Lancet:肺癌手术治疗的现状和未来
2011-12-06 MedSci原创 MedSci原创
（柳叶刀配图） 近日，《柳叶刀》杂志发表了一篇社论，谈到了“肺癌手术治疗的现状和未来”，主要内容的译文如下： 手术在早期非小细胞肺癌的治疗中扮演了重要角色，对I期和II期非小细胞肺癌，手术切除完全治愈的比例较高。 过去，相比美国和其它欧洲国家，英国的肺癌手术率很低，但最新的统计报告指出这一情况正在改变。据《英国胸外科医师活动及成果》的统计结果，英国的肺癌手术率上升的速
（柳叶刀配图）
近日，《柳叶刀》杂志发表了一篇社论，谈到了“肺癌手术治疗的现状和未来”，主要内容的译文如下：
过去，相比美国和其它欧洲国家，英国的肺癌手术率很低，但最新的统计报告指出这一情况正在改变。据《英国胸外科医师活动及成果》的统计结果，英国的肺癌手术率上升的速度很快，近4年来，接受手术治疗的肺癌患者增加了60%，术后死亡率由3.8%降到了2.1%。
报告称，这些成果的取得部分原因来自于胸外科医生正逐渐被界定为专科医生(相对于胸心外科医生而言)。越来越多的人投入到胸外科医生的行列，但胸外科医生的数目还远远不足。如果英国的肺癌手术率能达到全球肺癌手术率最高地区的水平,每年至少可以减少1000例肺癌患者的死亡。现有的证据支持将手术扩展到 N2疾病(单侧纵隔转移和(或)隆突下转移),随着检测水平的提高,越来越多的肺癌患者在可手术的早期阶段就被发现。
对新的手术技术还需要加强训练。科技的进步促进了胸腔镜肺叶切除技术(VATS肺叶切除)的发展，meta分析显示，在早期肺癌中，胸腔镜和开胸手术在患者死亡率，局部复发等方面的效果与开胸手术一致，而在5年生存率和全身复发等方面更有优势。风险和收益平衡分析显示，胸腔镜肺叶切除是早期肺癌最佳的手术方式， 然而，据统计报告结果，英国的胸腔镜手术的比例只有35%。
文章最后提到，随着胸外科朝着单独的专科发展，未来将会进一步鼓舞和提高肺癌的治疗水平。
附 Lancet 全文：
Improving rates of surgery for lung cancer
As two Seminars in this week's issue show, surgery has an important part to play in the management of early-stage lung cancer. Surgical lung resection offers good rates of cure for patients who have stage I or II non-small-cell lung cancer and immediate surgery is beneficial for those with small-cell lung cancer with very limited stage disease.
In the past, the UK's surgical resection rates have remained lower than those achieved in Europe and the USA, but a new auditsuggests that this situation is changing. The UK's second National Thoracic Surgery Activity and Outcomes Report shows that the number of patients with lung cancer undergoing surgery has increased by 60% in the past 4 years, while post operative mortality has halved during the past decade from 3·8% to 2·1%.
This improvement has been due in part to thoracic surgery becoming more defined as a specialty (as opposed to cardiothoracic surgery), resulting in an increase in surgeons in this area. However, there is still a need to boost numbers. The audit notes that, if the rate of operations across the country matched the best performing areas, then at least an additional 1000 lives could be saved each year. Furthermore, current evidence supports the expansion of surgery as part of multimodality management of patients with N2 disease (metastasis in ipsilateral mediastinal or subcarinal lymph nodes or both), and, as diagnostic techniques improve, more cancers will be detected at an operable stage.
Training in new surgical techniques also needs attention. Technical advances have led to the development of lung resection with video-assisted thoracoscopic access (VATS lung resection). In their Seminar on non-small-cell lung cancer, Peter Goldstraw and colleagues report no difference in mortality or local recurrence between open resections or VATS, but lower systemic recurrences and improved 5-year survival with VATS. The current balance of risks and benefits suggest that VATS might be a viable option for selected patients with early-stage lung cancer. Yet the national audit shows that only 35% of operations are done with VATS.
Further development of thoracic surgery as a specialty should be encouraged to improve the management of lung cancer in the future.
全文链接：http://www.lancet.com/journals/lancet/article/PIIS0140-6736%2811%2961724-8/fulltext
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