Goh Brian K P, Yeo Allen W Y, Koong Heng-Nung, Ooi London L P J, Wong Wai-Keong
Department of Surgery, Singapore General Hospital, Outram Road, Singapore 169608.
Surg Today. 2007;37(5):370-4. doi: 10.1007/s00595-006-3419-y. Epub 2007 Apr 30.
Complications of gastrointestinal tract (GIT) metastases from lung cancer are rare and the optimal management remains controversial. Whereas some authors advocate a nonoperative policy due to the poor prognosis, others recommend aggressive surgery as it offers effective palliation. The aim of this study is to present our experience with nine patients who underwent a laparotomy for complications of GIT metastases and to determine their outcome.
Between 1995 and 2005, nine patients who underwent a laparotomy for complications of pathologically proven GIT metastases secondary to lung cancer were retrospectively reviewed.
All patients were male with a median age of 63 years (range, 40-70 years) at initial presentation. The sites of symptomatic GIT metastases include the ileum (n = 3), jejunum (n = 3), cecum (n = 1), duodenum (n = 2) and stomach (n = 2) and the patients presented with obstruction (n = 2), hemorrhage (n = 3), intussusception (n = 3) and perforation (n = 1). The median time of symptomatic GIT metastases from initial presentation was 2 months (range, 0-8 months) and the histological subtypes of the lung cancer were squamous cell carcinoma (n = 3), large cell carcinoma (n = 3), adenocarcinoma (n = 1), pleomorphic carcinoma (n = 1) and pleomorphic with adenocarcinoma (n = 1). All patients underwent an exploratory laparotomy and the definitive surgical procedure was dependent on the site and extent of disease. These included a small bowel resection with primary anastomosis (n = 5), a subtotal gastrectomy with an extended right hemicolectomy (n = 1), a gastrojejunostomy (n = 1), a right hemicolectomy (n = 1), and an ulcerectomy with under-running of ulcers (n = 1). Eight of the nine patients (89%) recovered from surgery and were then discharged from hospital at a median time of 9.5 days (range, 6-24 days). All these eight patients survived for more than 30 days and the median survival was 6 months (range, 2-13 months). Four of the 8 patients (50%) lived for more than 6 months and all eight patients died of advanced metastatic lung cancer with multiple sites of metastases at the time of death.
Gastrointestinal tract metastases should always be considered in the differential diagnosis of lung cancer patients presenting with an acute abdomen. Aggressive surgical treatment is worthwhile in a selected group of patients as it provides effective palliation.
肺癌胃肠道转移的并发症罕见，最佳治疗方案仍存在争议。一些作者因预后不良主张采取非手术策略，而另一些人则推荐积极手术，因为其能提供有效的姑息治疗。本研究的目的是介绍我们对9例因胃肠道转移并发症接受剖腹手术患者的经验，并确定其预后。
回顾性分析1995年至2005年间9例因病理证实为肺癌继发胃肠道转移并发症而接受剖腹手术的患者。
所有患者均为男性，初次就诊时中位年龄为63岁（范围40 - 70岁）。有症状的胃肠道转移部位包括回肠（n = 3）、空肠（n = 3）、盲肠（n = 1）、十二指肠（n = 2）和胃（n = 2），患者表现为梗阻（n = 2）、出血（n = 3）、肠套叠（n = 3）和穿孔（n = 1）。从初次就诊到出现有症状的胃肠道转移的中位时间为2个月（范围0 - 8个月），肺癌的组织学亚型为鳞状细胞癌（n = 3）、大细胞癌（n = 3）、腺癌（n = 1）、多形性癌（n = 1）和多形性伴腺癌（n = 1）。所有患者均接受了剖腹探查术，最终手术方式取决于疾病的部位和范围。这些手术包括小肠切除并一期吻合（n = 5）、胃大部切除并扩大右半结肠切除（n = 1）、胃空肠吻合术（n = 1）、右半结肠切除（n = 1）以及溃疡切除并溃疡底部潜行缝合（n = 1）。9例患者中有8例（89%）术后康复，中位9.5天（范围6 - 24天）出院。这8例患者均存活超过30天，中位生存期为6个月（范围2 - 13个月）。8例患者中有4例（50%）存活超过6个月，所有8例患者均死于晚期转移性肺癌，死亡时伴有多个转移部位。
对于出现急腹症的肺癌患者，鉴别诊断时应始终考虑胃肠道转移。对于部分选定的患者，积极的手术治疗是值得的，因为它能提供有效的姑息治疗。
