Landreneau R J, De Giacomo T, Mack M J, Hazelrigg S R, Ferson P F, Keenan R J, Luketich J D, Yim A P, Coloni G F
Division of Thoracic Surgery, Lung Center, 02 Level, South Tower, Allegheny General Hospital, Pittsburgh, PA 15212-4772, USA.
Eur J Cardiothorac Surg. 2000 Dec;18(6):671-6; discussion 676-7. doi: 10.1016/s1010-7940(00)00580-7.
Careful patient selection is vital when video-assisted thoracoscopic surgical (VATS) therapeutic pulmonary metastasectomy of colorectal carcinoma is considered. Complete resection of all metastatic disease remains a vital concept. We reviewed our VATS experience for therapeutic metastasectomy of peripheral colorectal pulmonary metastases.
Over 90 months, therapeutic VATS metastasectomy was accomplished upon 80 patients with colorectal metastases. Thin cut computed tomography (CT) was central in identifying lesions. The mean interval from primary carcinoma to VATS resection was 41 months (1-156 months; median, 33). A solitary lesion was resected in 60 patients and multiple (2-7) lesions resected in 20 patients. Statistics were obtained using the Student's t-test.
No operative mortality or major postoperative complications occurred. The hospital stay was 4.5+/-2. 2 days (range, 1-13). All lesions were resected by VATS, with four conversions to thoracotomy to improve the margins. The mean survival of patients with one lesion was 34.8 months compared with 26.5 months for patients with multiple lesions (P=0.37). The mean survival was 20.5 months when metastases occurred <3 years vs. 28.1 months for >3 years from primary carcinoma resection (P=0.20). Twenty-five (31%) patients are disease free; with a mean interval of 38.7 (3-84; median, 35) months. Sixty-nine percent (55/80) of patients developed a recurrence: 6/80 (8%) local; 19/80 (24%) regional (same hemithorax away from resection); and 30/80 (38%) distant. The overall survival at 1 year was 81.2%, 48.4% at 3 years and 30.8% at 5 years.
Therapeutic VATS resection of colorectal metastases appears efficacious. Preoperative CT can identify peripheral colorectal metastases amenable to VATS. Conversion to thoracotomy is indicated when none of the lesions identified by CT are found or when clear surgical margins are jeopardized.
在考虑采用电视辅助胸腔镜手术（VATS）治疗结直肠癌肺转移瘤时，谨慎选择患者至关重要。彻底切除所有转移病灶仍然是一个关键理念。我们回顾了我们采用VATS治疗周围型结直肠癌肺转移瘤的经验。
在90多个月的时间里，对80例结直肠癌转移患者实施了VATS治疗性转移瘤切除术。薄层计算机断层扫描（CT）在识别病灶方面起核心作用。从原发性癌到VATS切除的平均间隔时间为41个月（1 - 156个月；中位数为33个月）。60例患者切除了单个病灶，20例患者切除了多个（2 - 7个）病灶。采用学生t检验进行统计分析。
未发生手术死亡或严重术后并发症。住院时间为4.5±2.2天（范围为1 - 13天）。所有病灶均通过VATS切除，4例转为开胸手术以改善切缘。单个病灶患者的平均生存期为34.8个月，多个病灶患者为26.5个月（P = 0.37）。转移发生在原发性癌切除后<3年时的平均生存期为20.5个月，>3年时为28.1个月（P = 0.20）。25例（31%）患者无疾病；平均间隔时间为38.7（3 - 84；中位数为35）个月。69%（55/80）的患者出现复发：80例中有6例（8%）局部复发；19例（24%）区域复发（同一半侧胸腔远离切除部位）；30例（38%）远处复发。1年总生存率为81.2%，3年为48.4%，5年为30.8%。
VATS治疗性切除结直肠癌转移瘤似乎有效。术前CT可识别适合VATS治疗的周围型结直肠癌转移灶。当CT识别出的病灶均未发现或手术切缘受到威胁时，应转为开胸手术。
