Long-term prognosis of video-assisted limited surgery for early lung cancer
Long-term prognosis of video-assisted limited surgery for early lung cancer
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DOI：
10.1016/j.ejcts.2009.07.017
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发表时间：
2010-02-01
影响因子：
3.4
通讯作者：
Okabe, Kazunori
中科院分区：
文献类型：
--
作者：
Sugi, Kazuro;Kobayashi, Seiki;Okabe, Kazunori
目的：本干预研究的目的是根据高分辨率计算机断层扫描（HRCT）的结果，前瞻性评估视频辅助有限手术（例如楔形切除和肺段切除术）治疗临床早期肺癌的长期预后。对象和方法：患者在 2001 年至 2004 年间参加了这项研究，并进行了随后五年的随访。在这些患者中，临床 IA 期肺癌主要包括直径小于 1.5 厘米的毛玻璃样混浊 (GGO) 的患者接受了胸腔镜肺楔形切除术（A 组）。肿瘤直径小于 2.0 cm 的患者（不属于 A 组）接受了电视辅助肺段切除术和肺门淋巴结清扫术，并进行肺叶特异性纵隔淋巴结取样（B 组）。对于肿瘤直径小于3.0 cm且不属于上述两组的患者，接受电视辅助肺叶切除术和肺门和纵隔淋巴结清扫术（C组）。结果：病例登记期间，共有159名患者登记入组（A组21例，B组43例，C组95例）。在 A 组和 B 组的患者中，28% 的患者转入需要切除较大体积的外科手术；整个研究人群中 6% 的患者转入开胸手术。所有患者均完成了5年随访。 A组无复发生存率为100%，B组为90.5%，C组为94.5%，各组间无显着性差异。总复发率为 11.9%，其中 6.3% 的患者出现局部复发，5.7% 的患者出现远端复发。观察到的局部复发包括 B 组残端复发 1 例，B 组 2 例、C 组 1 例恶性胸腔积液/胸膜播散。B 组 1 例、C 组 5 例胸腔内淋巴结复发。结论：本干预研究表明，临床早期肺癌的胸腔镜有限手术取决于术前检查结果。 从肿瘤学的角度来看，HRCT是可行且合适的。 (C) 2009 年欧洲心胸外科协会。由 Elsevier B.V. 出版。保留所有权利。
Objective: The present intervention study was conducted to prospectively evaluate the long-term prognosis for video-assisted limited surgery, such as wedge resection and segmentectomy, for clinically early lung cancers depending on findings in high-resolution computed tomography (HRCT). Subjects and methods: Patients were enrolled in the study between 2001 and 2004, and followed up for five subsequent years. Of these patients, those With a clinical stage IA lung cancer mainly comprising a ground glass-opacity (GGO) less than 1.5 cm across underwent thoracoscopic wedge resection of the lung (Group A). Patients with a tumour less than 2.0 cm in diameter, not classified in Group A, underwent video-assisted segmentectomy and hilar lymph node dissection with lobe-specific mediastinal nodes sampling (Group B). For patients with a tumour less than 3.0 cm in diameter, not classified in to any of the foregoing two groups, underwent video-assisted lobectomy and hilar and mediastinal lymph node dissection (Group C). Results: During the case registration period, 159 patients were registered for enrolment in the study (21 for Group A, 43 for Group B and 95 for Group C). Of the patients in Groups A and B, 28% were shifted to a surgical procedure involving a larger volume resected; 6% of the entire study population were shifted to thoracotomy. All patients completed the 5-year follow-up. The recurrence-free survival rate was 100% for Group A, 90.5% for Group B and 94.5% for Group C, with no significant difference among the groups. The total recurrence rate was 11.9% with localised recurrences observed in 6.3% of the patients and remote recurrences in 5.7%. The localised recurrences observed included stump recurrence in one case of Group B, and malignant pleural effusions/pleural dissemination in two cases of Group B and one case of Group C. Intrathoracic lymph node recurrences were observed in one case of Group B and five cases of Group C. Conclusions: The present intervention study showed that thoracoscopic-limited surgery for clinically early lung cancers depending on findings in preoperative HRCT is feasible and appropriate from the viewpoint of oncology. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.