Agaoglu Sanli Bahar, Turk Yunus, Sirzai Esra Yamansavci, Yazgan Serkan, Ucvet Ahmet
University of Health Sciences Turkey, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey.
Indian J Thorac Cardiovasc Surg. 2025 Apr;41(4):404-410. doi: 10.1007/s12055-024-01886-4. Epub 2025 Jan 16.
Lobectomy is the most frequently performed surgical treatment for lung cancer; isolated middle lobectomy (IML) is the least frequently performed lobectomy. Until recently, IML performed for Non-Small Cell Lung Cancer (NSCLC) located in the middle lobe of the lung was considered insufficient in oncologic surgery, and upper bilobectomy (Upper lobe + Middle lobe) or lower bilobectomy (Lower lobe + Middle lobe) was performed for isolated middle lobe tumors. Since postoperative morbidity and mortality rates are worse in bilobectomy compared to lobectomy, IMLs have become frequently performed. In this study, patients who underwent IML for NSCLC were compared with upper or lower lobectomies (ULL), and the oncologic results of patients who underwent IML were evaluated.
In this study, 45 patients who underwent IML at our institution between 2012 and 2022 and 45 patients, who underwent right upper or lower lobectomy and were similar in terms of gender and age, were retrospectively analyzed. Oncological outcomes between these two groups were evaluated.
The mean age of 45 patients, 34 (75.6%) male and 11 (24.5%) female, who underwent IML was found to be 62.5 ± 8.4 years. According to the type of surgery, 27 (60%) patients underwent thoracotomy and 18 (40%) patients underwent Video-Assisted Thoracoscopic Surgery (VATS). When tumor histopathologies were examined in all lobectomy patients, it was seen that squamous cell carcinoma was statistically significantly more dominant in IML patients than in the other two lobectomy groups ( = 0.014). In addition, it was seen that the tumor size was smaller in IML patients than in the other groups ( = 0.005). When the survival characteristics between these two groups were evaluated, the overall survival time (OS) of patients who underwent IML was 118.0 (59.0-124.0) months, while the overall survival time of patients who underwent ULL was 71.0 (66.0-74.0) months, and no statistically significant difference was found between the groups. No statistically significant difference was observed between the groups in terms of 30-day and 90-day mortality rates and 5-year survival rates.
There was no significant difference in survival between patients who underwent IML for NSCLC and those who underwent same-sided ULL. Based on these results, IML can be considered as an oncologically appropriate treatment option for masses confined to the middle lobe without the need for bilobectomy.
The online version contains supplementary material available at 10.1007/s12055-024-01886-4.
肺叶切除术是肺癌最常施行的外科治疗方法；孤立性中叶切除术（IML）是最不常施行的肺叶切除术。直到最近，对于位于肺中叶的非小细胞肺癌（NSCLC）施行的IML在肿瘤外科手术中仍被认为不够充分，对于孤立性中叶肿瘤会施行上叶双肺叶切除术（上叶 + 中叶）或下叶双肺叶切除术（下叶 + 中叶）。由于双肺叶切除术相比肺叶切除术术后发病率和死亡率更高，IML的施行频率已变得更高。在本研究中，将接受NSCLC的IML治疗的患者与接受上叶或下叶切除术（ULL）的患者进行比较，并评估接受IML治疗的患者的肿瘤学结果。
在本研究中，对2012年至2022年间在我院接受IML的45例患者以及45例接受右上叶或下叶切除术且在性别和年龄方面相似的患者进行回顾性分析。评估这两组之间的肿瘤学结果。
接受IML的45例患者中，男性34例（75.6%），女性11例（24.5%），平均年龄为62.5 ± 8.4岁。根据手术类型，27例（60%）患者接受了开胸手术，18例（40%）患者接受了电视辅助胸腔镜手术（VATS）。在所有肺叶切除术患者中检查肿瘤组织病理学发现，IML患者中鳞状细胞癌在统计学上比其他两组肺叶切除术患者更占优势（P = 0.014）。此外，发现IML患者的肿瘤大小比其他组更小（P = 0.005）。当评估这两组之间的生存特征时，接受IML的患者的总生存时间（OS）为118.0（59.0 - 124.0）个月，而接受ULL的患者的总生存时间为71.0（66.0 - 74.0）个月，但两组之间未发现统计学上的显著差异。在30天和90天死亡率以及5年生存率方面，两组之间未观察到统计学上的显著差异。
接受NSCLC的IML治疗的患者与接受同侧ULL治疗的患者在生存方面无显著差异。基于这些结果，IML可被视为一种在肿瘤学上适用于局限于中叶的肿块且无需进行双肺叶切除术的治疗选择。
在线版本包含可在10.1007/s12055 - 024 - 01886 - 4获取的补充材料。
