早期非小細胞肺癌に対する縮小手術の成績

Outcome of Limited Resection for Early Stage Non-small Cell Lung Cancer

前向き研究でない状況下での肺癌手術術式選択は手術チームの裁量に委ねられている．近年，小型末梢肺癌に対する積極的縮小手術の良好な予後が報告されるようになり1），現在実臨床での有力な選択肢となっている．当院での近年の手術成績を振り返り，妥当な選択がなされたかを検討した．

Objectives：Recent advancement in detection of small-sized early-stage lung cancer has made limited lung resection with curative intent a practical and vital option. In this retrospective study, we investigated the validity of choice of procedures at our institute with examining the survival outcomes of lung cancer patients who underwent surgery.

Methods：Data from consecutive patients with cTanyN0M0 lung cancer who underwent surgery between January 2006 and December 2012 were extracted by chart review, and the overall and recurrence-free survivals of the patients operated by wedge resection, by segmentectomy and by lobectomy were compared using the univariate and multivariate Cox proportional hazard model. A stepwise backward elimination method with a probability level of 0.15 was used to select the most powerful sets of outcome predictors. For all analyses, a p-value＜0.05 was considered statistically significant.

Results：Limited lung resection （wedge resection and segmentectomy） were selected for higher age patients, for lower respiratory function patients and for smaller size tumor than lobectomy group. By univariate and multivariate analysis, surgical procedure was not identified as independent risk factor for overall and recurrence-free survival.

Conclusion：In this study cohort, mode of surgical procedure did not affect the relapse risk and prognosis. The choice of procedures at our institute in this study period seemed to be appropriate.