Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer?
Are segmentectomy and lobectomy comparable in terms of curative intent for early stage non-small cell lung cancer?
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DOI：
10.1007/s11748-019-01219-y
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发表时间：
2019-11-06
影响因子：
1.2
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
--
作者：
Mimae, Takahiro;Okada, Morihito
1995年，Ginsberg等人在一项随机对照试验中比较了I期肺癌的肺叶切除术与有限切除术（包括肺段切除术和宽楔形切除术），发现有限切除术不应应用于其他方面健康且能够耐受肺叶切除术的临床IA期肺癌患者。然而，诊断技术的最新进展提高了检测早期和小肺癌的精度。因此，对于早期非小细胞肺癌（NSCLC）患者，根治性肺段切除术、解剖性肺段切除术伴肺门和纵隔淋巴结清扫术（在肿瘤学方面比楔形切除术更有价值）和肺叶切除术在治愈目的方面是否具有可比性仍存在争议。肺段切除术的作用根据肿瘤或患者特征而不同。高分辨率计算机断层扫描结果的肿瘤大小，位置，和存在或比率的毛玻璃样阴影（GGO）的组成部分和最大的标准化摄取值的氟-18-2-脱氧-d-葡萄糖正电子发射断层扫描是重要的选择外科手术，因为即使是早期NSCLC的恶性潜力是可变的。正在进行的JCOG 0802/WJOG 4607 L、JCOG 1211和CALGB 140503试验将根据术前高分辨率计算机断层扫描结果（关于保留的肺功能和长期预后），揭示肺段切除术对早期NSCLC患者的影响。肺段切除术是普通胸外科医生需要掌握的关键外科手术，考虑到如果手术切缘不足或术中确认淋巴结转移，可以转换为肺叶切除术。
In 1995, Ginsberg et al. compared lobectomy with limited resection including segmentectomy and wide-wedge resection for stage I lung cancer in a randomized controlled trial and found that limited resection should not be applied to otherwise healthy patients with clinical stage IA lung cancer who can tolerate lobectomy. However, recent advances in diagnostic technology have improved the precision of detecting early-stage and small lung cancers. Therefore, whether radical segmentectomy, anatomical segmentectomy with hilar and mediastinal lymph node dissection (that is more valuable than wedge resection in terms of oncological aspects) and lobectomy are comparable in terms of curative intent for patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. The role of segmentectomy differs according to tumor or patient characteristics. High resolution computed tomography findings of tumor size, location, and the presence or ratio of a ground glass opacity (GGO) component and the maximum of standardized uptake value on fluorine-18-2-deoxy-d-glucose positron emission tomography are important for selecting surgical procedures because the malignant potential of even early-stage NSCLC is variable. The ongoing JCOG0802/WJOG4607L, JCOG1211, and CALGB140503 trials will disclose the influence of segmentectomy for patients with early-staged NSCLCs that are small peripheral tumors based on preoperative high-resolution computed tomography findings about preserved pulmonary function and long-term prognosis. Segmentectomy is a key surgical procedure that general thoracic surgeons will need to master considering that it can be converted to lobectomy if the surgical margin is insufficient or lymph node metastasis is intraoperatively confirmed.