[结直肠癌肺转移的外科治疗。8年生存率及主要预后因素]

Baron O, Hamy A, Roussel J C, Galetta D, al Habash O, Duveau D, Despins P, de Lajartre A Y, Michaud J L

Service de Chirurgie Thoracique et Cardio-vasculaire, Hôpital G, Nantes.

Rev Mal Respir. 1999 Nov;16(5):809-15.

OBJECTIVE

In order to achieve a better definition of the indications for surgical excision of pulmonary metastases in colorectal cancer (CCR), a retrospective study of the eight year survival of patients who had been operated on was carried out with reference to the principal prognostic factors.

METHODS AND RESULTS

Between May 1986 and December 1997, 38 patients had an excision for pulmonary metastases for CCR. The mean delay between diagnosis of the metastases and surgical treatment of the CCR was 39 +/- 24 months (0-98). Thirty two patients (84%) had a single pulmonary metastasis. The mean diameter of the metastasis was 38 +/- 22 mm. Twenty metastases had a diameter < 30 mm. Five patients had a locoregional recurrence of their CCR before pulmonary surgery. Fourteen patients had an abnormally elevated level of carcinoembrionic antigen (ACE-CEA) before the pulmonary excision. Five pneumonectomies, 23 lobectomies, 1 bilobectomy and 11 atypical resections were carried out. A lymph node clearance was performed in 25 cases. Six patients (16%) had an associated excision of an hepatic metastasis. The in-hospital mortality was 2.6%. Chemotherapy was associated with a pulmonary excision in 17 patients (46%). The mean survival was 2.7 years (0.13-8.7 years). The survival at one year was 89 +/- 5.2% and at five years 35.2 +/- 10.1% and at eight years 18.8% +/- 10.3%. Age, sex, histological stage of the primary tumor, the size and the delay in appearance in the pulmonary metastases, the number of metastases, the preoperative CEA, the operative technique and the perioperative chemotherapy did not influence the levels of survival at five years. At the same time associated excision of an hepatic metastasis did not worsen the prognosis at five years.

CONCLUSION

Complete excision of pulmonary metastases in a colorectal cancer allows for significantly longer survival. This study associated with a literature review may help in advancing towards better selection of surgical candidates.

目的

为了更好地明确结直肠癌（CCR）肺转移灶手术切除的适应证，我们参照主要预后因素，对接受手术治疗患者的8年生存率进行了一项回顾性研究。

方法与结果

1986年5月至1997年12月期间，38例患者因CCR肺转移灶接受了切除手术。转移灶诊断与CCR手术治疗之间的平均间隔时间为39±24个月（0 - 98个月）。32例患者（84%）有单个肺转移灶。转移灶的平均直径为38±22毫米。20个转移灶直径<30毫米。5例患者在肺手术前出现CCR局部区域复发。14例患者在肺切除术前癌胚抗原（ACE - CEA）水平异常升高。实施了5例全肺切除术、23例肺叶切除术、1例双叶切除术和11例非典型切除术。25例进行了淋巴结清扫。6例患者（16%）同时切除了肝转移灶。住院死亡率为2.6%。17例患者（46%）在肺切除时联合了化疗。平均生存期为2.7年（0.13 - 8.7年）。1年生存率为89±5.2%，5年生存率为35.2±10.1%，8年生存率为18.8%±10.3%。年龄、性别、原发肿瘤的组织学分期、肺转移灶的大小和出现时间、转移灶数量、术前CEA、手术技术和围手术期化疗均不影响5年生存率。同时，肝转移灶的联合切除并未使5年预后变差。