Landreneau R J, Sugarbaker D J, Mack M J, Hazelrigg S R, Luketich J D, Fetterman L, Liptay M J, Bartley S, Boley T M, Keenan R J, Ferson P F, Weyant R J, Naunheim K S
Allegheny General Hospital Campus, Allegheny University for the Health Sciences, Pittsburgh, Pa. 15212, USA.
J Thorac Cardiovasc Surg. 1997 Apr;113(4):691-8; discussion 698-700. doi: 10.1016/S0022-5223(97)70226-5.
The role of nonanatomic wedge resection in the management of stage I (T1 N0 M0) non-small-cell lung cancer continues to be debated against the present gold standard of care--anatomic lobectomy.
We analyzed the results of 219 consecutive patients with pathologic stage I (T1 N0 M0) non-small-cell lung cancer who underwent open wedge resection (n = 42), video-assisted wedge resection (n = 60), and lobectomy (n = 117) to assess morbidity, recurrence, and survival differences between these approaches.
There were no differences among the three groups with regard to histologic tumor type. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. The mean hospital stay was significantly less in the wedge resection groups. There were no operative deaths among patients having wedge resection; however, a 3% operative mortality occurred among patients having lobectomy (p = 0.20). Kaplan-Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video-assisted wedge resection, 95%; lobectomy, 91%). At 5 years survival was 58% for patients having open wedge resection, 65% for those having video-assisted wedge resection, and 70% for those having lobectomy. Log rank testing demonstrated significant differences between the survival curves during the 5-year period of study (p = 0.02). This difference was a result of a significantly greater non-cancer-related death rate by 5 years among patients having wedge resection (38% vs 18% for those having lobectomy; p = 0.014).
Wedge resection, done by open thoracotomy or video-assisted techniques, appears to be a viable "compromise" surgical treatment of stage I (T1 N0 M0) non-small-cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non-small-cell lung cancer who have adequate physiologic reserve.
在I期（T1 N0 M0）非小细胞肺癌的治疗中，非解剖楔形切除术相对于当前的金标准治疗方法——解剖性肺叶切除术，其作用仍存在争议。
我们分析了219例连续的病理分期为I期（T1 N0 M0）的非小细胞肺癌患者的结果，这些患者分别接受了开放性楔形切除术（n = 42）、电视辅助楔形切除术（n = 60）和肺叶切除术（n = 117），以评估这些治疗方法在发病率、复发率和生存率方面的差异。
三组在组织学肿瘤类型方面没有差异。分析表明，与接受肺叶切除术的患者相比，楔形切除术组患者年龄显著更大，肺功能下降，尽管慢性阻塞性肺疾病的治疗发生率更高。楔形切除术组的平均住院时间显著更短。楔形切除术患者中没有手术死亡；然而，肺叶切除术患者中有3%的手术死亡率（p = 0.20）。Kaplan-Meier生存曲线在1年时几乎相同（开放性楔形切除术，94%；电视辅助楔形切除术，95%；肺叶切除术，91%）。在5年时，接受开放性楔形切除术的患者生存率为58%，接受电视辅助楔形切除术的患者为65%，接受肺叶切除术的患者为70%。对数秩检验显示在5年的研究期间生存曲线之间存在显著差异（p = 0.02）。这种差异是由于楔形切除术患者在5年时非癌症相关死亡率显著更高（38%对肺叶切除术患者的18%；p = 0.014）。
对于有心肺生理功能损害的患者，通过开胸手术或电视辅助技术进行的楔形切除术似乎是I期（T1 N0 M0）非小细胞肺癌一种可行的“折衷”手术治疗方法。由于局部复发风险增加，解剖性肺叶切除术仍然是有足够生理储备的I期非小细胞肺癌患者的首选手术治疗方法。
