结直肠癌分期性肺和肝转移瘤切除术——是否值得？

Staged pulmonary and hepatic metastasectomy in colorectal cancer--is it worth it?

作者信息

Reddy Rajashekara H V, Kumar Bhaskar, Shah Rajesh, Mirsadraee Saeed, Papagiannopoulos Kostas, Lodge Peter, Thorpe James A C

机构信息

Department of Thoracic Surgery, Leeds General Infirmary, D Floor, Jubilee Building, Great George Street, LS1 3EX, Leeds, UK.

出版信息

Eur J Cardiothorac Surg. 2004 Feb;25(2):151-4. doi: 10.1016/j.ejcts.2003.11.020.

DOI:10.1016/j.ejcts.2003.11.020

PMID:14747104

Abstract

OBJECTIVES

Resection of isolated pulmonary and hepatic metastases from colorectal cancer can offer potential cure. However, little data is available to determine the results of staged hepatic and pulmonary resections in the same patient.

METHODS

We retrospectively reviewed all patients who underwent staged hepatic and pulmonary metastasectomy for colorectal cancer in our institute from September 1998 to May 2002. Probability of survival was estimated by the Kaplan-Meier method.

RESULTS

Thirty-three metastasectomies (seven redo) were carried out in 26 patients. There were 19 male and 7 female patients with a mean age of 61 years (range 34-76 years). The mean disease-free interval for hepatic and pulmonary resection was 21.8 and 23.9 months, respectively. Sternotomy, thoracotomy and video assisted thoracoscopic approach were used in 3.03, 72.7 and 24.2% of patients, respectively. Wedge excision, lobectomy and pneumonectomy were carried out in 87.87, 9.09 and 3.03% of cases, respectively. There was one hospital death following acute respiratory failure after pneumonectomy. Mean follow-up was 23.3 months (range 2-71 months). The mean survival after last pulmonary resection was 34.7 months (SE 3.03 and 95% CI of 28.8-40.6).

CONCLUSIONS

Our results support aggressive surgical management of pulmonary and hepatic metastases in colorectal cancer.

摘要

目的

切除结直肠癌孤立性肺转移瘤和肝转移瘤可能带来治愈的机会。然而，关于同一患者分期进行肝转移瘤和肺转移瘤切除结果的数据却很少。

方法

我们回顾性分析了1998年9月至2002年5月在我院接受分期肝转移瘤和肺转移瘤切除的所有结直肠癌患者。采用Kaplan-Meier法估计生存率。

结果

26例患者共进行了33次转移瘤切除术（7例再次手术）。其中男性19例，女性7例，平均年龄61岁（范围34 - 76岁）。肝转移瘤和肺转移瘤切除的平均无病间期分别为21.8个月和23.9个月。分别有3.03%、72.7%和24.2%的患者采用胸骨切开术、开胸手术和电视辅助胸腔镜手术。分别有87.87%、9.09%和3.03%的病例采用楔形切除术、肺叶切除术和全肺切除术。1例患者在全肺切除术后因急性呼吸衰竭死亡。平均随访时间为23.3个月（范围2 - 71个月）。最后一次肺转移瘤切除术后的平均生存期为34.7个月（标准误3.03，95%可信区间28.8 - 40.6）。