肺癌再次手術的臨床重要性

The Clinical Significance of Reoperation for Lung Cancer

許南榮(Nan-Yung Hsu) ； 陳志毅(Chih-Yi Chen)

《中華民國癌症醫學會雜誌》 24卷6期 (2008/12) Pp. 356-361

https://doi.org/10.6588/JCOS.2008.24.6.3

摘要

背景：曾經接受肺癌切除手術的病患，在追蹤期間，又再次發現有肺癌病灶時，是否需要再次手術切除，是臨床上值得探討的課題。
方法：我們統計從1999年1月至2006年6月，三家醫學中心31例肺癌病患，經第一次根除性切除手術後，再經手術切除，佔所有肺癌切除的2.3%(31/1359)。除3例再手術為良性病灶外，有28例為肺癌。探討手術的併發症和死亡率，以及五年存活率。將28例分為二組，第一組14例為復發病灶（包括1例為局部復發，13例為遠處轉移），發生的時間，從第一次手術後6個月至21個月，中位數為13個月。第二組14例為第二次原發肺癌，發生的時間，從第一次手術後25個月至91個月，中位數為38個月。
結果：第一組復發病灶14例中，男性8例，女性6例，年齡範圍30-79歲，平均年齡69歲。手術切除範圍，第一次手術分別有1例做雙肺葉切除，9例做肺葉切除，4例做肺楔型切除；第二次手術，有2例做完全全肺切除，3例做肺葉切除，另9例做楔型切除。第二組第二次原發肺癌14例中，男性13例，女性1例，年齡範圍51-74歲，平均年齡64歲。手術切除範圍，第一次手術有3例做雙肺葉切除，6例做肺葉切除，5例做楔型切除；第二次手術有2例做完全全肺切除，3例做完全肺葉切除，9例做楔型切除。在這31例再次手術切除病患中，有1例病患第二次手術後一星期因呼吸衰竭死亡。有1例實施完全全肺切除術後產生支氣管肋膜廔管，經引流治療後，痊癒出院。28例的五年存活率為80%，比較二組平均存活率，第一組為41.67個月，第二組為54.50個月，二組並無顯著性差異(P=0.8829)。
結論：對於再次發生的肺癌病灶，只要病患沒有其他遠處轉移，身體評估狀況良好，積極手術實施再次切除是一合理、有效、可以提高病患存活率的作法。

關鍵字

肺癌 ； 復發 ； 第二次原發

並列摘要

Background: The necessity of reoperation for the resected non-small lung cancer patients with recurrent lung cancer is worth to investigate clinically.
Methods: We investigated 31 consecutive reoperation patients with non-small cell lung cancer (NSCLC), who have received previous curative resection, from three medical center hospitals between January 1999 and June 2006. The incidence rate was 2.3% (31/1359). Depites 3 benign lesions after reoperation, there were 28 patients with NSCLC. The 28 patients were classified to two groups, the first group includes 14 recurrence patients (one local recurrence and 13 distant metastasis). The relapse time was from 6 months to 21 months after operation (median time, 13 months). The second group includes 14 second primary cancer patients. The relapse time was from 25 months to 91 months after operation (median 38 months).
Results: Among the first group of 14 patients, the ages of 8 males and 6 females ranged from 30 to 69 years (mean, 69.0 years). The extend of resection of prior operation was 1 bilobectomy, 9 lobectomy and 4 wedge resection; the reoperation was 2 completion pneumonectomy, 3 lobectomy and 9 wedge resection. Among the second group of 14 patients, the ages of 13 males and 1 female ranged from 51 to 74 years (mean, 64.0 years). The extend of resection of prior operation was 3 bilobectomy, 6 lobectomy and 5 wedge resection; the reoperation was 2 completion pneumonectomy, 3 completion lobectomy and 9 wedge resection. Among these 31 patients, there was one surgical mortality due to respiratory failure. The surgical complications included one bronchial fistula, who was recovered after adequate drainage. The five-year survival rate of 27 NSCLC patients after reoperation was 80%. The median five-year survival time of the first group and the second group was 41.67 months and 54.50 month, respectively. There was no statistical difference between these two groups.
Conclusions: An aggressive surgical approach is safe, effective and warranted in patients with either a second primary lung cancer or relapse from their primary lung cancer, if there is no evidence of distant metastasis and the patients are in good health.

並列關鍵字

Lung cancer ； Recurrence ； Second primary