可手术的同时性多原发性肺癌的初步诊治体会附26例报告

Primary Experience of Synchronous Multiple Primary Lung Cancers with Operative Indication A Report of 26 Cases

目的总结可手术的同时性多原发性肺癌(synchronous multiple primary lung cancers,sMPLC)的初步诊治体会。方法回顾性分析2019年1月至2021年1月无锡市第五人民医院和江南大学附属医院胸外科收治并手术的26例sMPLC患者的临床资料。所有患者均采用单操作孔胸腔镜手术。单侧MPLC同期切除所有病灶,双侧MPLC采用分期手术切除,所有患者均行根治性淋巴结清扫。结果全部手术均在胸腔镜下顺利完成,无中转开胸。所有病灶均为R0切除。术后未出现严重并发症。5例接受了单个肺叶切除术,2例接受2个不同肺叶切除;6例针对主病灶行肺叶切除,对其余病灶行亚肺叶切除;13例采取亚肺叶切除。术后病理结果显示,所有病灶均为腺癌者23例,腺癌-鳞癌者2例,两个病灶均为鳞癌者1例。2例淋巴结见癌转移(N1),其余未见淋巴结转移。5例接受了术后辅助治疗。术后8例失访,余18例获1~23个月随访,有1例发现纵隔淋巴结转移,予放射治疗;其余未见复发或转移。结论sMPLC的诊断依赖于多学科的协作,治疗上首选外科手术,并根据术后病理及基因检测结果辅以综合治疗,能够取得良好的疗效。

Objective To summarize the preliminary experience of diagnosis and treatment for synchronous multiple primary lung cancer(sMPLC)patients with operative indication.Methods A retrospectively analysis was conducted.There were 26 patients with sMPLC who received surgical treatment in Wuxi No.5 People's Hospital and the Affiliated Hospital of Jiangnan University from January 2019 to January 2021.All patients underwent single utility port VATS surgery.All the lesions were removed simultaneously in ipsilateral MPLC cases,while the bilateral MPLC cases had staged surgery.And radical lymph node dissection was done in all patients.Results All the patients underwent total VATS surgery successfully with no conversion to open thoracotomy.No severe complications were observed.R0 resection was confirmed in all patients.5 patients received single lobectomy and 2 received double lobectomies.Lobectomy was performed for the main lesion and sub-lobectomy was performed for the remaining lesions in 6 cases.13 patients underwent sub-lobectomy for all lesions.It was confirmed all adenocarcinoma in 23 cases,adenocarcinoma and squamous cell carcinoma in 2 cases,and both squamous cell carcinoma in 1 case.N1 lymph node metastasis was found in 2 patients.5 received postoperative adjuvant therapy.18 cases were followed up for 1 to 23 months.Mediastinal metastasis was found in 1 case,and the other 17 cancer-free survived.Conclusion The diagnosis for patients with sMPLC relies on multidisciplinary collaboration.Surgical resection is the preferred method for sMPLC with good curative effects in strict indications.