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

Authors：

 汪进益 , 洪暄 , 刘刚 , 陈国涵 , 李钦传 , 刘中民

同济大学附属东方医院胸心外科（上海 200120）;

Corresponding author：

汪进益, Email: Jinyi_wang@126.com

Keywords：

局部进展期肺癌; 扩大切除术; 手术指征; 综合治疗; 预后

DOI：

10.7507/1007-4848.20150263

Video：

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目的总结针对局部进展期非小细胞肺癌（LA-NSCLC）施行肺癌扩大指征手术的临床经验。方法回顾性分析2008年1月至2012年12月同济大学附属东方医院胸心外科非计划性实施肺癌扩大指征手术治疗的14例LA-NSCLC患者的临床资料，其中男9例、女5例，年龄30～67（59.5±6.1）岁。行胸壁切除与重建术2例，主动脉切除及重建术1例，肺癌上腔静脉切除重建术3例，椎体部分切除术1例，左心房部分切除术1例，肺上沟瘤外科治疗2例，袖形全肺切除或肺叶切除隆突成形术3例，支气管肺动脉成形术1例。结果本组患者无围手术期死亡病例。术后病理诊断鳞癌7例，腺癌4例，鳞腺癌1例，腺样囊性癌2例。随访18.5（7～48）个月。全组患者中术后生存时间最长者超过4年；3例分别于术后7个月、11个月和17个月死于肿瘤远处转移；1例存活26个月，1例存活20个月，另1例术后3个月并发肺部感染死亡；4例已存活3年以上；另有3例术后随访至2013年9月，随访时间未满1年仍存活。结论肺癌扩大指征手术能使LA-NSCLC患者获得肺癌的完全性切除，其中相当部分患者术后可获良好的近远期效果，因此外科治疗依旧是肺癌治疗的基石，对有条件手术者应力争手术治疗。

Citation： 汪进益, 洪暄, 刘刚, 陈国涵, 李钦传, 刘中民. 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

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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.
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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.	汪进益,陈国涵,洪暄,等.同期肺叶切除联合心脏手术的临床应用.中国胸心血管外科临床杂志,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.	孟龙,陈景寒,王磊,等.手术切除T4期肺癌的疗效分析.中华胸心血管外科杂志,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.	张宜明,于长海,李捷,等.侵犯心脏大血管局部晚期肺癌的外科治疗.中国胸心血管外科临床杂志,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. 汪进益,陈国涵,洪暄,等.同期肺叶切除联合心脏手术的临床应用.中国胸心血管外科临床杂志,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. 孟龙,陈景寒,王磊,等.手术切除T4期肺癌的疗效分析.中华胸心血管外科杂志,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. 张宜明,于长海,李捷,等.侵犯心脏大血管局部晚期肺癌的外科治疗.中国胸心血管外科临床杂志,2010,17(5):410-412.

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