De Giacomo T, Rendina E A, Venuta F, Ciccone A M, Coloni G F
University of Rome La Sapienza, Department of Thoracic Surgery, Italy.
Chest. 1999 May;115(5):1441-3. doi: 10.1378/chest.115.5.1441.
The reported 5-year survival rate after pulmonary metastasectomy from colorectal carcinoma, usually accomplished through thoracotomy or median sternotomy, ranges from 9 to 47%. Video-assisted thoracoscopy (VAT) is employed routinely for many thoracic surgical procedures, but the main concern about this approach for resection of lung metastases is that VAT does not allow complete lung palpation to identify and remove metastases not detected by preoperative radiologic examinations.
In this study, we reviewed our experience with thoracoscopic resection of single peripheral lung metastases from colorectal carcinoma with potentially curative intent.
From July 1992 to September 1998, 24 patients (15 male, 9 female) with a mean age of 56 years, who previously had undergone resection for colorectal carcinoma and had a single limited and peripheral lung lesion identified by high-resolution CT, underwent thoracoscopic wedge resection of the lesions.
No intraoperative complications developed. Three patients had minor postoperative complications successfully treated. In one case, we found a benign lesion, and this patient was excluded from the analysis. In the remaining cases, metastases from colorectal cancer were confirmed. The median follow-up was 29 months, ranging from 3 to 67 months. Thirteen patients (56.5%) developed recurrence of the disease, and 5 of them (21.7%) had local recurrence. Cumulative 5-year survival estimated by Kaplan-Meier method was 49.5%, not really different from the data reported in the literature.
Thoracoscopic resection of single peripheral lung metastases from colorectal cancer with potentially curative intent seems effective and justified since the ultimate outcome of this highly selected group of patients seems to be not different from that obtained after a more invasive approach.
据报道，结直肠癌肺转移瘤切除术后的5年生存率通常通过开胸手术或正中胸骨切开术实现，范围为9%至47%。电视辅助胸腔镜手术（VAT）常用于许多胸外科手术，但对于这种切除肺转移瘤的方法，主要担忧在于VAT无法进行完整的肺部触诊，以识别和切除术前影像学检查未发现的转移瘤。
在本研究中，我们回顾了我们对有潜在治愈意图的结直肠癌单发性周围型肺转移瘤进行胸腔镜切除的经验。
1992年7月至1998年9月，24例患者（男性15例，女性9例），平均年龄56岁，此前已接受结直肠癌切除术，经高分辨率CT检查发现有单个局限性周围型肺部病变，接受了胸腔镜楔形切除术。
术中未出现并发症。3例患者出现轻微术后并发症，均成功治愈。1例患者发现为良性病变，该患者被排除在分析之外。其余病例均确诊为结直肠癌转移。中位随访时间为29个月，范围为3至67个月。13例患者（56.5%）出现疾病复发，其中5例（21.7%）为局部复发。采用Kaplan-Meier法估计的累积5年生存率为49.5%，与文献报道的数据并无实际差异。
对有潜在治愈意图的结直肠癌单发性周围型肺转移瘤进行胸腔镜切除似乎是有效且合理的，因为这一高度选择的患者群体的最终结果似乎与采用更具侵入性的方法所获得的结果并无不同。
