Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: Initial results of the randomized, prospective ACOSOG Z0030 trial
Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: Initial results of the randomized, prospective ACOSOG Z0030 trial
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DOI：
10.1016/j.athoracsur.2005.06.066
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发表时间：
2006-03-01
影响因子：
4.6
通讯作者：
Rusch, VW
中科院分区：
文献类型：
--
作者：
Allen, MS;Darling, GE;Rusch, VW
背景资料。关于肺癌肺大部切除术后的发病率和死亡率，或者纵隔淋巴结清扫术是否会增加发病率和死亡率，几乎没有前瞻性的多机构数据。对1999年7月至2004年2月1111例接受肺切除的患者的术后30天前瞻性收集的数据进行了分析，这是一项随机试验，比较了早期肺癌的淋巴结采样和纵隔淋巴结清扫。在随机抽取的1,111名患者中，有1,023人被纳入分析。中位年龄为68岁(从23岁到)；52%是男性。肺叶切除766例(75%)，全肺切除42例(4%)。病理分期：IA期424例(42%)，IB期418例(41%)，IIA期37例(4%)，IIB期97例(9%)。III型45例(5%)。498例患者进行了淋巴结采样，525例患者进行了淋巴清扫。手术死亡率分别为2.00%(10/498)和0.76%(4/525)。两组均有38%的患者出现并发症。淋巴结清扫术的中位手术时间较长，总胸管引流量较大(分别为15min和121mL)。两组平均住院天数均为6天，差异无统计学意义(P=0.404)。完整的纵隔淋巴清扫几乎不会增加肺癌肺切除术的发病率。这些数据来自目前接受了大范围肺切除的多机构患者队列，构成了一个新的基线，用于比较未来的结果。
Background. Little prospective, multiinstitutional data exist regarding the morbidity and mortality after major pulmonary resections for lung cancer or whether a mediastinal lymph node dissection increases morbidity and mortality.Methods. Prospectively collected 30-day postoperative data was analyzed from 1,111 patients undergoing pulmonary resection who were enrolled from July 1999 to February 2004 in a randomized trial comparing lymph node sampling versus mediastinal lymph node dissection for early stage lung cancer.Results. Of the 1,111 patients randomized, 1,023 were included in the analysis. Median age was 68 years (range, 23 to 89 years); 52% were men. Lobectomy was performed in 766 (75%) and pneumonectomy in 42 (4%). Pathologic stage was IA in 424 (42%), IB in 418 (41%), IIA in 37 (4%), IIB in 97 (9%). and III in 45 (5%). Lymph node sampling was performed in 498 patients and lymph node dissection in 525. Operative mortality was 2.0% (10 of 498) for lymph node sampling and 0.76% (4 of 525) for lymph node dissection. Complications occurred in 38% of patients in each group. Lymph node dissection had a longer median operative time and greater total chest tube drainage (15 minutes, 121 mL, respectively). There was no difference in the median hospitalization, which was 6 days in each group (p = 0.404).Conclusions. Complete mediastinal lymphadenectomy adds little morbidity to a pulmonary resection for lung cancer. These data from a current, multiinstitutional cohort of patients who under-went a major pulmonary resection constitute a new baseline with which to compare results in the future.