Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Resection of Small Cell Lung Cancer(SCLC)

소세포폐암의 수술 성적

  • 정경영 (연세대학교 의과대학 흉부외과학교실) ;
  • 홍기표 (연세대학교 의과대학 흉부외과학교실) ;
  • 김길동 (연세대학교 의과대학 흉부외과학교실) ;
  • 김대준 (연세대학교 의과대학 흉부외과학교실) ;
  • 김주항 (연세대학교 의과대학 흉부외과학교실, 연세암센타)
  • Published : 1998.12.01
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Abstract

Bafckground: Thr role and indication of surgery in the treatment of small cell lung cancer(SCLC) is currently limited and unsettled. Material and Method: We analyzed the surgical results of 9 patients with SCLC at Yosei Medical Center from January 1990 to December 1996. There were 8 males and 1 female, and their mean age was 57.2 years (range; 35-76). Preoperatively SCLC was confirmed in 5, but the other 4 cases were diagnosed as undifferentiated squamous cell carcinoma. All patients underwent pulmoinary resection(lobectomy;5, lobectomy, segmentectomy and en-bloc resection of rib;1, bilobectomy; 2, pneumonectomy;1) and mediastinal lymph node dissection. Results: There were no operative mortality with two complications(postoperative bleeding;1, arrhythmia;1). All cases were diagnosed as SCLC histologically and their TNM staging were confirmed as follows: T1N0M0;1, T2N0M0;4, T3N0M0;1, T3N1M0;1, T2N2M0; 1, T4N0M0;1. All patients had received postoperative chemotherapy, and radiotherapy was combined in 4 patients. During follow up period(range 1-63 months; mean 33.0months), there was only one metastasis to pelvic bone among 8 patients without lymph node metastasis, and all patients were alive. On the other hand, among 3 patients who had regional and/or mediastinal lymph node metastasis or T4 lesion, all patients had recurrences(local;2, brain;1), and 2 patients died. Conclusion: We suggest that the use of TNM staging is beneficial, and surgical resection should be recommended in the patients with early staged SCLC as an important treatment modality.

배경: 소세포폐암에 있어 수술의 적응은 제한적이었으며 수술의 결과에 대하여서도 논란이 많다. 대상 환자는 1992년 1월부터 1996년 12월까지 신촌세브란스 흉부외과에서 수술한 9명의 환자로서 남자가 8명, 여자가 1명이었으며 평균 연령은 57.2세(range; 35∼76세)이었다. 대상 및 방법: 수술전 소세포폐암으로 진단되었던 예는 5예이었으며 4예에서의 수술전 진단은 분화가 안된 편평상피세포암이었다. 수술은 전예에서 폐절제술 및 종격동림프절박리술을 시행하였고 폐단엽절제술이 5예, 폐단엽절제술과 분엽절제술 및 늑골을 포함한 En-block 절제 1예, 폐이엽절제술 2예, 전폐절제술 1예 등이었다. 결과: 수술사망 예는 없었으며 수술 후 합병증으로는 출혈 1예, 심부정맥 1예 등이 있었다. 수술 후 전예에서 소세포암이 확인되었고 수술 후 병기는 T1N0M0 1예, T2N0M0 4예, T3N0M0 1예, T3N1M0 1예, T2N2M0 1예, T4N0M0 1예이었다. 수술 후 5예에서는 항암화학요법을, 4예에서는 항암화학요법 및 방사선치료를 시행하였다. 전예에서 추적이 가능하여 평균 추적기간은 평균 33.0개월(1-63개월이었고 추적기간중 림프절로의 전이가 없는 경우 6예 중에서는 1예에서만 장골에 전이가 발견되었으나 생존해있고, 림프절로의 전이가 있거나 T4 병변인 3예에서는 2예는 국소 부위, 1예는 뇌에 재발이 있었으며 이중 2예는 사망하였다. 결론: 소세포폐암에서도 TNM 병기가 유용하며 종격동 또는 구역 림프절로의 전이가 없는 경우에는 수술 후 성적이 양호하여 초기 병기의 소세포폐암 환자에서는 항암화학요법과 함께 적극적인 수술 절제가 필요한 것으로 생각된다.

Keywords

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