Impact of postoperative complications on outcomes of second surgery for second primary lung cancer
Impact of postoperative complications on outcomes of second surgery for second primary lung cancer
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DOI：
10.1007/s00595-020-02038-y
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发表时间：
2020-06-01
期刊：
影响因子：
2.5
通讯作者：
Tsuchida, Masanori
中科院分区：
文献类型：
--
作者：
Sato, Seijiro;Nakamura, Masaya;Tsuchida, Masanori
目的第二原发性肺癌的最佳手术方式仍是一个争论的话题。本研究的目的是回顾第二原发性肺癌二次手术后的并发症，并根据这些并发症探讨结局。方法回顾性分析1996年1月至2017年12月间105例多原发肺癌患者行肺切除术的临床资料。结果二次手术后低体重指数（BMI <18.5kg/m2）（P = 0.004）和高Charlson合并症指数（CCI）（P = 0.002）是术后并发症的独立预测因素。生存分析显示，无术后并发症和有术后并发症患者的5年总生存率分别为74.5%和61.4%（P = 0.044），但5年癌症特异性生存率分别为82.5%和80.0%（P = 0.926）。在此期间，有并发症的患者比没有并发症的患者有更多的与手术相关的死亡（P = 0.011）。结论外科手术治疗第二原发肺癌是可行的，可能是有效的，但对于低BMI或高CCI的患者可能无法获得积极的围手术期和长期结局。应仔细考虑这些患者的治疗选择。
Purpose The best surgical approach for second primary lung cancer remains a subject of debate. The purpose of this study was to review the postoperative complications after second surgery for second primary lung cancer and to investigate the outcomes based on these complications. Methods The clinical data of 105 consecutive patients who underwent pulmonary resection for multiple primary lung cancers between January, 1996 and December, 2017, were reviewed according to the Martini-Melamed criteria. Results After the second surgery, low body mass index (BMI) (< 18.5 kg/m(2)) (P = 0.004) and high Charlson comorbidity index (CCI) (P = 0.002) were independent predictors of postoperative complications. Survival analysis revealed the 5-year overall survival rates of 74.5% and 61.4% for patients without postoperative complications and those with postoperative complications (P = 0.044), respectively, but the 5-year cancer-specific survival rates of 82.5% and 80.0% (P = 0.926), respectively. During this period, there were significantly more respiratory-related deaths of patients with complications than of those without complications (P = 0.011). Conclusion Surgical intervention is feasible and potentially effective for second primary lung cancer but may not achieve positive perioperative and long-term outcomes for patients with a low BMI or a high CCI. Treatment options should be considered carefully for these patients.