The Local Effect after Surgery in Non-small Cell Lung Cancer

비소세포성 폐암에서 수술 후의 국소 제어효과

  • Sa, Young-Jo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Jeon, Hyun-Woo (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Lee, Sun-Hee (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Wang, Young-Pil (Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital, The Catholic University of Korea College of Medicine) ;
  • Park, Jae-Kil (Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine)
  • 사영조 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 전현우 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 이선희 (가톨릭대학교 의과대학 성모병원 흉부외과학교실) ;
  • 왕영필 (가톨릭대학교 의과대학 강남성모병원 흉부외과학교실) ;
  • 박재길 (가톨릭대학교 의과대학 성모병원 흉부외과학교실)
  • Published : 2007.05.05

Abstract

Background: Recent progress in the surgical therapy for lung cancer is one of the best examples of the successful evolution of clinical medicine. We reviewed our experience to evaluate the surgical outcomes in patients with non-small cell lung cancer. Material and Method: We reviewed clinical records of 432 consecutive patients with proven non-small cell lung cancer who underwent complete removal of the primary tumor together with hilar and mediastinal lymph nodes from 1995 to 2005. The clinical characteristics, surgical methods, and recurrence patterns were analyzed. Result: Lobectomy was the most common procedure (66.7%) performed and sleeve lobectomy was the least (5.6%). In 179 patients (42.6%) the recurrence was noted and the regional recurrence (67 cases, 16.0%) was less than systemic recurrence (112 cases, 26.7%). The main sites of regional recurrence were hilum (25 cases, 37.3%) and ipsilateral mediastinum (54/432 cases, 25.4%). The hospital mortality rate was 2.8% (12/432 cases) and resection-morbidity rate was 12.5% (54/432 cases). Conclusion: The low recurrence rate, especially regional recurrence rate indicated that our surgical procedures with preoperative measures were considered useful and effective.

배경: 암에 대한 수술적 치료의 치근의 발전은 임상적으로 가장 혁신적인 발전 중의 하나이다. 저자들은 비소세포성 폐암환자에서 시행한 수술적 치료의 효과를 검토해 보았다. 대상 및 방법: 1995년부터 2005년까지 저자들이 수술적 치험한 증례 중 완전 절제가 시행되었던 폐암환자 432예를 대상으로 하여 임상적 소견들과 수술방법 그리고 재발 양상 등에 대하여 분석하였다. 결과: 폐엽절제술이 가장 많이 시행되었으며(66.7%),소매 폐엽절제술(5.6%)이 가장 적게 시행되었다. 179예(42.6%)에서 관찰기간 중 재발이 확인되었으며, 국소 재발 예는 67예(16.0%)로서 전신적 재발 112예(26.7%)보다 현저히 작았다. 주된 국소 재발 부위는 폐문부(37.3%)와 동측 종격동(25.4%)이었으며, 병원 사망률은 2.8% (12/432예)였고 수술 유병률은 12.5% (52/432예)였다. 결론: 낮은 사망률과 국소 재발률을 얻었으며, 따라서 저자들의 수술적 치료방법은 안전하며 유효한 방법이라고 생각되었다.

Keywords

References

  1. Ponn RB, LoCicero J 3rd, Daly BDT. Surgical treatment of non-small cell lung cancer. In: Shields TW, LoCicero J 3rd, Ponn RB, Rusch VW. General thoracic surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins Co. 2005;1548-87
  2. Izbicki JR, Knoefel WT, Passlick B, et al. Risk analysis and long term survival in patients undergoing extended resection of locally advanced lung cancer. J Thorac Cardiovasc Surg 1995;110:386-95 https://doi.org/10.1016/S0022-5223(95)70235-0
  3. Dartevelle PG. Extended operation for the treatment of lung cancer. Ann Thorac Surg 1997;63:12-9 https://doi.org/10.1016/S0003-4975(96)01084-3
  4. Hata E, Miyamoto H, Tanaka M, Sakao Y, Harada R. Superradical operation for lung cancer: bilateral mediastinal dissection (BMD) with or without cervical dissection (CD). Lung Cancer 1994;11(Suppl 2):41-2
  5. Keller SM, Adak S, Wagner H, Johnson DH. Eastern Cooperative Oncology Group. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa nonsmall cell lung cancer. Eastern cooperative oncology group. Ann Thorac Surg 2000;70:358-65 https://doi.org/10.1016/S0003-4975(00)01673-8
  6. Korean Association for the Study of Lung Cancer. Guidelines for the Management of Lung Cancer - Non-small cell lung cancer. http//www.lungca.or.kr/tmp/20061212.pdf. Accessed December 12, 2006
  7. Cahan WG. Radical lobectomy. J Thorac Cardiovasc Surg 1960;39:555-72
  8. Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer. J Thorac Cardiovasc Surg 1978;76:832-9
  9. Riquet M, Hidden G, Debesse B. Direct lymphatic drainage of lung segment to the mediastinal nodes. J Thorac Cardiovasc Surg 1989;97:623-32
  10. Hata E, Miyamoto H, Hayakawa K, Hayashida R. Rationale for extended lymphadenectomy for lung cancer. Theoretical Surg 1990;5:19-25
  11. Tsuchiya R, Asamura H, Kondo H, et al. Extended resection of the left atrium, great vessels, or both for lung cancer. Ann Thorac Surg 1994;57:960-5 https://doi.org/10.1016/0003-4975(94)90214-3
  12. Yokoi K, Matsuguma H, Anraku M. Extrapleural pneumonectomy for lung cancer with carcinomatous pleuritis. J Thorac Cardiovasc Surg 2002;123:184-5 https://doi.org/10.1067/mtc.2002.118039
  13. Albain KS, Rusch VW, Crowly JJ, et al. Concurrent cisplatin/Etoposide plus chest radiotherapy followed by surgery for stages IIIA (N2) and IIIB non-small cell cancer: mature results of Southwest Oncology Group phase II study 88-05. J Clin Oncol 1995;13:1880-92
  14. Thomas M, Rube C, Semik M, et al. Impact of preoperative bimodality induction including twice daily radiation on tumor regression and survival in stage III non-small cell lung cancer. J Clin Oncol 1999;17:1185-93 https://doi.org/10.1200/JCO.1999.17.4.1185
  15. Grunenwald DH, Le Chevalier T, Arriagada R. et al. Results of surgical resection in stage IIIB non-small cell lung cancer (NSCLC) after concomittent induction chemo-radiotherapy [Abstract]. Lung Cancer 1997;18(Suppl):73, A280
  16. Grunenwald DH. Surgery for advanced stage lung cancer. Semin Surg Oncol 2000;18:137-42 https://doi.org/10.1002/(SICI)1098-2388(200003)18:2<137::AID-SSU7>3.0.CO;2-A
  17. Paulson DL, Urschel Jr HC, McNamara JJ, Shaw RR. Bronchoplastic procedure for bronchogenic carcinoma. J Thorac Cardiovasc Surg 1970;59:38-48
  18. Roviaro GC, Varoli F, Rebuffat C, et al. Videothoracoscopic staging and treatment of lung cancer. Ann Thorac Surg 1995;59:971-4 https://doi.org/10.1016/0003-4975(95)00029-K
  19. Park IK, Kim DJ, Chung KY, Kim KD, Joo HC. Risk factors for recurrence in completely resected pT1/2N1 nonsmall cell lung cancer. Korean J Thorac Cardiovasc Surg 2005;38:421-7
  20. Mitsudomi T, Nishioka K, Maruyama R, et al. Kinetic analysis of recurrence and survival after potentially curative resection of nonsmall cell lung cancer. J Surg Oncol 1996; 63:159-65 https://doi.org/10.1002/(SICI)1096-9098(199611)63:3<159::AID-JSO5>3.0.CO;2-C