中央型非小细胞肺癌扩大袖式肺叶切除术后的手术结果

Background 背景

We primarily aimed to evaluate the operative techniques,  clinicopathological characteristics and surgical outcomes following extended sleeve lobectomy (ESL). Additionally, we evaluated the feasibility of ESL for centrally-located non-small cell lung cancer (NSCLC) in comparison with those of pneumonectomy (PN).

我们的主要目的是评估扩大袖式肺叶切除术(ESL)的手术技术、临床病理特征和手术结果。此外，我们评估了ESL治疗中央型非小细胞肺癌(NSCLC)与全肺切除术(PN)的可行性。

Methods 方法

A retrospective review identified 119 patients who underwent pulmonary resections for centrally-located NSCLC; 43 underwent ESLs and 76 underwent PNs. Perioperative morbidity and oncological outcomes of ESL were analyzed. Postoperative  morbidity was evaluated according to the Common Terminology Criteria for Adverse  Events ver. 5.0. Overall survival (OS) was evaluated using a Cox proportional hazard model.

一项回顾性研究确定了119例因中央型NSCLC接受肺切除术的患者;43例为ESL, 76例为PN。对ESL的围手术期发病率和肿瘤预后进行分析。术后发病率根据不良事件通用术语标准5.0评估。使用Cox比例风险模型评估总生存期(OS)。

Results 结果

According to the classifications of ESL, 10 (23%) patients comprised Type A, 8 (19%) Type B, 16 (37%) Type C, and 9 (21%) Type D. Pulmonary artery reconstructions were performed in 5 of Type A, 8 of Type B, 1 of Type C, and 1 of Type D, and  pulmonary vein reconstructions were 3 of Type A and 2 of Type C, respectively. The 30-day hospital mortality was found in 1 (2.3%), Grade 3 or more morbidities were in 13 (30%) following ESL. In particular, bronchial anastomosis/stump fistula was seen in 4 (9.3%), blood perfusion disorders due to the presence of thrombi were seen in 4 (9.3%) after ESLs. The 3y-OS was significantly better following ESL compared with that  following PN (62.8% vs. 45.2%, P=0.047).

根据ESL的分类，A型10例(23%)患者，B型8例(19%)，C型16例子(37%),9例(21%)D型。肺动脉重建， A型进行了5例，B型进行了8例，C型进行了1例，D型进行了1例；至于肺静脉重建， A型进行了3例，C型进行了2例。30天院内死亡1例(2.3%)，3级或3级以上的并发症13例(30%)。其中4例(9.3%)出现支气管吻合口/残端瘘，4例(9.3%)在ESLs后出现血栓引起的血液灌注障碍。

ESL术后3y-OS明显优于PN术后3y-OS (62.8% vs 45.2%，P=0.047)。

Conclusions 结论

ESLs to preserve lung parenchyma will likely become a promising operative strategy in appropriately selected patients with centrally-located NSCLC.

在适当选择的中央型非小细胞肺癌患者中，保留肺实质的ESLs可能成为一种有前途的手术策略。