Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer
Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer
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DOI：
10.1016/j.athoracsur.2007.05.007
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发表时间：
2007-09-01
影响因子：
4.6
通讯作者：
Landreneau, Rodney J.
中科院分区：
文献类型：
--
作者：
Schuchert, Matthew J.;Pettiford, Brian L.;Landreneau, Rodney J.
背景早期非小细胞肺癌（NSCLC）的肺段切除术仍然存在争议，并且以前与高局部复发率相关。我们比较了I期非小细胞肺癌解剖性肺段切除术和肺叶切除术的结果，并研究了手术切缘对复发的影响。从2002年至2006年，182例解剖性肺段切除术（114例开放手术，68例电视辅助胸外科手术[ VATS]）用于1A期（n = 109）或IB期（n = 73）NSCLC。与246例肺叶切除术（1A，114; 1B，132）进行了比较。分析的变量包括住院时间、死亡率、复发模式和生存率。所有肺段切除术切缘均无肿瘤（平均切缘18.2 mm）。与肺叶切除术相比，肺段切除术后的手术时间（147 vs 216分钟; p < 0.0001）和估计失血量（185 vs 291 mL; p = 0.0003）显著减少。平均随访18.1个月和28.5个月时，肺段切除术和肺叶切除术的30天死亡率（1.1%和3.3%）、总并发症、无病复发率和生存率相似。肺段切除术后复发32例（17.6%），平均14.3个月（14例局部[7.7%]，18例远端[9.9%]），89%的复发发生在肿瘤边缘小于或等于2cm时，与边缘/肿瘤直径比值小于1相比，边缘/肿瘤直径比值大于1与复发率显著降低相关（25.0%对6.2%; p = 0.0014）。解剖性肺段切除术可以通过开放或VATS方法安全地进行。对于I期NSCLC，肺段切除术的结局优于标准肺叶切除术。切缘/肿瘤比值小于1与较高的复发率相关。当肺段切除术无法获得良好风险患者的此类切缘时，应考虑将肺叶切除术作为主要治疗方法。
Background. Segmentectomy for early-stage non-small cell lung cancer (NSCLC) remains controversial and has been previously associated with high local recurrence rates. We compared the outcomes of anatomic segmentectomy with lobectomy for stage I NSCLC and investigated the impact of surgical resection margins on recurrence.Methods. From 2002 to 2006, 182 anatomic segmentectomies ( 114 open, 68 video-assisted thoracic surgery [ VATS]), were performed for stage 1A (n = 109) or IB ( n = 73) NSCLC. These were compared with 246 lobectomies ( 1A, 114; 1B, 132). Variables analyzed included hospital course, mortality, and patterns of recurrence and survival.Results. All segmentectomy surgical margins were free of tumor ( average margin, 18.2 mm). Operative time ( 147 versus 216 minutes; p < 0.0001) and estimated blood loss ( 185 versus 291 mL; p = 0.0003) were significantly reduced after segmentectomy compared with lobectomy. Thirty-day mortality (1.1% versus 3.3%), total complications, disease-free recurrence, and survival were similar between segmentectomy and lobectomy at a mean follow-up of 18.1 and 28.5 months, respectively. There were 32 recurrences after segmentectomy (17.6%) at a mean of 14.3 months ( 14 locoregional [7.7%], 18 distant [9.9%]), and 89% of recurrences were seen when tumor margins were 2 cm or less. Margin/tumor diameter ratios exceeding 1 were associated with a significant reduction in recurrence rates compared with ratios of less than 1 (25.0% versus 6.2%; p = 0.0014).Conclusions. Anatomic segmentectomy can be performed safely by an open or VATS approach. Segmentectomy outcomes compare favorably with standard lobectomy for stage I NSCLC. Margin/tumor ratios of less than 1 are associated with a higher rate of recurrence. Lobectomy should be considered as primary therapy when such margins are not obtainable with segmentectomy in the good-risk patient.