Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Surgical Experience of Pathological Stage IIIB Non-Small Cell Lung Cancer

병리학적 병기 IIIB폐암의 외과적 체험

  • Published : 1996.05.01
Download PDF
⟨ Previous Next ⟩

Abstract

From May 1988 to June 1994, )73 patients underwent exploratory thoracotomy for resection of non- small cell lung cancer, and 48 patients staged pathologically as lIIB were analyzed. 74 lesions were involvement of great vessel (n=26), heart (n=5), ipsilateral lung metastasis(n=4), esophagus (n=4), carina(n=3), mediastinum (n=2), trachea(n=1), spine (n=1) and 13lourO seeding(A=15). N3 lesions were involved in 6 patients. Extended pulmonary resection with radical mediastinal node dissection was possible in 25 patients, and exploration only was performed in 23 patients. The most frequent cause of unresectability was pleural seeding. Postoperative morbidity was )2 % (8125) and mortality was 16 % (41 25) in resected group. The adjutant therapy was given to 37 patients. The 1 year and 3 year survival for resected group ncluding operative deaths was 57.2%, and 2).8 % (median 15 months), but 48.4%, and 0 % (median 7 months) for exploration only group (Log-Rank test, p : 0.17). Our results suggest that extended pulmonary resection might be helpful for carefully selected patients with 74 non-small cell lung cancer, but meticulous preoperative work-up for staging, especially to detect pleural seeding and Invasion to the irlediastinal structures is a prerequisite to avoid unnecessary thoracotomy.

원자력병원에서는 1988년 5월부터 1994년 6월까지 373명의 비소세포 폐암 환자를 개흥하였으며, 이 중 병 리 학적 병기 lIIB로 판명된 48명의 겨록을 분석하였다. 74 병소는 대 혈관(26례), 심장(5례), 동측폐 전이 (4ET ), 식도(4El ), 기관 분기를(3례), 종격동(2례), 기관(1례), 및 척추 체부(1례) 등의 침범과 늑막 파종(늑막 전이, 15례)이었다. 수술은 48명중 25명에서 확대 폐절제및 림프절 절제를 시행하였으나, 23 례 에서는 시험 개흥술만 시행하였으며, 가장 흔한 절제 불가능의 원인은 늑막 파종이 었다. 절제 군의 수 술 유병률과 사망률은 각각 32 % (8125), 16 % (4125)이었고, 시험 개흥술 군에서는 각각 4% (1123), 0% (0123)이었다 수술 후 대부분의 환자에서 (37148) 항암 치료 또는 방사선 치료 등의 보조요법을 병 행하였 다. 수숲 후 1년 및 3년 생존률은 수술 사망을 포함하여 절제 군에서는 각각 57.2%, 23.8 % (중앙값, 15개 횡)이 었으며, 시험 개흥군에서는 각각 48.4%, 0 % (중앙값, 7개 월)이 었다(Log-Rank test, p = 0.17). 이상의 결과로,74환자의 일부에서 확대 폐절제의 역할이 인정 된다고 할 수 있으나 수술의 위험성 이 높으므 \ulcorner환자의 선택에 신중을 기해야 하며, 불필요한 개흥을 피하기 위해서는 늑막 파종과 종격동 구조물의 침습을수술전에 발견하기 위한보다 정교한 진단 및 병기 결정 과정이 요구된다.

Keywords

References

  1. 대한의학협회지 v.38 한국인 5대 암 질환의 진료 현황과 생존률 김진복
  2. Ann Thorac Surg v.57 Extended resection of the left atrium, great vessels, or both for lung cancer Tsuchiya,R.;Asamura,H.;Kondo,H.(et al.)
  3. Chest v.89 A new international staging system for lung cancer Mountain,C.F.
  4. Sem Oncol v.15 Prognostic implication of the international staging system for lung cancer Mountain,C.F.
  5. J Thorac Cardiovasc Surg v.96 Pognosis and survival in resected lung cancer based on the new international staging system Naruke,T.;Goya,T.;Tsuchiya,R.(et al.)
  6. Ann Thorac Surg v.46 Tracheal sleeve pneumonectomy for bronchogenic carcinoma: report of 55 cases Dartevelle,P.G.;Khalife,J.;Chapelier,A.(et al.)
  7. Ann Thorac Surg v.54 Surgical treatment for higher stage non-small cell lung cancer Ramdonck,D.E.V.;Schneider,A.;Ginsberg,R.J.
  8. Ann Thorac Surg v.57 Extended operatioon after induction therapy for stage IIIB(T4) non-small cell lung cancer Marcchiarini,P.;Chapelier,A.R.;Monnet,I.(et al.)
  9. Ann Thorac Surg v.58 Management of nonsmall cell lung cancer with direct mediastinal involvement Martini,N.;Yellin,A.;Ginsberg,R.J.(et al.)
  10. Ann Thorac Surg v.58 Neoadjuvant therapy : a novel and effective treatment for stage IIIB non- small cell lung cancer Rusch,V.W.;Albain,K.S.;Crowley,J.J.(et al.)
  11. Ann Thorac Surg v.51 Aggressive surgical intervention in N2 non-small cell cancer of lung Watanabe,Y.;Shimizu,J.;Oda,M.(et al.)
  12. Ann Thorac Surg v.40 The biologic operability of stage III non-small cell lung cancer Mountain,C.F.
  13. International trends in general thorac surgery. vol Ⅰ : lung cancer Follow-up supervision after resection for lung cancer Ginsberg,R.J.;Delarue,N.C.(ed.);Eschapasse,H.(ed.)
  14. Cancer: principles and practice of oncology(4th ed.) v.Ⅰ Cancer of lung Ginsberg,R.G.;Kris,M.G.;Armstrong,J.G.;Devita,V.T.(ed.);Hellman,S.(ed.);Rosenberg,S.A.(ed.)
  15. Mannual for staging of cancer.(4th ed.) American joint committee on cancer
  16. J Thorac Cardiovasc Surg v.102 Long term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary tumors Dartevelle,P.;Chapelier,A.;Pastorino,U.(et al.)
  17. Ann Thorac Surg v.55 Induction chemoyherapy for locally advanced non-small cell lung cancer Shepherd,F.A.
  18. Ann Thorac Surg v.59 Videothoracoscopic staging and treatment of lung cancer Roviaro,G.C.;Varoli,F.;Rebuffat,C.(et al.)
  19. Chest Surg Clin Nor Am v.4 Management of the malignant pleural effusion Moors,D.W.A.
  20. Sem Oncol v.20 Imaging in lung cancer White,C.S.;Templeton,P.A.;Belani,C.P.