新辅助化疗后肺叶袖式切除术治疗非小细胞肺癌的临床分析

Clinical effect of sleeve lobectomy for non-small cell lung cancer after neoadjuvant chemotherapy

目的研究新辅助化疗后行肺叶袖式切除治疗非小细胞肺癌患者的临床效果。方法回顾性分析行肺叶袖式切除的62例非小细胞肺癌患者的临床资料。其中20例患者在术前接受了新辅助化疗(NCT组),另外42例仅接受了肺叶袖式切除术(WNC组)。分析了两组患者在年龄、性别、袖式切除类型、肺癌TNM分期、主要并发症、90天死亡率、5年生存率的差异。结果 NCT组患者均接受了以铂剂为基础的化疗,其中13例患者(65%)新辅助治疗后有降期,其中4例获得了完全缓解。90天死亡率WNC组为4.8%(2例),而NCT组为0%。术后主要并发症发生率WNC组为35.7%(15/42),NCT组为30.0%(6/20)。术后吻合口并发症发生率WNC组为4.8%(2/42),NCT组为0%。5年生存率WNC组为46%,NCT组为39%(P>0.05)。局部复发率WNC组为9.5%(4/42),NCT组为10%(2/20,P>0.05)。结论与未接受新辅助化疗的病例相比,新辅助化疗后袖式切除术的吻合口并发症发生率并未增加,二者在局部肿瘤复发和5年生存率上也无显著性差异。因此,对于肿瘤分期较高的非小细胞肺癌,新辅助化疗后行肺叶袖式切除术是一个值得选择的治疗方法。

Objective To study the clinical outcomes of patients undergoing sleeve lobectomy after preoperative chemotherapy for non-small cell lung cancer.Methods Clinical records of 62 patients with non-small cell lung cancer who underwent sleeve lobectomy were retrospectively reviewed.Of the 62 total patients,42 did not receive preoperative chemotherapy（WNC） and 20 patients did（NCT）.The factors of age,sex,type of sleeve resection,clinicopathologic TNM stage,complications,90-day mortality and five-year survival were compared between the two groups.Results All of the NCT patients underwent platinum-based chemotherapy.13 patients（65%） were downstaged,with 4 complete responders.The 90-day mortality was 4.8%（2 patients） in the WNC group and 0% in the NCT group.The incidence of major complications in WNC group was 35.7%（15 of 42） with 4.8%（2 of 42） anastomosis-related complications.The incidence of major complications in the NCT group was 30.0%（6 of 20） with no anastomosis-related problems.Five-year survival in WNC group was 46% compared with 39% in NCT group（P0.05）.There were 9.5%（4 of 42） of patients with local recurrence in WNC group versus 10%（2 of 20） of patients in NCT group（P0.05）.Conclusion Anastomosis-related complications are not increased among the patients receiving neoadjuvant chemotherapy.Sleeve lobectomy after neoadjuvant chemotherapy for advanced non–small cell lung cancer can be performed with acceptable morbidity and mortality.