Intentional Limited Resection for Small Peripheral Lung Cancer Based on Intraoperative Pathologic Exploration
Intentional Limited Resection for Small Peripheral Lung Cancer Based on Intraoperative Pathologic Exploration
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DOI：
10.1007/s11748-005-1005-7
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发表时间：
2005-01-01
影响因子：
1.2
通讯作者：
Hirono, Tatsuhiko
中科院分区：
文献类型：
--
作者：
Watanabe, Takehiro;Okada, Akira;Hirono, Tatsuhiko
目的：本研究的目的是根据术中病理检查来评估我们对周围型小肺癌的有意性有限切除的充分性。研究方法：最大肿瘤直径为2 cm或更小的IA期非小细胞肺癌（NSCLC）患者适合进行有限切除。如果计算机断层扫描怀疑细支气管肺泡癌（BAC），术中病理检查显示病变为BAC，无活跃的成纤维细胞增殖灶（Noguchi A型和B型），则进行楔形切除术。如果肿瘤不怀疑是Noguchi A型或B型，则进行扩大的肺段切除术和术中淋巴结探查。结果：34例行局限性切除，14例行楔形切除，20例行扩大肺段切除。楔形切除术后的中位随访期为36个月，所有患者均存活，无复发迹象。扩大肺段切除术后的中位随访期为54个月。无局部复发，1例远处转移。扩大肺段切除术后5年生存率为93%。同期，57例肿瘤最大直径≤ 2 cm的IA期NSCLC患者行肺叶切除术，5年生存率为84%。扩大肺段切除术和肺叶切除术的5年生存率无显著差异。结论：根据高分辨率计算机断层扫描结果和术中病理探查仔细选择患者，使有意的有限切除成为治疗小型外周型NSCLC的可接受选择。
Objective: The aim of this study was to assess the adequacy of our intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration. Methods: Patients who had stage IA non-small cell lung cancer (NSCLC) with a maximum tumor diameter of 2 cm or less were candidates for limited resection. If bronchioloalveolar carcinoma (BAC) was suspected on computed tomography and intraoperative pathologic exploration revealed the lesion as BAC without foci of active fibroblastic proliferation (Noguchi type A and B), wedge resection was performed. If the tumor was not suspected of being Noguchi type A or B, extended segmentectomy with intraoperative lymph node exploration was performed. Results: Limited resection was performed in 34 patients, wedge resection in 14, and extended segmentectomy in 20. The median follow-up period after wedge resection was 36 months, and all patients are alive with no signs of recurrence. The median follow-up period after extended segmentectomy was 54 months. No local recurrences were found, but distant metastasis was diagnosed in one patient. The 5-year survival rate after extended segmentectomy was 93%. In the same period, lobectomy was performed in 57 patients with stage IA NSCLC with a maximum tumor diameter of 2 cm or less, and the 5-year survival rate was 84%. There were no significant differences in 5-year survival between extended segmentectomy and iobectomy. Conclusions: Careful selection of patients based on high-resolution computed tomography findings and intraoperative pathologic exploration makes intentional limited resection an acceptable option for the treatment of small peripheral NSCLC.