早期(T_1N_0M_0)非小细胞肺癌外科治疗的探讨

Surgical treatment for early stage (T_1N_0M_0) non-small-cell lung cancer

目的 探讨肺叶切除术和楔形切除术对早期 (T1N0 M0 )非小细胞肺癌 (NSCLC)的疗效。方法 分析 10 9例早期 (T1N0 M0 )NSCLC病例的手术效果 ,其中楔形切除术 5 1例 (开胸组 2 1例 ,胸腔镜组 30例 ) ,肺叶切除术 5 8例 ;包括各治疗组间对术后并发症发生率、病死率、术后复发率、生存率及肺功能的评估。结果 各治疗组间肿瘤的组织类型、术后并发症发生率和病死率及后期肺功能差异无显著性。楔形切除组年龄偏大 ,慢性阻塞性肺病 (COPD)发病率高 ,肺功能较差 ,与肺叶切除组相比 ,平均住院日明显减少 ,局部复发率增高 ,差异有统计学意义。 1年生存率各组相似 (开胸楔形切除组 94 % ,胸腔镜楔形切除组95 % ,肺叶切除组 91% ) ,5年生存率开胸楔形切除组 5 8% ,胸腔镜楔形切除组 6 5 % ,肺叶切除组 70 % ,差异有统计学意义 (P =0 0 2 )。结论 对有心肺功能损害的早期NSCLC病人 ,楔形切除术是一种可行的外科治疗 ;但由于局部复发率较高 ,只要病人心肺功能耐受 ,仍应首选肺叶切除术。

Objective: To determine the efficacy of lobectomy and wedge resection in the management of early stage (T 1N 0M 0) non small cell lung cancer. Methods: We analyzed the results of 109 patients with pathologic stage (T 1N 0M 0) non small cell lung cancer who underwent open wedge resection (n=21), video assisted wedge resection (n=30), and lobectomy (n=58) to assess perioperative morbidity and mortality, recurrence rates, survival difference and late pulmonary function among the three groups. Results: There were no differences among the three groups in regard to histologic tumor type, perioperative morbidity and mortality, late pulmonary function. Analysis demonstrated the wedge resection groups to be significantly older and to have reduced pulmonary function despite a higher incidence of treatment for chronic obstructive pulmonary disease when compared with patients having lobectomy. Statistically, the mean hospital stay was significantly less and locoregional recurrences rate higher in the wedge resection groups. Kaplan Meier survival curves were nearly identical at 1 year (open wedge resection, 94%; video assisted wedge resection, 95%; lobectomy, 91%). 5 year survival was 58%, 65% and 70% respectively. Log rank testing demonstrated significant differences between the survival curves during the 5 year period of study (P=0.02). Conclusion: Wedge resection, done by thoracotomy or video assisted techniques, appears to be a viable surgical treatment of stageⅠ(T 1N 0M 0) non small cell lung cancer for patients with cardiopulmonary physiologic impairment. Because of the increased risk for local recurrence, anatomic lobectomy remains the surgical treatment of choice for patients with stage I non small cell lung cancer who have adequate physiologic reserve.