全肺切除术及支气管成形肺叶切除术在非小细胞肺癌治疗中的研究（附64例报告）

BACKGROUND AND OBJECTIVE: Pneumonectomy was the initial successful surgery to treat lung cancer, but there has been being a lot of controversy since its inception. The aim of this study is to evaluate its potential role in the treatment of lung cancer through analyzing the survival for 64 cases underwent pneumonectomy or bronchoplasty lobectomy out of 804 cases underwent lung resection. METHODS: Eight hundred and four cases of lung cancer underwent pulmonary surgery. We retrospectively reviewed the clinical data, especially foucused on the survival of 64 pneumonectomies or bronchoplasty lobectomies. RESULTS: Of the 64 patients, 25 underwent pneumonectomy (6 right, 19 left) due to involvement of ipsilateral pulmonary artery trunk. Owning to involving ipsilateral main bronchus with the distance of tumor from carina < 2 cm, 4 pneumonectomies, 19 right upper bronchoplasty lobectomies, 1 left upper sleeve lobectomy and 1 left lower sleeve lobectomy were performed. Due to the ipsilateral main bronchus involvement with the distance of tumor from carina ≥2 cm, 13 cases underwent main bronchus bronchoplasty. One performed right sleeve pneumonectomy because of carina involvement. Overall 1-, 3- and 5-year survival rates of 64 pneumonectomies or bronchoplasty lobectomies were 93.6%, 69.0% and 45.1%, respectively, and that of 489 standard lobectomies done by the same surgery team in the same period were 92.5%, 77.3% and 56.9%, respectively. There was no significant difference in 5-year cumulative survival rates between the two groups (P=0.226). CONCLUSION: Although standard lobectomy remains the main type of surgery, pneumonectomy or bronchoplasty lobectomy is still one of option for the highly selective patients combining the support of induction chemotherapy.