Yedibela Süleyman, Klein Peter, Feuchter Karsta, Hoffmann Martin, Meyer Thomas, Papadopoulos Thomas, Göhl Jonas, Hohenberger Werner
Department of General Surgery, University of Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054, Erlangen, Germany.
Ann Surg Oncol. 2006 Nov;13(11):1538-44. doi: 10.1245/s10434-006-9100-2. Epub 2006 Sep 29.
Surgery has become a recognized therapeutic means in selected patients with pulmonary metastases from colorectal origin. We reviewed our experience in the surgical treatment of 153 patients with pulmonary colorectal metastases and investigated factors affecting survival.
A retrospective analysis of the records of all patients (n = 153) with pulmonary metastases from colorectal cancer who underwent thoracotomy between 1978 and 2003 at a single surgical center was performed.
One hundred fifty-three patients with pulmonary metastases from colon (n = 61) or rectal (n = 92) cancer underwent 180 thoracotomies. The 2- and 5-year probabilities of survival after the first thoracotomy were 64% and 37%, respectively. Sex, age, site, International Union Against Cancer stage of the primary tumor, prethoracotomy carcinoembryonic antigen level, size of metastases, and previous resection of hepatic metastases were not found to be statistically significant prognostic factors. Number of metastases (solitary vs. multiple), mode of operation (wedge vs. anatomical resection), disease-free interval (DFI; > 36 months), negative hilar or mediastinal lymph node status, resection margin > 10 mm, and administration of intraoperative blood substitution were predictors of a longer survival duration by univariate analysis, but only number of metastases (P = .019), mode of operation (P = .004), DFI (P = .027), and intraoperative blood substitution (P = .002) were identified as independent prognostic factors by multivariate analysis.
Pulmonary resection for metastases from colorectal cancer is safe and results in long-term survival in selected patients. Single metastases, anatomical resection, intraoperative blood substitution, and DFI > 36 months seem to be the most reliable predictors of survival.
手术已成为特定的结直肠癌肺转移患者公认的治疗手段。我们回顾了153例结直肠癌肺转移患者的手术治疗经验，并研究了影响生存的因素。
对1978年至2003年在单一手术中心接受开胸手术的所有结直肠癌肺转移患者（n = 153）的记录进行回顾性分析。
153例结肠癌（n = 61）或直肠癌（n = 92）肺转移患者接受了180次开胸手术。首次开胸术后2年和5年生存率分别为64%和37%。性别、年龄、部位、原发肿瘤的国际抗癌联盟分期、开胸术前癌胚抗原水平、转移灶大小以及既往肝转移灶切除术均未发现是具有统计学意义的预后因素。转移灶数量（单发与多发）、手术方式（楔形切除与解剖性切除）、无病间期（DFI；> 36个月）、肺门或纵隔淋巴结阴性、切缘> 10 mm以及术中输血在单因素分析中是生存时间较长的预测因素，但多因素分析仅确定转移灶数量（P = 0.019）、手术方式（P = 0.004）、DFI（P = 0.027）和术中输血（P = 0.002）为独立预后因素。
结直肠癌肺转移灶切除术是安全的，并且能使部分患者获得长期生存。单发转移灶、解剖性切除、术中输血以及DFI > 36个月似乎是最可靠的生存预测因素。
