Unplanned Extended Resection for Locally Advanced Non-small Cell Lung Cancer: A Retrospective Analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 汪進益 , 洪暄 , 劉剛 , 陳國涵 , 李欽傳 , 劉中民

同濟大學附屬東方醫院胸心外科（上海 200120）;

Corresponding?author：

汪進益, Email: Jinyi_wang@126.com

Keywords：

局部進展期肺癌; 擴大切除術; 手術指征; 綜合治療; 預后

DOI：

10.7507/1007-4848.20150263

Video：

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目的總結針對局部進展期非小細胞肺癌（LA-NSCLC）施行肺癌擴大指征手術的臨床經驗。方法回顧性分析2008年1月至2012年12月同濟大學附屬東方醫院胸心外科非計劃性實施肺癌擴大指征手術治療的14例LA-NSCLC患者的臨床資料，其中男9例、女5例，年齡30～67（59.5±6.1）歲。行胸壁切除與重建術2例，主動脈切除及重建術1例，肺癌上腔靜脈切除重建術3例，椎體部分切除術1例，左心房部分切除術1例，肺上溝瘤外科治療2例，袖形全肺切除或肺葉切除隆突成形術3例，支氣管肺動脈成形術1例。結果本組患者無圍手術期死亡病例。術后病理診斷鱗癌7例，腺癌4例，鱗腺癌1例，腺樣囊性癌2例。隨訪18.5（7～48）個月。全組患者中術后生存時間最長者超過4年；3例分別于術后7個月、11個月和17個月死于腫瘤遠處轉移；1例存活26個月，1例存活20個月，另1例術后3個月并發肺部感染死亡；4例已存活3年以上；另有3例術后隨訪至2013年9月，隨訪時間未滿1年仍存活。結論肺癌擴大指征手術能使LA-NSCLC患者獲得肺癌的完全性切除，其中相當部分患者術后可獲良好的近遠期效果，因此外科治療依舊是肺癌治療的基石，對有條件手術者應力爭手術治療。

Citation： 汪進益, 洪暄, 劉剛, 陳國涵, 李欽傳, 劉中民. Unplanned Extended Resection for Locally Advanced Non-small Cell Lung Cancer: A Retrospective Analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(11): 1064-1066. doi: 10.7507/1007-4848.20150263 Copy

1.	Fidler MJ,Kim AW,Zusag T,et al.Treatment of locally advanced non-small cell lung cancer.Clin Adv Hematol Oncol,2009,7(7):455-464,479-480.
2.	Donington JS,Pass HI.Surgical approach to locally advanced nonsmall cell lung cancer.Cancer J,2013,19(3):217-221.
3.	Salama JK,Vokes EE.New radiotherapy and chemoradiotherapy approaches for non-small-cell lung cancer.J Clin Oncol,2013,31(8):1029-1038.
4.	Pitz CC,Brutel de la Rivière A,van Swieten HA,et al.Results of surgical treatment of T4 non-small cell lung cancer.Eur J Cardiothorac Surg,2003,24(6):1013-1018.
5.	Muralidaran A,Detterbeck FC,Boffa DJ,et al.Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass:a systematic review.J Thorac Cardiovasc Surg,2011,142(5):1137-1142.
6.	Hasegawa S,Bando T,Isowa N,et al.The use of cardiopulmonary bypass during extended resection of non-small cell lung cancer.Interact Cardiovasc Thorac Surg,2003,2(4):676-679.
7.	DiPerna CA,Wood DE.Surgical management of T3 and T4 lung cancer.Clin Cancer Res,2005,11(13 Pt 2):5038s-5044s.
8.	汪進益,陳國涵,洪暄,等.同期肺葉切除聯合心臟手術的臨床應用.中國胸心血管外科臨床雜志,2012,19(1):93-94.
9.	Wu L,Xu Z,Zhao X,et a1.Surgical treatment of lung cancer invading the left atrium or base of the pulmonary vein.World J Surg,2009,33(3):492-496.
10.	Dyszkiewicz W,Jemielity M,Piwkowski C,et al.The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease.Eur J Cardiothorac Surg,2008,34(3):531-535.
11.	Mason DP.The role of surgery for locally advanced non-small cell lung cancer.Cleve Clin J,2012,79(Electronic Suppl 1):eS38-eS41.
12.	孟龍,陳景寒,王磊,等.手術切除T4期肺癌的療效分析.中華胸心血管外科雜志,2006,22(3):161-163.
13.	Shimizu J,Ishida Y,Kinoshita T,et al.Left upper division sleeve segmentectomy for early stage squamous cell carcinoma of the segmental bronchus:report of two cases.Ann Thorac Cardiovasc Surg,2003,9(1):62-67.
14.	Wang XX,Liu TL,Yin XR.Surgical treatment of Ⅲb-T4 lung cancer invading left atrium and great vessels.Chin Med J(Engl),2010,123(3):265-268.
15.	Farjah F,Wood DE,Varghese TK Jr,et al.Trends in the operative management and outcomes of T4 lung cancer.Ann Thorac Surg,2008,86(2):368-374.
16.	Rigas JR,Kelly K.Current treatment paradigms for locally advanced non-small cell lung cancer.J Thorac Oncol,2007,2(Suppl 2):S77-S85.
17.	Shien K,Toyooka S,Kiura K,et al.Induction chemoradiotherapy followed by surgical resection for clinical T3 or T4 locally advanced non-small cell lung cancer.Ann Surg Oncol,2012,19(8):2685-2692.
18.	Barnett SA,Rusch VW,Zheng J,et al.Contemporary results of surgical resection of non-small cell lung cancer after induction therapy:a review of 549 consecutive cases.J Thorac Oncol,2011,6(9):1530-1536.
19.	Ratto GB,Costa R,Vassallo G,et al.Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer.Ann Thorac Surg,2004,78(1):234-237.
20.	Spaggiari L,Leo F,Veronesi G,et al.Superior vena cava resection for lung and mediastinal malignancies:a single-center experience with 70 cases.Ann Thorac Surg,2007,83(1):223-229.
21.	Martin J,Ginsberg RJ,Venkatraman ES,et al.Long-term results of combined-modality therapy in resectable non-small-cell lung cancer.J Clin Oncol,2002,20(8):1989-1995.
22.	Shargall Y,de Perrot M,Keshavjee S,et al.15 years single center experience with surgical resection of the superior vena cava for non-small cell lung cancer.Lung Cancer,2004,45(3):357-363.
23.	Chida M,Minowa M,Miyoshi S,et al.Extended sleeve lobectomy for locally advanced lung cancer.Ann Thorac Surg,2009,87(3):900-905.
24.	張宜明,于長海,李捷,等.侵犯心臟大血管局部晚期肺癌的外科治療.中國胸心血管外科臨床雜志,2010,17(5):410-412.

1. Fidler MJ,Kim AW,Zusag T,et al.Treatment of locally advanced non-small cell lung cancer.Clin Adv Hematol Oncol,2009,7(7):455-464,479-480.
2. Donington JS,Pass HI.Surgical approach to locally advanced nonsmall cell lung cancer.Cancer J,2013,19(3):217-221.
3. Salama JK,Vokes EE.New radiotherapy and chemoradiotherapy approaches for non-small-cell lung cancer.J Clin Oncol,2013,31(8):1029-1038.
4. Pitz CC,Brutel de la Rivière A,van Swieten HA,et al.Results of surgical treatment of T4 non-small cell lung cancer.Eur J Cardiothorac Surg,2003,24(6):1013-1018.
5. Muralidaran A,Detterbeck FC,Boffa DJ,et al.Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass:a systematic review.J Thorac Cardiovasc Surg,2011,142(5):1137-1142.
6. Hasegawa S,Bando T,Isowa N,et al.The use of cardiopulmonary bypass during extended resection of non-small cell lung cancer.Interact Cardiovasc Thorac Surg,2003,2(4):676-679.
7. DiPerna CA,Wood DE.Surgical management of T3 and T4 lung cancer.Clin Cancer Res,2005,11(13 Pt 2):5038s-5044s.
8. 汪進益,陳國涵,洪暄,等.同期肺葉切除聯合心臟手術的臨床應用.中國胸心血管外科臨床雜志,2012,19(1):93-94.
9. Wu L,Xu Z,Zhao X,et a1.Surgical treatment of lung cancer invading the left atrium or base of the pulmonary vein.World J Surg,2009,33(3):492-496.
10. Dyszkiewicz W,Jemielity M,Piwkowski C,et al.The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease.Eur J Cardiothorac Surg,2008,34(3):531-535.
11. Mason DP.The role of surgery for locally advanced non-small cell lung cancer.Cleve Clin J,2012,79(Electronic Suppl 1):eS38-eS41.
12. 孟龍,陳景寒,王磊,等.手術切除T4期肺癌的療效分析.中華胸心血管外科雜志,2006,22(3):161-163.
13. Shimizu J,Ishida Y,Kinoshita T,et al.Left upper division sleeve segmentectomy for early stage squamous cell carcinoma of the segmental bronchus:report of two cases.Ann Thorac Cardiovasc Surg,2003,9(1):62-67.
14. Wang XX,Liu TL,Yin XR.Surgical treatment of Ⅲb-T4 lung cancer invading left atrium and great vessels.Chin Med J(Engl),2010,123(3):265-268.
15. Farjah F,Wood DE,Varghese TK Jr,et al.Trends in the operative management and outcomes of T4 lung cancer.Ann Thorac Surg,2008,86(2):368-374.
16. Rigas JR,Kelly K.Current treatment paradigms for locally advanced non-small cell lung cancer.J Thorac Oncol,2007,2(Suppl 2):S77-S85.
17. Shien K,Toyooka S,Kiura K,et al.Induction chemoradiotherapy followed by surgical resection for clinical T3 or T4 locally advanced non-small cell lung cancer.Ann Surg Oncol,2012,19(8):2685-2692.
18. Barnett SA,Rusch VW,Zheng J,et al.Contemporary results of surgical resection of non-small cell lung cancer after induction therapy:a review of 549 consecutive cases.J Thorac Oncol,2011,6(9):1530-1536.
19. Ratto GB,Costa R,Vassallo G,et al.Twelve-year experience with left atrial resection in the treatment of non-small cell lung cancer.Ann Thorac Surg,2004,78(1):234-237.
20. Spaggiari L,Leo F,Veronesi G,et al.Superior vena cava resection for lung and mediastinal malignancies:a single-center experience with 70 cases.Ann Thorac Surg,2007,83(1):223-229.
21. Martin J,Ginsberg RJ,Venkatraman ES,et al.Long-term results of combined-modality therapy in resectable non-small-cell lung cancer.J Clin Oncol,2002,20(8):1989-1995.
22. Shargall Y,de Perrot M,Keshavjee S,et al.15 years single center experience with surgical resection of the superior vena cava for non-small cell lung cancer.Lung Cancer,2004,45(3):357-363.
23. Chida M,Minowa M,Miyoshi S,et al.Extended sleeve lobectomy for locally advanced lung cancer.Ann Thorac Surg,2009,87(3):900-905.
24. 張宜明,于長海,李捷,等.侵犯心臟大血管局部晚期肺癌的外科治療.中國胸心血管外科臨床雜志,2010,17(5):410-412.

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Unplanned Extended Resection for Locally Advanced Non-small Cell Lung Cancer: A Retrospective Analysis

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