Izbicki J R, Knoefel W T, Passlick B, Habekost M, Karg O, Thetter O
Department of Surgery, University of Munich, Germany.
J Thorac Cardiovasc Surg. 1995 Aug;110(2):386-95. doi: 10.1016/S0022-5223(95)70235-0.
Although locally advanced lung cancer frequently necessitates extended resections to preserve a chance for cure, a higher morbidity is associated with extended resections. It is not known whether the increased morbidity is of relevance for the long-term outcome. It also remains unclear whether exclusion of certain patients according to their risk factors can diminish mortality in these patients. This study therefore investigated whether certain risk factors predispose patients undergoing extended pulmonary resections to increased morbidity or mortality. It also assessed the long-term survival. The cases of 126 consecutive patients with locally advanced lung cancer (stage T3 or T4) were prospectively documented. Seventy-five percent of the patients required an extended resection and 25% a nonextended resection. Extended resections were associated with a significantly increased overall morbidity (p < 0.002). However, mortality, severe complications, or multiple complications were not significantly increased after extended resections. No risk factor predisposed to an increased mortality. Risk factors that were associated with particular postoperative complications were pathologic ergonometry (p < 0.002), a positive cardiac score (p < 0.003), coronary artery disease (p = 0.021), and an increased pulmonary risk score (p < 0.05). Overall 3-year survival was 31%. Patients undergoing extended resections for stage T3 or T4 tumors with no residual tumor (70% of the patients) showed a 3-year survival of 33%. We conclude that postoperative mortality cannot be reduced by excluding patients on the basis of particular risk factors from operations that require extended resections. If a patient is considered to be eligible to undergo pulmonary resection, he or she can be considered to be eligible to undergo extended pulmonary resection. Because prognosis is dismal in nonresected locally advanced lung cancer, we recommend an aggressive surgical approach.
尽管局部晚期肺癌常常需要进行扩大切除术以保留治愈机会，但扩大切除术会带来更高的发病率。目前尚不清楚发病率的增加是否与长期预后相关。根据危险因素排除某些患者是否能降低这些患者的死亡率也仍不明确。因此，本研究调查了某些危险因素是否会使接受扩大肺切除术的患者发病率或死亡率增加。研究还评估了长期生存率。前瞻性记录了126例连续的局部晚期肺癌（T3或T4期）患者的病例。75%的患者需要进行扩大切除术，25%的患者需要进行非扩大切除术。扩大切除术与总体发病率显著增加相关（p<0.002）。然而，扩大切除术后死亡率、严重并发症或多种并发症并未显著增加。没有危险因素会导致死亡率增加。与特定术后并发症相关的危险因素有病理测力计检查（p<0.002）、阳性心脏评分（p<0.003）、冠状动脉疾病（p = 0.021）和肺风险评分增加（p<0.05）。总体3年生存率为31%。对T3或T4期肿瘤进行扩大切除术且无残留肿瘤的患者（占患者的70%）3年生存率为33%。我们得出结论，不能通过根据特定危险因素将患者排除在需要扩大切除术的手术之外来降低术后死亡率。如果认为一名患者有资格接受肺切除术，那么他或她也可以被认为有资格接受扩大肺切除术。由于未接受手术的局部晚期肺癌预后不佳，我们建议采取积极的手术方法。
