Aysun KOSİF MISIRLIOĞLU, Levent ALPAY, Serda KANBUR, Altuğ KOŞAR, Hakan SÖNMEZ, Mine DEMİR, Volkan BAYSUNGUR, İrfan YALÇINKAYA, Tülay ÖRKİ

Akciğer kanserinin cerrahi tedavisinde sleeve rezeksiyonlarının yeri

Amaç: Bronşial sleeve rezeksiyonlar akciğerin habis ve selim patolojilerinde pnömonektomi operasyonunun alternatifi olarak geliştirilmiş tekniklerdir. Gereç ve Yöntem: Bu çalışma İstanbul Süreyyapaşa Göğüs Cerrahi merkezinde Eylül 1994- Mayıs 2009 tarihleri arasında 71 hastaya uygulanan sleeve rezeksiyonları incelemek amacıyla yapılmıştır. Bulgular: Uzun dönem takipte sleeve rezeksiyon uygulanan hastalardan 26'sı kaybedildi, ortalama takip süresi 33 ay, maksimum takip süresi 120 aydı. Standart sapması 27.7 olarak bulundu. İki yıllık sağkalım %67.2 ort.57.3 ay±7.5 olarak saptandı.Komplikasyonların ortaya çıkmasıyla; operasyon yapılan taraf, anastomoz şekli tek- tek, devamlı sütür , olguların yaşı arasındaki ilişki araştırıldı ancak istatistiksel olarak anlamlı bir sonuç bulunamadı. Sırasıyla; p=0.09, p=0.4, p=0.3 .Operasyon tarafının sağ ya da sol olmasının sağkalıma etkisi araştırıldığında istatistiksel olarak anlamlı bir sonuç bulunamadı p=0.13 . Sağ kalım oranlarını, komplikasyonların varlığına göre değerlendirdiğimizde istatistiksel olarak anlamlı olmamakla birlikte, anlamlıya yakın sonuç elde edildi p= 0.08 . Sağkalım oranlarının, uygulanan ek cerrahi işlemlerden etkilendiği istatistiksel olarak anlamlı bulundu p= 0.03 . N faktörü; N0, N1 ve N2 olmak üzere üç ayrı gruba ayrıldı ve sağkalıma etkisi araştırıldı ve istatistiksel olarak anlamlı bulundu p= 0.03 . 2 yıllık sağkalım N0'da % 81.5, N1'de % 63, N2'de % 21 olarak bulundu. Tümör çaplarının sağkalıma etkisi istatistiksel olarak anlamlı bulunmadı p=0.6 Sonuç: Sleeve rezeksiyonlar diğer rezeksiyonlar gibi düşük mortalite ve morbidite ile yapılabilir.

Anahtar Kelimeler:

sleeve, akciğer kanseri cerrahisi

The role of sleeve resections in surgical treatment of lung cancer

Aim: Bronchial sleeve resections are developed as alternative techniques to pneumonectomy operation in malignant and benign pathologies of the lung. Patients and Methods: This study was carried out between September 1994 and May 2009 in order to examine 71 patients who underwent sleeve resection in Istanbul Sureyyapasa Chest Surgery Center. Results: Twenty-six of the patients died in long term follow-up, mean and maximum follow-up duration was 33 months and 120 months, respectively. Standard deviation was 27.7. General survival rate in two years was 67.2% mean 57.3±7.5 months . With the development of complications; the relationships between operation side, anastomosis technique seperate, continuous suture , patients' age were investigated, however statistically significant results were found p=0.09, p=0.4, p=0.3, respectively . The effect on survival was investigated between right and left sided operation, no significant results were found statistically p=0.13 . When survival rates were analysed according to the presence of complications; better statistical results were found, however still with no statistical significance p= 0.08 . It was statistically significant that survival rates were affected by additional surgical procedures p= 0.03 . It was also statistically significant that N factor, which was divided into three groups: N0, N1 and N2, had an influence on survival p=0.03 . The two-year survival rate was 81.5% in N0, 63% in N1, 21% in N2. There was no statistically significant effect on survival by tumor diameters p=0.6 . Conclusion: Sleeve resections can be performed with low mortality and morbidity rates like other resections.

Keywords:

sleeve, lung cancer surgery,

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