Mehran R J, Deslauriers J, Piraux M, Beaulieu M, Guimont C, Brisson J
Division of Thoracic Surgery, Laval University, Ste-Foy, Quebec, Canada.
J Thorac Cardiovasc Surg. 1994 Feb;107(2):576-82; discussion 582-3.
Sleeve lobectomy is a lung-saving procedure indicated for central tumors for which the alternative is a pneumonectomy. The relation between survival and nodal status is controversial because, in most series, the presence of N1 disease adversely affects the prognosis with few or no long-term survivors. During the period 1972 to 1992, 142 patients underwent sleeve resection for lung cancer at our institution. Mean age (+/- standard deviation) was 60.7 +/- 9.1 years (range 11 to 78 years), and indications for operation were a central tumor in 112 patients (79%), a peripheral tumor in 18 patients (13%), and compromised pulmonary function in 12 patients (8%). Histologic type was predominantly squamous (72.5%) followed by nonsquamous (24.6%) and carcinoid tumors (2.8%). Resection was complete in 124 patients (87%) and incomplete in 18 (13%), and the operative mortality was 2.1% (n = 3). Follow-up was complete for the 139 remaining patients. Including operative deaths, survivals at 5 and 10 years for all patients were 46% (95% confidence intervals 38% to 55%) and 33% (95% confidence intervals 24% to 42%), respectively. For patients with N0 status (n = 73), 5- and 10-year survivals were 57% (95% confidence intervals 45% to 69%) and 46% (95% confidence intervals 32% to 60%); for patients with N1 status (n = 55), these rates were 46% (95% confidence intervals 32% to 60%) and 27% (95% confidence intervals 14% to 40%) (p = 0.13). No patient with N2 status (n = 14) survived 5 years. Local recurrences occurred in 23% of cases, but the prevalence was not statistically different between patients with N0 disease (16.6%) and N1 disease (23.1%) (p = 0.43). These data suggest that sleeve resection is an adequate operation for patients with resectable lung cancer and N0 N1 status. The presence of N2 disease significantly worsens the prognosis and may contraindicate the use of the procedure.
袖状肺叶切除术是一种保肺手术,适用于中心型肿瘤,而替代方案是全肺切除术。生存与淋巴结状态之间的关系存在争议,因为在大多数系列研究中,N1期疾病的存在会对预后产生不利影响,长期存活者很少或没有。在1972年至1992年期间,我们机构有142例患者接受了肺癌袖状切除术。平均年龄(±标准差)为60.7±9.1岁(范围11至78岁),手术指征为112例患者(79%)有中心型肿瘤,18例患者(13%)有周围型肿瘤,12例患者(8%)肺功能受损。组织学类型主要为鳞状细胞癌(72.5%),其次是非鳞状细胞癌(24.6%)和类癌肿瘤(2.8%)。124例患者(87%)切除完整,18例患者(13%)切除不完整,手术死亡率为2.1%(n = 3)。其余139例患者随访完整。包括手术死亡患者在内,所有患者的5年和10年生存率分别为46%(95%置信区间38%至55%)和33%(95%置信区间24%至42%)。对于N0期患者(n = 73),5年和10年生存率分别为57%(95%置信区间45%至69%)和46%(95%置信区间32%至60%);对于N1期患者(n = 55),这些比率分别为46%(95%置信区间32%至60%)和27%(95%置信区间14%至40%)(p = 0.13)。没有N2期患者(n = 14)存活5年。局部复发发生在23%的病例中,但N0期疾病患者(16.6%)和N1期疾病患者(23.1%)之间的发生率在统计学上没有差异(p = 0.43)。这些数据表明,袖状切除术对于可切除肺癌且处于N0、N1期的患者是一种合适的手术。N2期疾病的存在会显著恶化预后,可能是该手术的禁忌证。