Limited Resection for Lung Cancer in High-Risk Patients

背景　一般而言，對於大部份肺癌病患的外科治療，我們都選擇作肺葉或全肺切除手術以求根治治療。也唯有如此，才可能提供較好的治癒機會。然而，對於高危險病患，則侷限性肺切除術仍不失為一妥協性的做法。方法　針對臨床上為T1或T2的高危險肺癌病變，實施侷限性的肺切除，我們做了回顧性研究。我們總共收集51例病患，有37例實施楔形切除、14例實施肺節切除，其中35例年齡等於或大於70歲，23例肺功能第一秒用力吐氣等於或小於1.2公升，另有24例伴隨其他疾病。結果　結果沒有任何住院死亡病例，但是手術後有三例持續性氣漏超過兩週，兩例有手術後呼吸衰竭，但在使用呼吸器治療後，全部復原良好。追蹤時間由0.5至4.9年（平均3.1年）。一年、兩年及三年存活率分別為91%、76%和51%。對於有一種、兩種及三種高危險因子情況的平均存活時間為36.0、34.9和32.8個月（p=0.4231）。在追蹤期間，有21（41.2%）位復發病例，8例（15.7%）為局部復發，16例（31.4%）有遠處轉移，3例（6%）則同時有局部復發和遠處轉移。結論　對於某些高危險肺癌病患，選擇性地實施局限性肺切除手術治療，則手術相關的死亡率和罹病率並沒有明顯的增加，然而卻可能會有較高的復發率。所以就臨床上而言，仍不失為是一種安全妥協性的做法。

關鍵字

高危險,侷限性切除,肺癌

並列摘要

Background. Radical lobectomy and pneumonectomy are the treatment of choice for most patients with lung cancer and have been traditionally thought to be the only chance for cure. However, limited resection is sometimes considered as a compromise in high-risk patients. Methods. We retrospectively reviewed our experiences in performing limited resections for patients with clinical T1 or T2 lung cancers who were poor surgical risks. Data were collected from 51 patients that received wedge (37 patients) or segmental (14 patients) resections due to either advanced age (35 patients were 70 years or older), poor pulmonary function (23 patients with FEV1 (forced expiratory volume in first second) equal to or less than 1.2 L) or concomitant serious diseases (24 patients). Results. No hospital deaths occurred but three patients had prolonged air leak after operations and two patients developed respiratory failure with good recovery using ventilator support. The follow-up period ranged from 0.5 to 4.9 years (median, 3.1 years). The 1-year, 2-year and 3-year survival rates were 91%, 76%, and 51%, respectively. The median survival time of patients met one, tow, or three criteria of high-risk factors were 36.0, 34.9, and 32.8 months, respectively (p=0.4231). Recurrence of disease developed in 21 (41%) of 51 patients. Five patients (10%) had local recurrence along; 13(26%) had distant metastasis alone; while three (6%) had both local recurrence and distant metastasis. Conclusions. Limited resection in selected high-risk patients with lung cancer may achieve acceptable operative mortality (0%) and morbidity rates (9.8%), however, both local (9.8%) and distal metastasis (31.4%) rates seemed relatively high and the long-term survival needs further evaluation.

並列關鍵字

high-risk,limited resection,lung cancer

國際替代計量

Limited Resection for Lung Cancer in High-Risk Patients

全文下載

主題瀏覽