Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer
Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer
复制标题
DOI：
10.21037/jtd.2016.11.106
复制
发表时间：
2016-11-01
影响因子：
2.5
通讯作者：
Tsuchida, Masanori
中科院分区：
文献类型：
--
作者：
Koike, Terumoto;Koike, Teruaki;Tsuchida, Masanori
工作背景：虽然肺叶切除术是非小细胞肺癌（NSCLC）的标准手术方法，但最近的研究表明，在小尺寸外周肿瘤患者中进行有限切除术后，预后良好。我们进行了一项随机对照试验，这样的患者，以估计术后的结果和肺功能以下这些手术technology.Methods：2005年和2008年之间，符合条件的患者与肿瘤2厘米或更小被随机分配1：1进行肺叶切除术或有限切除术，32和33例非小细胞肺癌患者，每组分别进行了分析。主要终点为5年总生存率（OS）和无病生存率（DFS），次要终点为术后肺功能，包括用力肺活量（FVC）和1秒用力呼气量（FEV 1）。结果：肺叶切除组和局限性切除组的5年OS率分别为93.8%和90.9%（P=0.921）。肺叶切除组和有限切除组的5年DFS率分别为93.8%和90.9%（P=0.714）。两个切除组之间的这些比率没有显著差异。肺叶切除术组和有限切除术组的中位术后/术前FVC比值分别为84.1%和90.0%，而中位术后/术前FEV 1比值分别为81.9%和89.1%。两个比率均显着较高的有限切除组（P=0.032和P=0.005的FVC和FEV 1比值，分别）。结论：一个类似的结果，与更多的保留术后肺功能，观察到的患者进行有限切除术相比，那些谁接受肺叶切除术。正在进行的关于小外周NSCLC患者的肺叶与肺叶下切除术的大规模多机构前瞻性随机试验有望提供关于小外周肿瘤的有意有限切除的明确信息。
Background: Although lobectomy is the standard surgical procedure for non-small cell lung cancer (NSCLC), recent studies show favorable outcomes after limited resection in patients with small-sized peripheral tumors. We conducted a randomized controlled trial of such patients to estimate postoperative outcomes and pulmonary function following these surgical techniques.Methods: Between 2005 and 2008, eligible patients with tumors of 2 cm or less were randomly assigned 1: 1 to undergo lobectomy or limited resection; 32 and 33 NSCLC patients in each group, respectively, were analyzed. The primary end points were 5-year overall survival (OS) and disease-free survival (DFS), while the secondary end points were postoperative pulmonary function including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1).Results: The 5-year OS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.921). The 5-year DFS rates were 93.8% and 90.9% in the lobectomy and limited resection groups, respectively (P=0.714). These rates did not differ significantly between the two resection groups. The median postoperative/preoperative FVC ratios were 84.1% and 90.0% in the lobectomy and limited resection groups, respectively, while the median postoperative/preoperative FEV1 ratios were 81.9% and 89.1%, respectively. Both ratios were significantly higher in the limited resection group (P=0.032 and P=0.005 for FVC and FEV1 ratios, respectively).Conclusions: A similar outcome, with more preserved postoperative pulmonary function, was observed in patients who underwent limited resection compared to those who underwent lobectomy. Ongoing large-scale multi-institutional prospective randomized trials of lobar versus sublobar resection in patients with small peripheral NSCLCs will hopefully provide definitive information about intentional limited resection of small peripheral tumors.