Tsuchiya R, Asamura H, Kondo H, Goya T, Naruke T
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Ann Thorac Surg. 1994 Apr;57(4):960-5. doi: 10.1016/0003-4975(94)90214-3.
One hundred one patients with locally advanced lung cancer underwent combined resection of the lung and the left atrium with or without the great vessels. A single additional organ was resected in 92 patients, two organs in 8 patients, and three organs in 1 patient. The left atrium was resected in 44 patients, the superior vena cava in 32, the adventitia of the aorta in 21, the aorta in 7, and the pulmonary artery in 7. The most important factors affecting survival defined by multivariate analysis were postoperative pneumonia, complete resection, postoperative bleeding, and lymph node metastasis (p < 0.05). Thirteen patients survived 3 years or more and 10 of the 13 survived 5 years or more. The 5-year survival rate for all patients, including 8 with operative death, was 13%, and the median survival time was 9.2 months. The 5-year survival and median survival time were 19% and 13.8 months after complete resection and 0% and 6.5 months after incomplete resection (p < 0.01). The 5-year survival and median survival time for patients with pathologic stage IIIA, IIIB, and IV were 16.8% and 16.8 months; 18.3% and 9.8 months; and 0% and 5.4 months, respectively. There was a significant difference between stages IIIA plus IIIB and stage IV (p < 0.05). The 5-year survival after left atrium resection was 22%. Extended resection was worthwhile for the patients undergoing complete resection and without postoperative complications.
101例局部晚期肺癌患者接受了肺和左心房联合切除术，部分患者还切除了大血管。92例患者额外切除了一个器官，8例患者切除了两个器官，1例患者切除了三个器官。44例患者切除了左心房，32例切除了上腔静脉，21例切除了主动脉外膜，7例切除了主动脉，7例切除了肺动脉。多因素分析确定的影响生存的最重要因素为术后肺炎、完全切除、术后出血和淋巴结转移（p<0.05）。13例患者存活3年或更长时间，其中10例存活5年或更长时间。包括8例手术死亡患者在内，所有患者的5年生存率为13%，中位生存时间为9.2个月。完全切除后5年生存率和中位生存时间分别为19%和13.8个月，不完全切除后分别为0%和6.5个月（p<0.01）。病理分期为IIIA、IIIB和IV期的患者5年生存率和中位生存时间分别为16.8%和16.8个月；18.3%和9.8个月；以及0%和5.4个月。IIIA期加IIIB期与IV期之间存在显著差异（p<0.05）。左心房切除术后5年生存率为22%。对于接受完全切除且无术后并发症的患者，扩大切除术是值得的。
