Yoshino I, Yokoyama H, Yano T, Ueda T, Takai E, Mizutani K, Asoh H, Ichinose Y
Department of Chest Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
J Surg Oncol. 1997 Jan;64(1):32-5. doi: 10.1002/(sici)1096-9098(199701)64:1<32::aid-jso7>3.0.co;2-q.
We retrospectively compared sleeve lobectomy (SL) and pneumonectomy (PN) for lung cancer in terms of surgical complications and postoperative disease-free survival, as well as incidence and pattern of recurrent disease.
From 1977 to 1993. 29 patients with primary lung cancer underwent sleeve resection at our institution. The pneumonectomy group consisted of 29 cases that had been selected during the same period according to the following criteria: (1) in a tumor located in the upper lobe, there was no invasion within 1 cm from both the carina and the orifice of the middle and the lower lobe bronchus, whereas in a tumor located in the middle or lower lobe, there was no invasion within 1 cm of the orifice of the upper bronchus, (2) there was no invasion to the trunks of the pulmonary vessels, (3) there was no invasion to any other lobes, (4) a complete resection was achieved.
No differences were observed between the two groups regarding stage, histological population, or age. The incidence of postoperative complications was 13.7% in the SL group (2 cases each of pneumonia and arrythmia), and 24.1% in the PN group (3 bronchopulmonary fistula, 2 bleeding, 1 instance each of arrythmia and acute cardiac failure, and 2 operation-related deaths) (P < 0.05). The 3-year disease-free survival was 65.7% in SL, 58.8% in PN (no statistical significance in the log-rank test). Recurrent disease was observed in the local regions of three patients in the SL group and six patients in the PN group, and at distant organs of six patients in the SL group and seven in the PN group.
These findings thus suggest that as a curative treatment, lobectomy with bronchoplasty may be a safer procedure than pneumonectomy for lung cancer.
我们回顾性比较了袖状肺叶切除术（SL）和全肺切除术（PN）治疗肺癌的手术并发症、术后无病生存率以及复发疾病的发生率和模式。
1977年至1993年，我院29例原发性肺癌患者接受了袖状切除术。全肺切除术组由同期按照以下标准选取的29例患者组成：（1）肿瘤位于上叶时，距隆突及中下叶支气管开口1厘米范围内无侵犯；肿瘤位于中叶或下叶时，距上叶支气管开口1厘米范围内无侵犯；（2）未侵犯肺血管主干；（3）未侵犯其他肺叶；（4）实现了完整切除。
两组在分期、组织学类型或年龄方面未观察到差异。SL组术后并发症发生率为13.7%（肺炎和心律失常各2例），PN组为24.1%（3例支气管肺瘘、2例出血、心律失常和急性心力衰竭各1例，2例手术相关死亡）（P<0.05）。SL组3年无病生存率为65.7%，PN组为58.8%（对数秩检验无统计学意义）。SL组3例患者和PN组6例患者出现局部复发，SL组6例患者和PN组7例患者出现远处器官复发。
这些结果表明，作为一种根治性治疗方法，支气管成形肺叶切除术治疗肺癌可能比全肺切除术更安全。
