Jensik R J, Faber L P, Kittle C F, Meng R L
J Thorac Cardiovasc Surg. 1981 Nov;82(5):658-68.
A second resective procedure has been done on 64 patients with multiple primary bronchogenic carcinoma, and a third operation has been performed in six. Fifty-three initial resections and all repeat procedures were performed at Rush-Presbyterian-St. Luke's Medical Center. Six patients had synchronous primary cancers, and in the 58 with metachronous disease the cumulative probability of tumor-free interval was 47% at 3 years. The initial resection performed was pneumonectomy in seven, lobectomy in 40, and segmentectomy in 17 patients. At the second operation, segmental resection was done in 41, lobectomy in six, completion lobectomy in four, and completion pneumonectomy in 13 patients. At the third operation, segmentectomy was done in three, completion lobectomy in two, and completion pneumonectomy in one patient. Ten patients had a tumor of different histologic type identified at the second procedure, but all patients with three operations had the same tumor cell type in each specimen. Six patients died following the second operation (a postoperative mortality of 9.3%), but there were no deaths in the six patients undergoing three procedures. Cumulative survival following the second resection was 36% at 5 years, 22% at 10 years and 13% at 15 years. In summary, second or third surgical efforts for reappearing bronchogenic cancers are justified and have significantly prolonged survival. The use of segmental or subsegmental resective techniques have provided superior survival results.
已对64例多原发性支气管癌患者进行了第二次切除手术，其中6例进行了第三次手术。53例初次切除手术及所有再次手术均在拉什长老会圣卢克医疗中心进行。6例患者有同时性原发性癌症，在58例有不同时性疾病的患者中，3年无瘤间期的累积概率为47%。初次切除手术中，7例行全肺切除术，40例行肺叶切除术，17例行肺段切除术。在第二次手术中，41例行肺段切除术，6例行肺叶切除术，4例行完全性肺叶切除术，13例行完全性全肺切除术。在第三次手术中，3例行肺段切除术，2例行完全性肺叶切除术，1例行完全性全肺切除术。10例患者在第二次手术时发现肿瘤组织学类型不同，但所有接受三次手术的患者每个标本中的肿瘤细胞类型相同。6例患者在第二次手术后死亡（术后死亡率为9.3%），但接受三次手术的6例患者无死亡。第二次切除术后的累积生存率在5年时为36%，10年时为22%，15年时为13%。总之，对复发性支气管癌进行第二次或第三次手术是合理的，且显著延长了生存期。采用肺段或亚肺段切除技术可提供更好的生存结果。
