Morbidity, mortality, and survival after bronchoplastic procedures for lung cancer.
Morbidity, mortality, and survival after bronchoplastic procedures for lung cancer.
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肺癌支气管成形术后的发病率、死亡率和生存率。
DOI：
10.1016/s1010-7940(96)01023-8
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
F. Sartori
中科院分区：
文献类型：
--
作者：
F. Rea;M. Loy;L. Bortolotti;P. Feltracco;David Fiore;F. Sartori
目的支气管成形术是治疗肺功能受限的良性病变、低度恶性肿瘤和肺癌的有效手术方法。我们分析了我们的经验，以验证我们的病人的死亡率、发病率和长期生存。我们做了92例支气管镜成形术，94例支气管袖成形术和31例气管支气管镜。组织学检查显示：表皮样癌133例，腺癌28例，小细胞肺癌11例，大细胞癌5例，腺鳞癌2例，支气管类癌29例，腺样癌6例，粘液表皮样瘤3例。在结节状态方面，N0病99例，N1病，N2病54例。36例术前放疗，181例术前未放疗。在63例患者中，我们使用了吻合口周围带蒂皮瓣；在154例患者中，我们没有使用它。我们考虑了所有217例患者的30天死亡率和发病率；在217例患者中，我们只分析了179例患者的长期生存，因为我们排除了38例低度恶性肿瘤患者。结果27例患者(12.5%)有术后并发症。30天病死率为6.2%(14例)。除低度恶性外，所有患者的5年和10年生存率分别为49%和38%。N0状态患者的5年和10年生存率分别为72.4%和59.4%；N1状态患者的5年和10年生存率分别为35.7%和26.8%；而N2状态患者的5年和10年生存率分别为22%和14.4%。有无带蒂皮瓣的患者术后并发症发生率无显著差异，而有无术前放疗的患者术后并发症发生率有显著差异。结论支气管成形术是治疗肺部恶性肿瘤的一种安全、有效的方法。气管-支气管袖与较高的术后死亡率和并发症发生率相关，这些手术应仅限于无n2疾病的患者。术前放疗明显增加了死亡率和发病率。多因素分析显示，只有淋巴结状况影响患者的长期生存(P=0.0002)。
ObjectiveBronchoplastic procedures represent an effective surgical therapy for benign lesions, tumors of low-grade malignancy and also bronchogenic carcinoma in patients with a limited pulmonary function. We analyzed our experience in order to verify the mortality, morbidity, and long term survival in our patients.MethodsFrom 1980 to 1994, 217 patients underwent bronchoplastic procedures. We performed 92 bronchoplasties, 94 bronchial sleeves, and 31 tracheo-bronchial sleeves. Histologic examination revealed 133 epidermoid carcinomas, 28 adenocarcinomas, 11 small cells lung cancers, 5 large cells carcinomas, 2 adenosquamous carcinomas, 29 bronchial carcinoids, 6 adenoidocistic carcinomas, and 3 mucoepidermoid tumors. Regarding nodal status, 99 patients had N0 disease, 64 patients had N1 disease, and 54 patients had N2 disease. Thirty-six patients had preoperative irradiation and 181 patients had no preoperative irradiation. In 63 patients we used a perianastomotic pedicled flap; in 154 we did not use it. We considered all the 217 patients for the analysis of 30-day mortality and morbidity; of the 217 patients we analyzed long-term survival only in 179 because we excluded 38 patients with low grade malignant neoplasm.ResultsTwenty-seven patients (12.5%) had postoperative complications. The 30-day mortality was 6.2%(14 patients). Survival at 5 and 10 years for all patients but those with low grade malignant neoplasm was 49 and 38%, respectively. For patients with N0 status 5-and 10-year survival was 72.4 and 59.4%; for patients with N1 status these rates were 35.7 and 26.8%; for patients with N2 status, 5-and 10-year survival was 22 and 14.4%. Postoperative complication rates for patients with or without pedicled flap are not significantly different; however, the rates for patients with or without preoperative irradiation are significantly different.ConclusionsBronchoplastic procedures are a safe and effective therapy for selected patients with pulmonary malignancy. Tracheo-bronchial sleeves are associated with high postoperative mortality and complication rates and these procedures should be limited to patients without N2 disease. Preoperative irradiation increases significantly the mortality and morbidity. A multivariate analysis shows that only the nodal status affects long-term survival (P= 0.0002).