Motta G, Nahum M A, Testa T, Spinelli E, Gasparo A, de Bernardis E
Department of Patologia Chirurgica II, University of Genoa, School of Medicine, Italy.
Ann Ital Chir. 1996 May-Jun;67(3):381-5.
Preceded by an international overview on the surgical approach to the peripheral higher stage NSCLC, the cumulative clinical experience from ten Italian University Departments and Teaching Hospitals, is analyzed in the light of the corresponding international contributions. Accordingly, the clinical records of 470 patients affected by such Stage III tumors and surgically treated, were collected and retrospectively reviewed. 43 out of 120 patients belonging to the group of apical invasive Pancoast's tumour underwent an en-bloc chest-wall resection, while an extrapleural dissection was performed in the remaining 77. Combined segmentectomy was prevalent (54%), while lobectomy/bilobectomy was performed in 38%, wedge resection in 5% and pneumonectomy in 3% of all cases respectively. Preoperative high-voltage radiation was given in 70% of them; while adjuvant RT was requested in 17% of cases, mainly because of N1-2 status. Actuarial 5-year survival was 14% with a range of 0% in N2 cases to 21% in NO-1 ones. When considering surgical modes, the en-bloc chest-wall resection had a 5-year survival of 20% while the more limited extrapleural dissection yield only a 9% survival. Compared with the international experience the 14% 5-year survival is standing at the bottom of the scale. On the other hand, 350 patients belong to the other two main groups of peripheral tumors taken in consideration: the ones which, even apical, are yet lying anteriorly far enough from the costo-vertebral angle (apical non Pancoast tumor), and the other ones which are lower placed along the thoracic cage. The majority of these patients (213) were treated by an extrapleural dissection, while the remaining minority (123) received an en-bloc chest-wall resection with 1-2 ribs resected in 46%, 3 ribs in 38% and 4 ribs or more in 16%, respectively. Combined lobectomy/bilobectomy was prevalent (64%), while pneumonectomy was performed in 16%, more limited resections in 16% and exploration alone in 4% respectively. 5-year survival was 18% ranging from 0% in N2 patients to 23% in the NO-1 ones. The extrapleural dissection had a 5-year survival rate of 24.5%, while the en-bloc chest-wall resection yield a lower rate of 15.6%. This overall survival can be indeed considered nearer the international one, even if both surgical approach and the related 5-year survival rates are in full discordance with the compared international references.
在对外周晚期非小细胞肺癌手术方法进行国际概述之后，根据相应的国际研究成果，分析了意大利十个大学科室和教学医院的累积临床经验。因此，收集并回顾性分析了470例患有此类III期肿瘤并接受手术治疗患者的临床记录。在120例肺尖浸润性潘科斯特瘤患者中，43例行胸壁整块切除术，其余77例行胸膜外剥离术。联合肺段切除术最为常见（54%），肺叶切除术/双肺叶切除术占38%，楔形切除术占5%，全肺切除术占3%。70%的患者术前接受了高电压放疗；17%的病例需要辅助放疗，主要是因为N1-2分期。精算5年生存率为14%，N2期患者为0%，NO-1期患者为21%。在考虑手术方式时，胸壁整块切除术的5年生存率为20%，而更有限的胸膜外剥离术的生存率仅为9%。与国际经验相比，14%的5年生存率处于较低水平。另一方面，350例患者属于另外两组主要的外周肿瘤：一组即使是肺尖肿瘤，但位于前方，离肋椎角足够远（肺尖非潘科斯特瘤），另一组位于胸廓较低位置。这些患者大多数（213例）接受了胸膜外剥离术，其余少数（123例）接受了胸壁整块切除术，分别有46%切除1-2根肋骨，38%切除3根肋骨，16%切除4根或更多肋骨。联合肺叶切除术/双肺叶切除术最为常见（64%），全肺切除术占16%，更有限的切除术占16%，仅探查术占4%。5年生存率为18%，N2期患者为0%，NO-1期患者为23%。胸膜外剥离术的5年生存率为24.5%，而胸壁整块切除术的生存率较低，为15.6%。即使手术方法和相关的5年生存率与所比较的国际参考文献完全不一致，但总体生存率确实更接近国际水平。
