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单中心前瞻性研究 : 选择性 cT1N0M0 非小细胞肺癌的肺段切除术

单中心前瞻性研究 : 选择性 cT1N0M0 非小细胞肺癌的肺段切除术. Segmentectomy for selected cT1N0M0 non–small cell lung cancer: A prospective study at a single institute Hiroaki Nomori , PhD a , Takeshi Mori, PhD b , Koei Ikeda, PhD b , Kentaro Yoshimoto, PhD b , Kenichi Iyama , PhD c , Makoto Suzuki, PhD b

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单中心前瞻性研究 : 选择性 cT1N0M0 非小细胞肺癌的肺段切除术

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  1. 单中心前瞻性研究:选择性cT1N0M0非小细胞肺癌的肺段切除术单中心前瞻性研究:选择性cT1N0M0非小细胞肺癌的肺段切除术 Segmentectomy for selected cT1N0M0 non–small cell lung cancer: A prospective study at a single institute Hiroaki Nomori, PhDa, Takeshi Mori, PhDb, Koei Ikeda, PhDb, Kentaro Yoshimoto, PhDb, Kenichi Iyama, PhDc, Makoto Suzuki, PhDb a Division of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japanb Department of Thoracic Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japanc Department of Pathology, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan

  2. http://jtcs.ctsnetjournals.org/cgi/content/abstract/144/1/87

  3. Background 为了研究肺段切除术是否能够根治cT1N0M0非小细胞肺癌(NSCLC)，日本庆应大学医学院普胸外科的Hiroaki Nomori等进行了此项单中心单组前瞻性研究. (J ThoracCardiovascSurg2012;144:87-93)

  4. Methods • 他们将肺段切除术的纳入标准规定如下： • (1)外周型cT1N0M0 NSCLC; • (2)前哨淋巴结术中冰冻切片同位素检查未转移； • (3)切缘距肿瘤大于2cm； • (4)患者自己选择行肺段切除术； • (5)排除右肺中叶肿瘤。

  5. Methods • 这179名患者中，有134名（75%）肿瘤直径小于等于2cm，45名（25%）肿瘤直径在2.1cm到3cm之间。随访中位时间为43个月。 自2005年至2009年，245名cT1N0M0 NSCLC患者中有195名(80%)符合标准，纳入研究。其中179名最后进行了肺段切除术及系统淋巴结清扫。

  6. Results 淋巴结分期：结果显示，179名患者切除的全部181个肿瘤均为pN0期。 复发情况：179名患者中，6名出现远处复发病灶，3名出现局部复发（1名在肺段切除术后21个月出现同叶肺转移，2名分别在肺段切除术后60个月和62个月出现手术切缘局部复发）。 生存率：对于肿瘤直径小于等于2cm 的患者，5年总体生存率为94%，对于肿瘤直径在2.1cm到3cm之间则为81%。术后肺功能保留了术前的90% ± 12%。

  7. Conclusions 研究认为，对于选择性cT1N0M0/pN0 NSCLC患者，接受肺段切除术及系统淋巴结清扫且手术切缘足够能够满足根治需要。在术后较长时间内，应对手术边界是否出现局部复发进行监控。

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