Konvansiyonel Hiler Diseksiyonun Uygulanamadığı Durumlarda Küçük Hücreli Dışı Akciğer Kanseri İçin İntraperikardiyal Lobektomi

Öz

İntraperikardiyal vasküler kontrol, santral yerleşimli tümörlerde veya konvansiyonel hiler diseksiyonun güvenli şekilde gerçekleştirilemediği durumlarda lobektomi sırasında gerekli olabilir. Bununla birlikte, özellikle lobektomi düzeyinde intraperikardiyal vasküler kontrolü değerlendiren kanıtlar sınırlıdır. Bu retrospektif tek merkezli çalışmaya, Ocak 2010 ile Aralık 2025 tarihleri arasında küçük hücreli dışı akciğer kanseri nedeniyle intraperikardiyal lobektomi uygulanan ardışık 29 hasta dahil edildi. İntraperikardiyal vasküler kontrol endikasyonları, perioperatif sonuçlar, rezeksiyon durumu, genel sağkalım (OS) ve hastalıksız sağkalım (DFS) değerlendirildi. OS ve DFS Kaplan–Meier yöntemiyle tahmin edilirken, medyan takip süresi ters Kaplan–Meier yöntemiyle hesaplandı. Hastaların ortalama yaşı 59,6±8,2 yıl olup, %89,7’si neoadjuvan tedavi almıştı. İntraperikardiyal vasküler kontrol endikasyonu hastaların %58,6’sında tümöre bağlı hiler veya vasküler tutulum, %31,0’ında güvenli ekstraperikardiyal diseksiyonun mümkün olmaması ve %10,3’ünde tedaviye bağlı hiler veya mediastinal fibrozis idi. Hastaların %89,7’sinde R0 rezeksiyon sağlandı. Postoperatif komplikasyon oranı %44,8, majör morbidite oranı %24,1 ve 30 günlük mortalite oranı %3,4 idi. Kardiyak tamponad veya kardiyak herniasyon görülmedi. Medyan 87 aylık takip süresinde medyan OS 64 ay ve 5 yıllık OS %52,9 olarak bulundu. Medyan DFS 21 ay olup, 5 yıllık DFS %40,2 idi. İntraperikardiyal vasküler kontrol, konvansiyonel hiler diseksiyonun güvenli olmadığı veya proksimal vasküler kontrolün gerekli olduğu durumlarda, yüksek komplet rezeksiyon oranı ve kabul edilebilir perioperatif sonuçlarla lobektominin tamamlanmasına olanak sağlayabilecek yararlı bir teknik seçenek olabilir.

Anahtar Kelimeler

• İntraperikardiyal Lobektomi
• küçük hücreli dışı akciğer kanseri
• vasküler kontrol
• extended lobektomi
• hiler diseksiyon

When Conventional Hilar Dissection Is Not Feasible: Intrapericardial Lobectomy for Non-Small Cell Lung Cancer

Öz

Intrapericardial vascular control may be required during lobectomy for centrally located tumors or when conventional hilar dissection cannot be performed safely. However, evidence specifically addressing intrapericardial vascular control at the lobectomy level remains limited. This retrospective single-center study included 29 consecutive patients who underwent intrapericardial lobectomy for non-small cell lung cancer between January 2010 and December 2025. Indications for intrapericardial vascular control, perioperative outcomes, resection status, overall survival (OS), and disease-free survival (DFS) were evaluated. OS and DFS were estimated using the Kaplan–Meier method, and median follow-up was calculated using the reverse Kaplan–Meier method. The mean age was 59.6±8.2 years, and 89.7% of patients had received neoadjuvant treatment. The indication for intrapericardial vascular control was tumor-related hilar or vascular involvement in 58.6%, unsafe extrapericardial dissection in 31.0%, and treatment-related hilar or mediastinal fibrosis in 10.3%. R0 resection was achieved in 89.7% of patients. Postoperative complications occurred in 44.8%, with major morbidity in 24.1% and 30-day mortality in 3.4%. No cardiac tamponade or cardiac herniation occurred. At a median follow-up of 87 months, median OS was 64 months, and 5-year OS was 52.9%. Median DFS was 21 months, with a 5-year DFS of 40.2%. Intrapericardial vascular control may provide a useful technical option when conventional hilar dissection is unsafe or proximal vascular control is required, allowing lobectomy to be completed with a high rate of complete resection and acceptable perioperative outcomes.

Anahtar Kelimeler

• intrapericardial lobectomy
• non-small cell lung cancer
• vascular control
• extendet lobectomy
• hilar dissection

Kaynakça

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