Paone J F, Spees E K, Newton C G, Lillemoe K D, Kieffer R F, Gadacz T R
Chest. 1982 Feb;81(2):203-7. doi: 10.1378/chest.81.2.203.
Thirty-two patients with peripheral bronchogenic neoplasms adherent to the chest wall underwent en bloc pulmonary and thoracic wall resections. Presenting symptoms were thoracic wall pain (75 percent), hemoptysis (12.5 percent), and cough with weight loss (12.5 percent). Patients were selected for surgical resection only after a search for metastatic disease, including mediastinoscopy, showed negative results. A standard posterolateral thoracotomy incision was used which did not require skeletal reconstruction or prosthetic material for closure. There were nine major postoperative complications (28.8 percent), principally respiratory, and one operative death (3.1 percent). The five-year actuarial survival was 35 percent. None of the patients with regional lymph node involvement or positive chest wall margins lived more than two years after surgery. Preoperative irradiation performed in 12 patients (37.5 percent) improved operability, but did not significantly alter survival. These results indicate that patients with peripheral bronchogenic carcinoma involving the thoracic wall may be successfully managed with en bloc pulmonary and chest wall resection, particularly if surgery is performed in the early stage of the disease.
32例外周型支气管肿瘤侵犯胸壁的患者接受了肺和胸壁整块切除术。主要症状为胸壁疼痛（75%）、咯血（12.5%）以及伴有体重减轻的咳嗽（12.5%）。仅在包括纵隔镜检查在内的转移性疾病检查结果为阴性后，才选择患者进行手术切除。采用标准后外侧开胸切口，关闭切口时无需进行骨骼重建或使用假体材料。术后有9例主要并发症（28.8%），主要为呼吸系统并发症，1例手术死亡（3.1%）。5年精算生存率为35%。区域淋巴结受累或胸壁切缘阳性的患者术后均未存活超过两年。12例患者（37.5%）术前接受放疗改善了手术可操作性，但未显著改变生存率。这些结果表明，外周型支气管癌侵犯胸壁的患者通过肺和胸壁整块切除术可能得到成功治疗，特别是如果在疾病早期进行手术。
