肺部恶性肿瘤的患者进行回顾性分析。外科医生根据临床诊断或活检标本的确认来进行肺叶切除术。通过活检标本确诊的肺癌与临床疑似病例进行比较。单变量和多变量分析确定了与无活检标本确认的肺叶切除术相关的变量。
结果
在 2006 年至 2019 年间，在 2617 名患者中进行了 2651 例肺叶切除术，术前活检标本确诊肺癌的比例为 51.6%（1368/2651），术前临床疑似的比例为 48.4%（1283/2651）。在 1283 例临床疑似病例中，585 例（45.6%）的术中活检标本在肺叶切除术前证实为肺癌，而 698 例（54.4%）在没有诊断的情况下进行了肺叶切除术。最终病理学证实 698 例无术前诊断的病例中 90%（628 例）为肺癌，10%（70 例）为非恶性疾病。非肿瘤性病理学包括肉芽肿（30/70[43%]）、肺炎（12/70[17%]）、支气管扩张（7/70[10%]）和其他病变（21/70[30%]）。该队列的手术死亡率为 0.94%（2651 例中的 25 例），仅诊断性肺叶切除术的死亡率为 1.0%（698 例中的 7 例）。多变量分析确定患者年龄、肺叶切除术类型（右中叶）和中间研究三分位数与诊断性肺叶切除术相关。
结论
在没有诊断的情况下对疑似肺癌患者进行肺叶切除术很常见，这代表了实践中的差异，且很少（10%的诊断性，2.6%的所有肺叶切除术）切除非恶性疾病。在进行肺叶切除术之前进行组织确认是首选方法，特别是当手术风险增加时。在仔细选择的患者和病变中，诊断性肺叶切除术是可以接受的。
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