초록접수 현황
| 16F-294 | 포럼 발표 |
Extended Sleeve Lobectomy for Locally Advanced NSCLC : A 20-Year Single Center Experience
Tae Hee Hong, Jong Ho Cho, Hong Kwan Kim, Yong Soo Choi, Jhingook Kim, Jae Il Zo, Young Mog Shim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : Extended sleeve lobectomy (ESL), an atypical bronchoplasty with resection of more than one lobe, have theoretical advantages including avoidance of pneumonectomy. However, little have been known about clinical outcome after ESL including hospital mortality, type and pattern of complications, and local recurrence rate.
Methods : Between March 1995 and April 2016, a total of 565 patients with locally advanced non-small cell lung cancer (NSCLC) underwent sleeve resection. Among them, 63 patients had ESL procedure. We retrospectively analyzed those patients in terms of hospital mortality, postoperative complications, and local recurrence.
Results : The patients were classified into 4 types: (A) Anastomosis between the right main and lower bronchi with upper bilobectomy (n=14), (B) Anastomosis between the right main and upper bronchi with lower bilobectomy (n=37), (C) Anasotmosis between left main and basal segmental bronchi with left upper lobectomy and lower lobe superior segmentectomy (n=4), and (D) Anastomosis between the left main and upper division bronchi with left lower lobectomy and lingular segmentectomy (n=8). There were no operative deaths within 30 days, but two hospital deaths from postoperative acute lung injury. 8 (12.7%) of the 63 patients had complications at the anastomosis site including 3 strictures and 5 bronchopleural fistulas. Two patients(3.2%) had pulmonary vein thrombosis, which might be attributed to overstretching of pulmonary vein. Five patients(7.9%) had local control failure with relapse at the anastomosis site. In the comparison to patients undergone simple sleeve lobectomy, there was no significant differences of hospital mortality (3.2% vs 2.3%, p=0.344), incidence of morbidity (15.9% vs 14.4%, p=0.737) as well as local failure rate (7.9% vs 5.5%, p=0.284).
Conclusion : ESL is technically more demanding, but it does not increase morbidity or mortality compared to simple sleeve lobectomy. We recommend that ESL is helpful for avoidance of pneumonectomy and should be considered in patients with locally advanced NSCLC.
Methods : Between March 1995 and April 2016, a total of 565 patients with locally advanced non-small cell lung cancer (NSCLC) underwent sleeve resection. Among them, 63 patients had ESL procedure. We retrospectively analyzed those patients in terms of hospital mortality, postoperative complications, and local recurrence.
Results : The patients were classified into 4 types: (A) Anastomosis between the right main and lower bronchi with upper bilobectomy (n=14), (B) Anastomosis between the right main and upper bronchi with lower bilobectomy (n=37), (C) Anasotmosis between left main and basal segmental bronchi with left upper lobectomy and lower lobe superior segmentectomy (n=4), and (D) Anastomosis between the left main and upper division bronchi with left lower lobectomy and lingular segmentectomy (n=8). There were no operative deaths within 30 days, but two hospital deaths from postoperative acute lung injury. 8 (12.7%) of the 63 patients had complications at the anastomosis site including 3 strictures and 5 bronchopleural fistulas. Two patients(3.2%) had pulmonary vein thrombosis, which might be attributed to overstretching of pulmonary vein. Five patients(7.9%) had local control failure with relapse at the anastomosis site. In the comparison to patients undergone simple sleeve lobectomy, there was no significant differences of hospital mortality (3.2% vs 2.3%, p=0.344), incidence of morbidity (15.9% vs 14.4%, p=0.737) as well as local failure rate (7.9% vs 5.5%, p=0.284).
Conclusion : ESL is technically more demanding, but it does not increase morbidity or mortality compared to simple sleeve lobectomy. We recommend that ESL is helpful for avoidance of pneumonectomy and should be considered in patients with locally advanced NSCLC.
책임저자: Jong Ho Cho
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Tae Hee Hong, E-mail : taehee888@naver.com