Wedge Resection Versus Anatomic Resection: Extent of Surgical Resection for Stage I and II Lung Cancer.
Wedge Resection Versus Anatomic Resection: Extent of Surgical Resection for Stage I and II Lung Cancer.
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楔形切除与解剖切除：I 期和 II 期肺癌的手术切除范围。
DOI：
10.1200/edbk_179730
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
M. Yotsukura
中科院分区：
文献类型：
--
作者：
H. Asamura;K. Aokage;M. Yotsukura
目前，有根治性意图的肺癌外科手术包括切除承载癌病变的适当范围的肺实质和局部区域淋巴结，以评估可能的癌症转移。就实质切除的范围而言，至少肺叶切除是首选的。肺癌手术的历史始于1933年左右的肺切除术(即双侧全肺切除)，可以被描述为试图将实质切除的程度降至最低。20世纪60年代初，肺切除术被肺叶切除术取代，长期以来一直被推崇为标准的手术方式。然而，由于北美肺癌研究小组在20世纪80年代进行的一项随机试验的结果，不建议从肺叶切除术过渡到较小的切除术，如分段切除术或楔形切除术。到目前为止，实质切除的范围仍然是肺叶切除，较小的切除仅适用于肺储备受损的患者。最近，由于CT筛查程序的出现和成像技术的改进，更微弱和更小的肺癌正在被发现。对于这些较小和早期的肺癌，是否仍然应该选择肺叶切除术仍有一些不确定性，就像对直径为3厘米或更大的较大肿瘤一样。因此，一些随机试验正在进行中，以比较肺叶切除和较小的切除；终点是总体存活率和术后肺功能。在这些试验的结果出来之前，肺癌仍然应该通过肺叶切除而不是有限的切除来切除，例如分段切除或楔形切除。
Currently, surgery for lung cancer with curative intent consists of resection (removal) of the proper extent of lung parenchyma that bears the cancer lesion along with locoregional lymph nodes to assess possible cancer metastasis. Lobectomy, at least, is preferred with regard to the extent of parenchymal resection. The history of lung cancer surgery, which started around 1933 as pneumonectomy (resection of the entire lung on either side), can be characterized as an attempt to minimize the extent of parenchymal resection. In the early 1960s, pneumonectomy was replaced by lobectomy, which has long been respected as the standard surgical mode. However, the transition from lobectomy to a lesser resection, such as segmentectomy or wedge resection, was not recommended because of the results of a randomized trial performed by the North American Lung Cancer Study Group in the 1980s. As of now, the extent of parenchymal resection remains lobectomy, and lesser resection is indicated only for patients who have a compromised pulmonary reserve. Very recently, because of the advent of CT screening programs and improvements in imaging technology, fainter and smaller lung cancers are being discovered. For these smaller and earlier lung cancers, there is some uncertainty about whether lobectomy still should be indicated, as it is for larger tumors with a diameter of 3 cm or more. Therefore, several randomized trials are ongoing to compare lobectomy with lesser resections; endpoints are overall survival and postoperative pulmonary function. Until the results of these trials are available, lung cancer should still be removed by lobectomy rather than by limited resection, such as segmentectomy or wedge resection.