Tsubota N, Ayabe K, Doi O, Mori T, Namikawa S, Taki T, Watanabe Y
General Thoracic Surgery, Hyogo Medical Center, Japan.
Ann Thorac Surg. 1998 Nov;66(5):1787-90. doi: 10.1016/s0003-4975(98)00819-4.
Lesser resection for small lung tumors remains an unresolved problem. This study was conducted to see whether this type of operation is acceptable or not.
From 1992 to 1994, 55 patients were enrolled in a multicenter trial of limited surgical resection for peripheral tumors of less than 2 cm diameter. The procedure consisted of segmentectomy with exploration of lymph nodes by examining frozen sections. The operation was modified if the report was positive. The intersegmental plane was identified by keeping the resected segments inflated and the preserved segments collapsed. To divide the plane, stapling or electrocauterization on the edge of the collapsed area was used. In this way the resection line was delivered beyond the burdened segment; this was called extended segmentectomy.
There were no perioperative deaths, but there were eight postoperative deaths. In 1 patient who died because of local recurrence, it had been known that the margin to the lesion had been narrow (15 mm); 1 had bilateral intrapulmonary nodules, 1 had nodules in the side that was not operated on, and another succumbed to a second neoplasm of small cell lung cancer 4 years after the first operation. The remaining 4 died of nonpulmonary diseases. Almost all other patients are alive and free from recurrence, except for 1 in whom N2 disease was not detected intraoperatively but was confirmed after the operation.
The interim results suggest that extended segmentectomy is applicable in patients with a small peripheral lung cancer. However, a wide margin and aggressive intraoperative pathologic examinations are mandatory.
对于小的肺部肿瘤行局限性切除仍是一个未解决的问题。本研究旨在探讨这种手术方式是否可接受。
1992年至1994年，55例患者参加了一项多中心试验，对直径小于2 cm的周围型肿瘤进行有限性手术切除。手术步骤包括节段切除术并通过检查冰冻切片来探查淋巴结。如果报告为阳性，则修改手术方式。通过使切除的节段充气而保留的节段萎陷来确定节段间平面。为了划分该平面，在萎陷区域的边缘使用吻合器或电灼术。通过这种方式，切除线超出受累节段；这被称为扩大节段切除术。
围手术期无死亡病例，但有8例术后死亡。1例因局部复发死亡，已知其病变切缘狭窄（15 mm）；1例有双侧肺内结节，1例在未手术侧有结节，另1例在首次手术后4年死于小细胞肺癌的第二种肿瘤。其余4例死于非肺部疾病。几乎所有其他患者均存活且无复发，除1例术中未检测到N2疾病但术后确诊。
中期结果表明，扩大节段切除术适用于周围型小肺癌患者。然而，切缘要宽且术中进行积极的病理检查是必需的。
