Completion pneumonectomy in cancer patients: experience with 55 cases
Completion pneumonectomy in cancer patients: experience with 55 cases
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DOI：
10.1016/j.ejcts.2003.12.002
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发表时间：
2004-03-01
影响因子：
3.4
通讯作者：
Fuentes, P
中科院分区：
文献类型：
--
作者：
Guggino, G;Doddoli, C;Fuentes, P
目的：分析单机构完成肺切除术的经验。方法：从1989年至2002年，55例连续癌症患者接受了全肺切除术（平均年龄62岁; 25-79岁）。38例患者的适应症为支气管肺癌（4例首次癌症，8例复发癌症，26例第二次癌症），3例肺转移，（乳腺癌、结直肠肿瘤和肺癌各1例）、1例肺肉瘤和13例既往接受过非小细胞肺癌手术治疗的其他非恶性疾病（支气管胸膜瘘4例，放射性坏死3例，曲菌球2例，厚胸膜1例，大咯血1例，肺炎2例）。在完成全肺切除术之前，50例患者接受了肺叶切除术，3例接受了双叶切除术，2例接受了较小的切除术。两个程序之间的平均间隔对于整个组为51个月（1 - 469），对于肺癌为60个月（12-469），对于肺转移为43个月（21-59），并且对于非恶性疾病为29个月（I - 126）。结果：右侧切除35例（64%），左侧切除20例（36%）。手术入路为后外侧开胸50例（91%），外侧开胸5例（9%）。49例患者（89%）采用心包内途径。5例患者接受了扩大切除术（2例胸壁，1例膈肌，1例锁骨下动脉和1例上级腔静脉）。手术死亡率为16.4%（n = 9）：恶性疾病（n = 5）为11.9%，良性疾病（n = 4）为30.8%。右侧全肺切除术（n = 7）的手术死亡率为20%，左侧手术（n = 2）的手术死亡率为10%。23名患者（42%）出现非致命性重大并发症。全组完成肺切除术后的3年和5年生存率分别为48.4%和35.2%。支气管肺癌患者的3年和5年生存率分别为56.9%和43.4%。结论：这些结果表明，在肺恶性肿瘤的情况下，完全肺切除术的手术风险与标准肺切除术相似。相反，在癌症患者中，炎症性疾病的完全肺切除术是一种非常高风险的手术。(C)2003 Elsevier B. V.保留所有权利。
Objective: Analysis of a single institution experience with completion pneumonectomy. Methods: From 1989 to 2002, 55 consecutive cancer patients received completion pneumonectomy (mean age 62 years; 25-79). Indications were bronchogenic carcinoma in 38 patients (4 first cancers, 8 recurrent cancers, 26 second cancers), lung metastases in three (one each from breast cancer, colorectal neoplasm and lung cancer), lung sarcoma in one, and miscellaneous non-malignant conditions in 13 patients having been surgically treated for a non-small cell lung cancer previously (bronchopleural fistula in 4, radionecrosis in 3, aspergilloma in 2, pachypleura in 1, massive hemoptysis in I and pneumonia in 2). Before completion pneumonectomy, 50 patients had had a lobectomy, three a bilobectomy, and two lesser resections. The mean interval between the two procedures was 51 months for the whole group (1 -469), 60 months for lung cancer (12-469), 43 months for pulmonary metastases (21-59) and 29 months for non-malignant disorders (I - 126). Results: There were 35 right (64%) and 20 left (36%) resections. The surgical approaches were a posterolateral thoracotomy in 50 cases (91%) and a lateral thoracotomy in five cases (9%). Intrapericardial route was used in 49 patients (89%). Five patients had an extended resection (2 chest wall, 1 diaphragm, I subclavian artery and 1 superior vena cava). Operative mortality was 16.4% (n = 9): 11.9% for malignant disease (n = 5) and 30.8% for benign disease (n = 4). Operative mortality was 20% for right completion pneumonectomies (n = 7) and 10% for left-sided procedures (n = 2). Twenty-three patients (42%) experienced non-fatal major complications. Actuarial 3- and 5-year survival rates from the time of completion pneumonectomy were 48.4 and 35.2% for the entire group. Three- and five-year survival for patients with bronchogenic carcinoma were 56.9 and 43.4%, respectively. Conclusions: These results suggest that completion pneumonectomy in the setting of lung malignancies can be done with an operative risk similar to the one reported for standard pneumonectomy. In contrast, in cancer patients, completion pneumonectomy for inflammatory disorders is a very high-risk procedure. (C) 2003 Elsevier B.V. All rights reserved.