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山东大学学报 (医学版) ›› 2022, Vol. 60 ›› Issue (11): 23-27.doi: 10.6040/j.issn.1671-7554.0.2022.0978

• 胸外科肺癌、食管癌微创诊治和加速康复专题 • 上一篇    下一篇

微创袖式肺叶切除手术:免疫治疗时代的机遇和挑战

高会江,魏煜程*()   

  1. 青岛大学附属医院胸外科, 山东 青岛 266003
  • 收稿日期:2022-08-18 出版日期:2022-11-01 发布日期:2022-11-04
  • 通讯作者: 魏煜程 E-mail:weiyuchengchest@163.com
  • 作者简介:魏煜程,主任医师,医学博士,硕士研究生导师。青岛大学附属医院胸外科副主任,西海岸院区胸外科主任。担任中国抗癌协会纵隔肿瘤专业委员会常委,中国老年保健协会肺癌专业委员会常委,山东省中青年肺癌联盟副主任委员,山东省临床肿瘤学会食管癌专家委员会副主任委员,青岛市抗癌协会胸部肿瘤专业委员会主任委员,MEDIASTINUM杂志编委。长期致力于胸部肿瘤的微创手术治疗及复杂局部晚期胸部肿瘤的外科手术及综合治疗。2012年受邀参加英国皇家外科学院举行的欧洲腔镜肺叶切除20周年纪念大会,做大会发言,获“Master of Thoracic Surgery”称号。以第一作者及通讯作者在《Annals of Thoracic Surgery》《Journal of Thoracic Disease》《Thoracic Cancer》及《中华外科杂志》《中华胸心外科杂志》《中国肺癌杂志》等专业学术期刊发表论文20余篇,累计影响因子30余分。培养硕士研究生20余人
  • 基金资助:
    青岛大学附属医院青年基金(QDFYQN 202101013)

Minimally invasive sleeve lobectomy: opportunities and challenges in the era of immunotherapy

Huijiang GAO,Yucheng WEI*()   

  1. Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, China
  • Received:2022-08-18 Online:2022-11-01 Published:2022-11-04
  • Contact: Yucheng WEI E-mail:weiyuchengchest@163.com

摘要:

袖式肺叶切除手术是局部晚期可切除中央型肺癌的一种标准治疗方式。与全肺切除手术相比,袖式肺叶切除手术可以在不影响患者生存的前提下,最大限度地通过保留肺组织而改善患者的生活质量。尽管支气管袖式肺叶切除增加了手术难度,但随着胸腔镜以及机器人技术的发展,微创袖式肺叶切除手术已经成为胸外科的常规术式。目前,随着免疫治疗在肺癌新辅助以及诱导治疗领域中的研究进展,越来越多的局部晚期可切除或潜在可切除的肺癌通过免疫治疗获得了根治的机会,这在改善患者预后的同时也为胸外科微创手术,尤其是微创袖式肺叶切除手术提出了更高的要求。本文对微创袖式肺叶切除手术的现状进行系统阐述以及前景展望。

关键词: 中央型肺癌, 微创, 袖式肺叶切除, 免疫治疗, 生存

Abstract:

Sleeve lobectomy, as a standard treatment for locally advanced resectable central lung cancer, can maximize the preservation of lung tissue and improve patients' quality of life without affecting survival, compared with total pneumonectomy. With the development of thoracoscopic and robotic technology, minimally invasive sleeve lobectomy has become a routine procedure in thoracic surgery, although bronchial sleeve lobectomy has increased the difficulty of operation. At present, with the development of immunotherapy in the field of neoadjuvant and induction therapy for lung cancer, a growing number of locally advanced resectable or potentially resectable lung cancer has been treated with immunotherapy. This not only improves the prognosis of patients, but also puts forward higher requirements for minimally invasive thoracic surgery, especially minimally invasive sleeve lobectomy. In this paper, the current situation of minimally invasive sleeve lobectomy is systematically described and the prospect is prospected.

Key words: Centrally-located lung cancer, Minimally invasive, Sleeve lobectomy, Immunotherapy, Survival

中图分类号: 

  • R734.2
1 Siegel RL , Miller KD , Fuchs HE , et al. Cancer statistics, 2022[J]. CA Cancer J Clin, 2022, 72 (1): 7- 33.
doi: 10.3322/caac.21708
2 Xia C , Dong X , Li H , et al. Cancer statistics in china and united states, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135 (5): 584- 590.
doi: 10.1097/CM9.0000000000002108
3 Paulson DL , Shaw RR . Preservation of lung tissue by means of bronchoplastic procedures[J]. Am J Surg, 1955, 89 (2): 347- 355.
doi: 10.1016/0002-9610(55)90074-X
4 Tedder M , Anstadt MP , Tedder SD , et al. Current morbidity, mortality, and survival after bronchoplastic procedures for malignancy[J]. Ann Thorac Surg, 1992, 54 (2): 387- 391.
doi: 10.1016/0003-4975(92)91413-4
5 Abdelsattar ZM , Shen KR , Yendamuri S , et al. Outcomes after sleeve lung resections versus pneumonectomy in the united states[J]. Ann Thorac Surg, 2017, 104 (5): 1656- 1664.
doi: 10.1016/j.athoracsur.2017.05.086
6 Li Z , Chen W , Xia M , et al. Sleeve lobectomy compared with pneumonectomy for operable centrally located non-small cell lung cancer: a meta-analysis[J]. Transl Lung Cancer Res, 2019, 8 (6): 775- 786.
doi: 10.21037/tlcr.2019.10.11
7 Merritt RE , Mathisen DJ , Wain JC , et al. Long-term results of sleeve lobectomy in the management of non-small cell lung carcinoma and low-grade neoplasms[J]. Ann Thorac Surg, 2009, 88 (5): 1574- 1581.
doi: 10.1016/j.athoracsur.2009.07.060
8 Ludwig C , Stoelben E , Olschewski M , et al. Comparison of morbidity, 30-day mortality, and long-term survival after pneumonectomy and sleeve lobectomy for non-small cell lung carcinoma[J]. Ann Thorac Surg, 2005, 79 (3): 968- 973.
doi: 10.1016/j.athoracsur.2004.08.062
9 Kwon ST , Zhao L , Reddy RM , et al. Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection[J]. J Thorac Cardiovasc Surg, 2017, 154 (2): 652- 659.
doi: 10.1016/j.jtcvs.2017.02.008
10 Bendixen M , Jorgensen OD , Kronborg C , et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial[J]. Lancet Oncol, 2016, 17 (6): 836- 844.
doi: 10.1016/S1470-2045(16)00173-X
11 Yang HX , Woo KM , Sima CS , et al. Long-term survival based on the surgical approach to lobectomy for clinical stage Ⅰ nonsmall cell lung cancer: comparison of robotic, video-assisted thoracic surgery, and thoracotomy lobectomy[J]. Ann Surg, 2017, 265 (2): 431- 437.
doi: 10.1097/SLA.0000000000001708
12 潘茂杰, 高会江, 蒋志慧, 等. 基于倾向性评分匹配法的胸腔镜与开放袖式肺叶切除术近期与远期疗效比较[J]. 中华外科杂志, 2018, 56 (7): 533- 537.
13 Gao HJ , Jiang ZH , Gong L , et al. Video-assisted vs thoracotomy sleeve lobectomy for lung cancer: a propensity matched analysis[J]. Ann Thorac Surg, 2019, 108 (4): 1072- 1079.
doi: 10.1016/j.athoracsur.2019.04.037
14 Zhang C , Ma Y , Yu Z , et al. Comparison of efficacy and safety of hybrid video-assisted thoracoscopic surgery vs. thoracotomy sleeve lobectomy for non-small cell lung cancer: a propensity score matching study[J]. J Thorac Dis, 2022, 14 (7): 2635- 2644.
doi: 10.21037/jtd-22-754
15 Yang Y , Mei J , Lin F , et al. Comparison of the short- and long-term outcomes of video-assisted thoracoscopic surgery versus open thoracotomy bronchial sleeve lobectomy for central lung cancer: a retrospective propensity score matched cohort study[J]. Ann Surg Oncol, 2020, 27 (11): 4384- 4393.
doi: 10.1245/s10434-020-08805-y
16 Xie D , Deng J , Gonzalez-Rivas D , et al. Comparison of video-assisted thoracoscopic surgery with thoracotomy in bronchial sleeve lobectomy for centrally located non-small cell lung cancer[J]. J Thorac Cardiovasc Surg, 2021, 161 (2): 403- 413.e2.
doi: 10.1016/j.jtcvs.2020.01.105
17 Ettinger DS , Wood DE , Aisner DL , et al. Non-small cell lung cancer, version 3.2022, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2022, 20 (5): 497- 530.
doi: 10.6004/jnccn.2022.0025
18 Provencio M , Serna-Blasco R , Nadal E , et al. Overall survival and biomarker analysis of neoadjuvant nivolumab plus chemotherapy in operable stage ⅢA non-small-cell lung cancer (NADIM phase Ⅱ trial)[J]. J Clin Oncol, 2022, 40 (25): 2924- 2933.
doi: 10.1200/JCO.21.02660
19 Sierra-Rodero B , Cruz-Bermudez A , Nadal E , et al. Clinical and molecular parameters associated to pneumonitis development in non-small-cell lung cancer patients receiving chemoimmunotherapy from NADIM trial[J]. J Immunother Cancer, 2021, 9 (8): e002804.
doi: 10.1136/jitc-2021-002804
20 Provencio M , Nadal E , Insa A , et al. Neoadjuvant chemotherapy and nivolumab in resectable non-small-cell lung cancer (NADIM): an open-label, multicentre, single-arm, phase 2 trial[J]. Lancet Oncol, 2020, 21 (11): 1413- 1422.
doi: 10.1016/S1470-2045(20)30453-8
21 Forde PM , Spicer J , Lu S , et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer[J]. N Engl J Med, 2022, 386 (21): 1973- 1985.
doi: 10.1056/NEJMoa2202170
22 Deng H , Liu J , Cai X , et al. Radical minimally invasive surgery after immuno-chemotherapy in initially-unresectable stage ⅢB non-small cell lung cancer[J]. Ann Surg, 2022, 275 (3): e600- e602.
doi: 10.1097/SLA.0000000000005233
23 Liang H , Yang C , Gonzalez-Rivas D , et al. Sleeve lobectomy after neoadjuvant chemoimmunotherapy/chemotherapy for local advanced non-small cell lung cancer[J]. Transl Lung Cancer Res, 2021, 10 (1): 143- 155.
doi: 10.21037/tlcr-20-778
24 Petersen RH , Hansen HJ . Learning curve associated with VATS lobectomy[J]. Ann Cardiothorac Surg, 2012, 1 (1): 47- 50.
25 Rendina EA , Venuta F , Ricci P , et al. Protection and revascularization of bronchial anastomoses by the intercostal pedicle flap[J]. J Thorac Cardiovasc Surg, 1994, 107 (5): 1251- 1254.
doi: 10.1016/S0022-5223(94)70045-1
26 Storelli E , Tutic M , Kestenholz P , et al. Sleeve resections with unprotected bronchial anastomoses are safe even after neoadjuvant therapy[J]. Eur J Cardiothorac Surg, 2012, 42 (1): 77- 81.
doi: 10.1093/ejcts/ezr291
27 Lewis RJ , Caccavale RJ , Sisler GE , et al. One hundred consecutive patients undergoing video-assisted thoracic operations[J]. Ann Thorac Surg, 1992, 54 (3): 421- 426.
doi: 10.1016/0003-4975(92)90431-3
28 Santambrogio L , Cioffi U , De Simone M , et al. Video-assisted sleeve lobectomy for mucoepidermoid carcinoma of the left lower lobar bronchus: a case report[J]. Chest, 2002, 121 (2): 635- 636.
doi: 10.1378/chest.121.2.635
29 Mahtabifard A , Fuller CB , McKenna RJ Jr . Video-assisted thoracic surgery sleeve lobectomy: a case series[J]. Ann Thorac Surg, 2008, 85 (2): S729- 732.
doi: 10.1016/j.athoracsur.2007.12.001
30 Schmid T , Augustin F , Kainz G , et al. Hybrid video-assisted thoracic surgery-robotic minimally invasive right upper lobe sleeve lobectomy[J]. Ann Thorac Surg, 2011, 91 (6): 1961- 1965.
doi: 10.1016/j.athoracsur.2010.08.079
31 Gu C , Pan X , Chen Y , et al. Short-term and mid-term survival in bronchial sleeve resection by robotic system versus thoracotomy for centrally located lung cancer[J]. Eur J Cardiothorac Surg, 2018, 53 (3): 648- 655.
doi: 10.1093/ejcts/ezx355
32 Gonzalez-Rivas D , Fernandez R , Fieira E , et al. Uniportal video-assisted thoracoscopic bronchial sleeve lobectomy: first report[J]. J Thorac Cardiovasc Surg, 2013, 145 (6): 1676- 1677.
doi: 10.1016/j.jtcvs.2013.02.052
33 Gonzalez-Rivas D , Yang Y , Stupnik T , et al. Uniportal video-assisted thoracoscopic bronchovascular, tracheal and carinal sleeve resections[J]. Eur J Cardiothorac Surg, 2016, 49 (Suppl 1): i6- 16.
34 Cerfolio RJ . Robotic sleeve lobectomy: technical details and early results[J]. J Thorac Dis, 2016, 8 (Suppl 2): 223- 226.
35 Pan X , Gu C , Wang R , et al. Initial experience of robotic sleeve resection for lung cancer patients[J]. Ann Thorac Surg, 2016, 102 (6): 1892- 1897.
doi: 10.1016/j.athoracsur.2016.06.054
36 Zhong Y , Wang Y , Hu X , et al. A systematic review and meta-analysis of thoracoscopic versus thoracotomy sleeve lobectomy[J]. J Thorac Dis, 2020, 12 (10): 5678- 5690.
doi: 10.21037/jtd-20-1855
37 No authors listed . Neoadjuvant PD-1 blockade in resectable lung cancer; nivolumab and ipilimumab in advanced melanoma; overall survival with combined nivolumab and ipilimumab in advanced melanoma; prolonged survival in stage Ⅲ melanoma with ipilimumab adjuvant therapy; combined nivolumab and ipilimumab or monotherapy in untreated melanoma; combined nivolumab and ipilimumab or monotherapy in untreated melanoma; nivolumab and ipilimumab versus ipilimumab in untreated melanoma; rapid eradication of a bulky melanoma mass with one dose of immunotherapy; genetic basis for clinical response to ctla-4 blockade; genetic basis for clinical response to CTLA-4 blockade in melanoma; nivolumab plus ipilimumab in advanced melanoma; safety and tumor responses with lambrolizumab (anti-PD-1) in melanoma; hepatotoxicity with combination of vemurafenib and ipilimumab[J]. N Engl J Med, 2018, 379 (22): 2185.
doi: 10.1056/NEJMx180040
38 Kim HK , Cho JH , Choi YS , et al. Outcomes of neoadjuvant concurrent chemoradiotherapy followed by surgery for non-small-cell lung cancer with N2 disease[J]. Lung Cancer, 2016, 96, 56- 62.
doi: 10.1016/j.lungcan.2016.03.016
39 Rendina EA , Venuta F , De Giacomo T , et al. Safety and efficacy of bronchovascular reconstruction after induction chemotherapy for lung cancer[J]. J Thorac Cardiovasc Surg, 1997, 114 (5): 830- 835.
doi: 10.1016/S0022-5223(97)70088-6
40 Chriqui LE , Forster C , Lovis A , et al. Is sleeve lobectomy safe after induction therapy a systematic review and meta-analysis[J]. J Thorac Dis, 2021, 13 (10): 5887- 5898.
doi: 10.21037/jtd-21-939
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