Shennib H A, Landreneau R, Mulder D S, Mack M
Department of Surgery, McGill University, Montreal, Quebec, Canada.
Ann Surg. 1993 Oct;218(4):555-8; discussion 558-60. doi: 10.1097/00000658-199310000-00015.
This study assessed the reliability and safety of VATR for treatment of peripheral T1 lung cancer in high-risk patients.
Surgical resection is the best therapy for stage I lung cancer. Patients with poor cardiopulmonary status or those who are elderly (> 75 years of age) are considered to be at high risk from thoracotomy and are frequently referred for radiation therapy or expectant palliative management. Data from previous studies suggest that survival with wedge resection is similar to that with lobectomy. The authors propose VATR, which is minimally invasive, as a therapeutic option in patients considered to be at high risk for resection by thoracotomy.
Between November 1990 and November 1992, more than 400 thoracoscopic lung resections were performed. Thirty patients with poor pulmonary function (forced expiratory volume FEV1] < 1 L or < 35% predicted; arterial oxygen tension [PaO2] < 60 mmHg on room air; diffusion capacity [DCO] < 40%) underwent 31 VATRs (1 patient had a staged procedure for bilateral synchronous lung cancers). All patients had T1 peripheral lesions with no bronchoscopically visible lesions. Computed tomography of the chest revealed no evidence of mediastinal disease in all patients.
Patients had a mean FEV1 value of 0.9 L (38% predicted) and a mean age of 71 years. Tumors were located in left upper lobe (LUL) in 13 patients, in right lower lobe (RLL) in 7 patients, in right upper lobe (RUL) in 6 patients, in left lower lobe (LLL) in 4 patients, and in right middle lobe (RML) in 1 patient. Computed tomography-guided wire localization, methylene blue surface injection, and intraoperative ultrasonography were used to assist in defining difficult lesions. All lesions were successfully resected without converting to thoracotomy. One patient died on the 34th postoperative day of myocardial infarction (operative mortality rate of 3%). Five patients had prolonged air leaks (< 5 days), with a median chest tube time of 3 days. Two patients experienced pneumonia.
The authors concluded that VATR is a safe and reliable procedure for treatment of peripheral T1 lung cancer in high-risk patients. Long-term follow-up will be required to determine the efficacy of this procedure regarding survival and locoregional recurrence.
本研究评估了电视辅助胸腔镜肺叶切除术（VATR）治疗高危患者外周T1期肺癌的可靠性和安全性。
手术切除是I期肺癌的最佳治疗方法。心肺功能差或老年患者（>75岁）被认为开胸手术风险高，常接受放射治疗或姑息治疗。以往研究数据表明，楔形切除术的生存率与肺叶切除术相似。作者提出VATR，其为微创治疗方法，可作为开胸手术高危切除患者的治疗选择。
1990年11月至1992年11月期间，进行了400多例胸腔镜肺切除术。30例肺功能差的患者（用力呼气量[FEV1]<1L或<预测值的35%；室内空气中动脉血氧分压[PaO2]<60mmHg；弥散功能[DCO]<40%）接受了31例VATR（1例患者因双侧同步肺癌进行了分期手术）。所有患者均有T1期外周病变，支气管镜检查未见明显病变。胸部计算机断层扫描显示所有患者均无纵隔疾病证据。
患者平均FEV1值为0.9L（预测值的38%），平均年龄71岁。肿瘤位于左上叶（LUL）13例，右下叶（RLL）7例，右上叶（RUL）6例，左下叶（LLL）4例，右中叶（RML）1例。采用计算机断层扫描引导下金属丝定位、亚甲蓝表面注射和术中超声检查来辅助确定困难病变。所有病变均成功切除，未中转开胸。1例患者术后第34天死于心肌梗死（手术死亡率3%）。5例患者出现持续漏气（<5天），胸腔引流管留置时间中位数为3天。2例患者发生肺炎。
作者得出结论，VATR是治疗高危患者外周T1期肺癌的一种安全可靠的方法。需要长期随访以确定该手术在生存和局部区域复发方面的疗效。
