Lesser T, Brenner A, Bartel M
Abteilung Thorax- und Gefässchirurgie, Chirurgische Universitätsklinik Jena.
Zentralbl Chir. 1997;122(8):642-8.
The poor prognosis of bronchial carcinoma is reflected among other things in a high recurrence rate. In general, recurrence is inoperable and only suitable for conservative/palliative management. The rate of curative surgical reintervention may be increased by early identification of recurrence. The value of tumour follow-up and the role of reoperation need to be assessed. 150 patients who underwent curative resection of non-small-cell lung cancer were followed-up for a mean of 4.5 years as part of a comprehensive after-care program. Fifty patients (33%) developed a recurrence at a mean of 13 months after operation. A second curative resection was possible in 9 patients (6%) with a mean survival of 22 months. Six of these patients had re-thoracotomy (completion pneumonectomy in 4 for local recurrence, mediastinal metastasectomy in 2), and in 3 patients a solitary cerebral metastasis was excised. Our results show that with focused, schematic tumour follow-up early recognition of recurrence is possible. Despite this, reoperation is only indicated in a selected group of patients because of multifocal recurrence, or local or functional inoperability. Further intensification of tumour follow-up is limited by personnel, logistical, and financial considerations. As an alternative, individualised, function-oriented tumour after-care could be considered.
支气管癌的不良预后在高复发率等方面有所体现。一般来说，复发后无法进行手术，仅适合保守/姑息治疗。早期发现复发可提高根治性手术再次干预的比例。需要评估肿瘤随访的价值及再次手术的作用。作为综合后续护理计划的一部分，对150例行非小细胞肺癌根治性切除术的患者进行了平均4.5年的随访。50例患者（33%）在术后平均13个月出现复发。9例患者（6%）可行二次根治性切除术，平均生存22个月。其中6例患者接受了再次开胸手术（4例因局部复发行全肺切除术，2例因纵隔转移行转移灶切除术），3例患者切除了孤立性脑转移瘤。我们的结果表明，通过有针对性的、系统性的肿瘤随访，有可能早期识别复发。尽管如此，由于多灶性复发、局部或功能上无法手术，再次手术仅适用于部分选定的患者。肿瘤随访的进一步强化受到人员、后勤和财务等因素的限制。作为一种替代方案，可以考虑个体化的、以功能为导向的肿瘤后续护理。
