文章：

对于中央型非小细胞肺癌患者，复杂袖状肺叶切除术的术后主要并发症发生率低于全肺切除术。

Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer

原文发布日期：6 January 2024

DOI: 10.3390/cancers16020261

类型: Article

开放获取: 是

英文摘要：

Background: Standard sleeve lobectomies are recommended over pneumonectomy (PN), but the efficacy and oncological proficiency of complex sleeve lobectomies (CSLs) have not been completely investigated. The aim of this study was to report our experience in CSL in patients affected by a centrally located non-small-cell lung cancer (NSCLC), comparing all the variables and outcomes with PN. Methods: From 2014 to 2022, we collected the data of patients who underwent PN and CSL for NSCLC, excluding neuroendocrine tumors, salvage surgery or carinal resection. Regression analysis was used to assess the association between procedures and complications; the Kaplan–Meier method and Cox regression analysis were used to evaluate survival and risk factors of reduced survival. Results: We analyzedn= 38 extended sleeve lobectomies andn= 6 double-sleeve lobectomies (CSL group) andn= 60 PNs. We had a trend toward higher postoperative mortality in the PN group (5% vs. 0%,p= 0.13). Major complications and bronchial fistula developed in 21.7% and 6.8% (p= 0.038) and in 6.7% and 4.5% (p= 0.64), respectively. The right side was identified as risk factor for major complications, whereas age > 70 and PN had a trend of association in multivariable analysis. The median OS was similar between the two groups (p= 0.76) and cancer recurrence was the only significant risk factors of reduced OS. Excluding functionally compromised patients, the OS of CSL was better than that of PN (67% vs. 42%,p= 0.25). Conclusions: Considering that major complications are often associated with mortality after surgery for centrally located NSCLC, CSLs could be considered an alternative to PN while also ensuring comparable survival.

摘要翻译： 

背景：标准袖状肺叶切除术通常被推荐用于替代全肺切除术，但对于复杂袖状肺叶切除术的疗效及肿瘤学适用性尚未得到充分研究。本研究旨在总结我们对中央型非小细胞肺癌患者实施复杂袖状肺叶切除术的经验，并与全肺切除术的各项变量及临床结局进行对比分析。 方法：本研究收集了2014年至2022年间接受全肺切除术或复杂袖状肺叶切除术的非小细胞肺癌患者数据，排除神经内分泌肿瘤、挽救性手术及隆突切除病例。采用回归分析评估手术方式与并发症的关联性，通过Kaplan-Meier法与Cox回归分析评估生存率及生存期缩短的风险因素。 结果：研究共纳入38例扩大袖状肺叶切除术、6例双袖状肺叶切除术（复杂袖状肺叶切除组）及60例全肺切除术。全肺切除组呈现术后死亡率升高趋势（5% vs. 0%，p=0.13）。两组主要并发症发生率分别为21.7%与6.8%（p=0.038），支气管胸膜瘘发生率分别为6.7%与4.5%（p=0.64）。多变量分析显示右侧手术是主要并发症的风险因素，而年龄>70岁及全肺切除术呈现关联趋势。两组中位总生存期无显著差异（p=0.76），肿瘤复发是导致生存期缩短的唯一显著风险因素。排除功能受损患者后，复杂袖状肺叶切除术组总生存率优于全肺切除术组（67% vs. 42%，p=0.25）。 结论：鉴于中央型非小细胞肺癌术后主要并发症常与死亡率相关，复杂袖状肺叶切除术在保证相当生存率的同时，可作为全肺切除术的可行替代方案。

原文链接：

Complex Sleeve Lobectomy Has Lower Postoperative Major Complications Than Pneumonectomy in Patients with Centrally Located Non-Small-Cell Lung Cancer