Clinical controlled comparison between lobectomy and segmental resection for patients over 70 years of age with clinical stage I non-small cell lung cancer
Clinical controlled comparison between lobectomy and segmental resection for patients over 70 years of age with clinical stage I non-small cell lung cancer
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DOI：
10.1016/j.ejso.2012.08.001
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发表时间：
2012-12-01
期刊：
影响因子：
3.8
通讯作者：
Zhang, C. F.
中科院分区：
文献类型：
--
作者：
Cheng, Y. D.;Duan, C. J.;Zhang, C. F.
目的：探讨老年（>= 70岁）临床I期非小细胞肺癌（NSCLC）患者的标准手术方法。方法：采用非随机前瞻性对照研究，比较肺叶切除术与节段性切除术治疗不同肺功能的老年临床I期肺癌患者。分析围手术期指标，包括胸腔引流时间、引流量、术后并发症发生率、局部复发率、1、3、5年生存率。结果：184例患者纳入研究。根据肺功能将患者分为两组：1组患者肺功能较差，1秒用力呼气量（FEV1）小于1.5 L 64例，2组患者FEV1 >= 1.5 L 120例。1组患者术后机械通气时间较2组长，呼吸相关并发症发生率高于2组（21.9% vs. 8.35%, p = 0.009）。肺叶切除术与节段性切除术的局部复发率和长期生存率无显著差异。在行节段性淋巴结切除术的患者中，行局部淋巴结清扫的患者3年和5年生存率高于行选择性淋巴结切除术的患者（77.8比51.7%,p = 0.042； 55.6比27.6%,p = 0.034），但在肺叶切除术中无显著性差异。结论：对于FEV1 < 1.5 l的老年临床I期NSCLC患者，节段性切除联合局部淋巴结切除是最佳选择(C) 2012 Elsevier Ltd.。版权所有。
Aims: The standard surgical procedure for elderly (>= 70 years) patients with clinical stage I non-small cell lung cancer (NSCLC) was investigated.Methods: A non-randomized prospective controlled study was conducted to compare lobectomy with segmental resection for the treatment of elderly clinical stage I lung cancer patients under different pulmonary function. Perioperative indicators including time and volume of thoracic drainage, incidence of postoperative complications, locoregional recurrence rates, and I, 3, and 5-year survival rates were analyzed.Results: A total of 184 patients were included in the study. Patients were classified into two groups according to pulmonary function: group I included 64 patients who had poor pulmonary function, with a forced expiratory volume in 1 s (FEV1) of less than 1.5 L, whereas group 2 consisted of 120 patients with an FEV1 >= 1.5 L. The patients in group I had a longer postoperative mechanical ventilation time and a higher incidence rate of respiratory associated complications than those in group 2(21.9 vs. 8.35%, p = 0.009). The local recurrence and long-term survival rates were not significantly different between lobectomy and segmental resection. Among the patients who underwent segmental resection, those who had regional lymph node dissection showed a higher 3-year and 5-year survival rate than those undergoing selected lymph node resection (77.8 vs. 51.7%, p = 0.042; 55.6 vs. 27.6%, p = 0.034), but this was not significant in lobectomy.Conclusions: Segmental resection combined with regional lymph node resection could be the best choice for elderly clinical stage I NSCLC patients with FEV1 < 1.5 L. (C) 2012 Elsevier Ltd. All rights reserved.