What is the role of wedge resection for T1a lung cancer?
What is the role of wedge resection for T1a lung cancer?
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DOI：
10.21037/jtd.2018.03.188
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发表时间：
2018-04-01
影响因子：
2.5
通讯作者：
Altorki, Nasser
中科院分区：
文献类型：
--
作者：
Harrison, Sebron;Stiles, Brendon;Altorki, Nasser
自 1995 年以来，肺叶切除术成为健康状况良好的早期肺癌患者的标准治疗方法。这是基于肺癌研究组在 1982 年至 1988 年间进行的一项比较肺叶切除术和亚肺叶切除术 (SLR) 治疗 I 期肺癌的单一随机试验的结果。该研究的结论包括，有限切除后局部区域复发 (LR) 显着增加三倍，但试验的两组之间在全身复发方面没有差异。尽管总生存率和癌症特异性生存率均有利于肺叶切除术，但两者均未达到统计学意义。无论如何，这项具有里程碑意义的试验确立了肺叶切除术作为早期肺癌的首选肿瘤切除术。自肺癌研究组的研究时期以来，胸外科实践发生了显着发展，这导致一些外科医生质疑其与当代实践的相关性。随着更小、分期更精确的肿瘤检出率的增加，加上心肺储备有限的老年人群的增加，人们重新燃起了对亚肺叶切除术的兴趣，其中包括楔形切除术，作为一种确定的治疗策略或作为体能状态不佳患者的折衷方法。在某种程度上，局部控制竞争技术（例如立体定向放射或经皮和经支气管消融技术）的出现和使用的增加进一步激发了人们对楔形切除术的兴趣。尽管 LCSG 的结果仍然给楔形切除术作为癌症手术的合理性蒙上了很长的阴影，但在随后的几年里已经发表了许多关于这个主题的文献。我们在这篇综述中概述了相互矛盾的数据，并提出了我们对楔形切除在早期肺癌中的作用的看法。
Since 1995, lobar resection became the standard of care for medically fit patients with early stage lung cancer. This was based on the results of a single randomized trial comparing lobectomy and sublobar resection (SLR) in stage I lung cancer conducted by the lung cancer study group between 1982 and 1988. The conclusions of the study included a statistically significant tripling in loco-regional recurrence (LR) after limited resection but no difference between the two arms of the trial in systemic recurrence. Although both overall survival and cancer specific survival favored lobectomy, neither achieved statistical significance. Regardless, this landmark trial established lobectomy as the preferred oncological resection for early stage lung cancer. The practice of thoracic surgery has evolved significantly since the study period of the Lung Cancer Study Group, and this has led some surgeons to question its relevance to contemporary practice. The increased detection of smaller more precisely staged tumors combined with the rising segment of the population that is elderly with limited cardiopulmonary reserve has renewed interest in sub-lobar resection including wedge resection as either a definitive therapeutic strategy or as a compromise approach in patients with poor performance status. The interest in wedge resections is also to some extent further fueled by the emergence and increased utilization of competing technologies of local control such as stereotactic radiation or percutaneous and trans-bronchial ablative techniques. Although the results of the LCSG still cast a long shadow over the soundness of wedge resection as a cancer operation, much literature has been published in the subsequent years on this topic. We present in this review an overview of the conflicting data and offer our perspective on the role of wedge resection in early stage lung cancer.