Mehmet DAKAK, Burçin ÇELİK, Onur GENÇ, Sedat GÜRKÖK, Orhan YÜCEL, Hasan ÇAYLAK, Ersin SAPMAZ, Sezai ÇUBUK, Kuthan KAVAKLI

Soliter pulmoner nodüllerde cerrahi yaklaşım

Amaç: Bu çalışmada soliter pulmoner nodül (SPN) nedeniyle cerrahi uyguladığımız olgular geriye dönük olarak incelendi.Çalışma planı: Mayıs 1995 - Aralık 2008 tarihleri arasında SPN nedeniyle cerrahi rezeksiyon uygulanan 110 olguya (96 erkek, 14 kadın; ort. yaş 37.4 yıl; dağılım 16-73 yıl) ait tıbbi kayıtlar geriye dönük olarak incelendi.Bulgular: Tüm lezyonların %35� malign ve %65� benign idi. Malign nodüllerin %76�ı kırk yaş üzeri hastalarda mevcut iken benign nodüllerin %72�i kırk yaş altı hasta grubunda bulundu. Lezyonların %82�i (n=9) metastatik idi. Soliter pulmoner nodüllerin %95� torakotomi aracılığı ile rezeke edildi. Seksen beş olguya (%77) sınırlı rezeksiyon, yirmi beş olguya (%23) ise anatomik rezeksiyon uygulandı. Tüm nodüllerin %25�ne, malign lezyonların %74�ne primer akciğer kanseri tanısı konuldu. Hamartom (%35) ve tüberküloz (%33) ise en sık görülen benign lezyonlardı. Primer akciğer kanseri olgularında beş yıllık sağkalım oranı %68 olarak hesaplandı. Mortalite izlenmez iken sekiz olguda (%7) morbidite saptandı.Sonuç: Erken evre akciğer kanserini temsil eden lezyonlarda cerrahi tedavinin mutlak bir kür şansını sağlayabilmesi nedeniyle tüm SPN�er malignite yönünden açıklığa kavuşturulmalıdır. Lezyonun potansiyel malignite riskine göre cerrahi değerlendirme yapılır.

Surgical management of solitary pulmonary nodules

Background: In this study, we retrospectively reviewed the patients who were operated on for solitary pulmonary nodules (SPN).Methods: The medical records of 110 patients (96 males, 14 females; mean age 37.4 years; range 16 to 73 years) who were operated for SPNs between May 1995 and December 2008 were reviewed retrospectively.Results: Thirty five percent of the lesions were malignant and 65% were benign. Seventy six percent of the malignant nodules were diagnosed in patients over 40-years-old and 72% of the benign nodules were found in patients under 40-years of age. The lesions were metastatic in 82% (n=9). Ninety five percent of the solitary pulmonary nodules were resected via thoracotomy. Limited resection was performed in 85 (77%) of the patients and anatomic resection was performed in 25 (23%). Primary lung cancer was the diagnosis in 25% of all nodules and 74% of the malignant lesions. The majority of benign lesions were hamartomas (35%) and tuberculosis (33%). The five-year survival rate of the patients with primary lung cancer was calculated at 68%. While there was no mortality, morbidity involved eight (7%) patients.Conclusion: Since surgical resection can provide potential cure for lesions which represent early stage lung cancer, malignancy should be ruled out for all SPNs. There may be less predilection for operation if the likelihood of malignancy is low.

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