Macchiarini P, Chapelier A R, Monnet I, Vannetzel J M, Rebischung J L, Cerrina J, Parquin F, Ladurie F L, Lenot B, Dartevelle P G
Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie-Lannelongue, Paris-Sud University, Le Plessis Robinson, France.
Ann Thorac Surg. 1994 Apr;57(4):966-73. doi: 10.1016/0003-4975(94)90215-1.
Twenty-three patients with stage IIIb (T4) non-small cell lung cancer received induction chemotherapy (median, 2 cycles) with (n = 12) or without (n = 11) radiation (median, 45 Gy) before operation. Nine tumors involved the carina (n = 8) or lateral tracheal wall (n = 1), 11 were located centrally and invaded the proximal pulmonary artery (n = 6), veins (n = 3), or both (n = 2), three were apical tumors involving T4 structures, and six were associated with histologically diseased mediastinal nodes. Five complete and 18 partial responses were observed after induction treatment. Resection of all residual tumor at the primary site and involved vestiges was possible in 21 patients (91%); in two apical tumors, tumor was left behind. Nine right tracheal sleeve and 11 intrapericardial pneumonectomies and three resections of apical tumors were performed; 11 patients (48%) had radical mediastinal lymph node dissection. Complete sterilization of the primary tumor was observed in 3 patients (13%). Mean operating time was 209.3 +/- 86.8 minutes, and mean blood loss was 896.9 +/- 1031 mL. Major postoperative complications occurred in 6 patients (26%), including hemothorax requiring drainage (n = 1) or reoperation (n = 1), acute distress syndrome (n = 2), and bronchopleural fistula (n = 2), and their incidence was significantly higher (p = 0.0003) among patients receiving induction chemoradiation than among those receiving chemotherapy alone (42 versus 9%). Early (< 1 month) postoperative mortality was 8.6% (n = 2). With a median follow-up of 25 months (range, 12 to more than 39 months), the projected 3-year overall survival was 54%.(ABSTRACT TRUNCATED AT 250 WORDS)
23例Ⅲb期（T4）非小细胞肺癌患者在手术前接受了诱导化疗（中位数为2个周期），其中12例联合（n = 12）或11例不联合（n = 11）放疗（中位数为45 Gy）。9个肿瘤累及隆突（n = 8）或气管侧壁（n = 1），11个位于中央，侵犯近端肺动脉（n = 6）、静脉（n = 3）或两者（n = 2），3个为累及T4结构的肺尖肿瘤，6个与纵隔淋巴结组织学病变相关。诱导治疗后观察到5例完全缓解和18例部分缓解。21例患者（91%）能够切除原发部位的所有残留肿瘤及受累遗迹；2个肺尖肿瘤残留了肿瘤。进行了9例右主支气管袖状切除术、11例心包内全肺切除术和3例肺尖肿瘤切除术；11例患者（48%）进行了根治性纵隔淋巴结清扫术。3例患者（13%）原发肿瘤完全消除。平均手术时间为209.3±86.8分钟，平均失血量为896.9±1031 mL。6例患者（26%）发生了主要术后并发症，包括需要引流（n = 1）或再次手术（n = 1）的血胸、急性呼吸窘迫综合征（n = 2）和支气管胸膜瘘（n = 2），接受诱导放化疗的患者中其发生率显著高于单纯接受化疗的患者（42%对9%，p = 0.0003）。术后早期（<1个月）死亡率为8.6%（n = 2）。中位随访25个月（范围12至超过39个月），预计3年总生存率为54%。（摘要截短于250字）
