Pitz C C, Brutel de la Rivière A, Elbers H R, Westermann C J, van den Bosch J M
Department of Pulmonology, Sint Antonius Hospital, EM Nieuwegein, The Netherlands.
Thorax. 1996 Aug;51(8):846-50. doi: 10.1136/thx.51.8.846.
The optimum operative procedure for lung cancer with chest wall invasion (T3) remains controversial. In this study results of en bloc resection and extrapleural dissection are reviewed to determine survival characteristics.
Between 1977 and 1993 125 patients underwent surgery for primary non-small cell lung cancer with chest wall invasion. Patients with superior sulcus tumours, metastatic carcinomas, synchronous tumours, or recurrences were excluded. Extrapleural dissection was performed in 73 patients and en bloc resection (range 1-4 ribs) in 52. Resection was regarded as complete in 86 and incomplete in 39 patients. Actuarial survival time was estimated and risk factors for late death were identified.
Hospital mortality was 3.2%. (n = 4). Estimated mean five year survival was 24% for all hospital survivors (n = 121), 11% for patients with incomplete resection, and 29% for patients having a complete resection. In patients who underwent complete resection mediastinal lymph node involvement and intrapleural tumour spill worsened the prognosis. Patients with adenocarcinoma had a better chance of long term survival. No relationship was found between survival and age, type of operative procedure, depth of chest wall invasion, and postoperative radiotherapy.
Both operative procedures show reasonable survival results. Incomplete resection, mediastinal lymph node involvement, and intrapleural tumour spill adversely influence survival.
对于侵犯胸壁的肺癌（T3期），最佳手术方式仍存在争议。本研究回顾了整块切除和胸膜外剥离术的结果，以确定生存特征。
1977年至1993年间，125例原发性非小细胞肺癌侵犯胸壁的患者接受了手术。排除肺上沟瘤、转移性癌、同步性肿瘤或复发病例。73例患者接受了胸膜外剥离术，52例患者接受了整块切除（切除1 - 4根肋骨）。86例患者的切除被视为完整，39例患者的切除不完整。估计了精算生存时间，并确定了晚期死亡的危险因素。
医院死亡率为3.2%（n = 4）。所有医院幸存者（n = 121）的估计平均五年生存率为24%，切除不完整的患者为11%，切除完整的患者为29%。在接受完整切除的患者中，纵隔淋巴结受累和胸腔内肿瘤播散会使预后恶化。腺癌患者有更好的长期生存机会。未发现生存与年龄、手术方式、胸壁侵犯深度和术后放疗之间存在关联。
两种手术方式均显示出合理的生存结果。切除不完整、纵隔淋巴结受累和胸腔内肿瘤播散对生存有不利影响。
