Asamura H
Division of Thoracic Surgery, National Cancer Center Hospital.
Gan To Kagaku Ryoho. 1997 Oct;24 Suppl 3:366-72.
Surgery is defined as purely a local treatment modality. In the treatment of non-small cell lung cancer, surgery remains the first-line treatment of choice for local diseases. Thus, stages I, II, and a part of IIIA disease are definite indications for surgical therapy. The standard operative mode in curative intent for such local diseases is the resection of the entire lobe or lung where the cancer is located. The prognostic significance of hilar/mediastinal lymph node dissection remains controversial, although it can provide the most accurate information regarding the metastatic status of hilum and mediastinum. For locally advanced diseases of stages IIIA and IIIB, the surgical approach still remains investigational in a combined modality setting. For N2 diseases (with mediastinal node metastasis), the prognostic benefit of both preoperative and postoperative chemo (-radio) therapy has not been definitively demonstrated yet, although several reports suggested their potential benefits. They await further evaluation by clinical trials in a phase III setting. Although aggressive surgical approaches for tumors invading surrounding vital structures (IIIB disease) have been reported, it is also still uncertain whether their results can really exceed those obtained by chemoradiotherapy.
手术被定义为一种纯粹的局部治疗方式。在非小细胞肺癌的治疗中，手术仍然是局部疾病的一线首选治疗方法。因此，I期、II期以及部分IIIA期疾病是手术治疗的确切指征。对于此类局部疾病，具有治愈意图的标准手术方式是切除癌症所在的整个肺叶或肺部。肺门/纵隔淋巴结清扫的预后意义仍存在争议，尽管它可以提供有关肺门和纵隔转移状态的最准确信息。对于IIIA期和IIIB期的局部晚期疾病，在联合治疗模式下，手术方法仍处于研究阶段。对于N2期疾病（伴有纵隔淋巴结转移），术前和术后化疗（放化疗）的预后益处尚未得到明确证实，尽管有几份报告表明它们具有潜在益处。它们有待在III期临床试验中进一步评估。尽管有报道称对侵犯周围重要结构的肿瘤（IIIB期疾病）采取积极的手术方法，但这些结果是否真的能超过放化疗所取得的结果仍不确定。
