Nakajima Jun, Murakawa Tomohiro, Fukami Takeshi, Takamoto Shinichi
Department of Cardiothoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Interact Cardiovasc Thorac Surg. 2008 Apr;7(2):212-6; discussion 216-7. doi: 10.1510/icvts.2007.167239. Epub 2007 Dec 14.
We retrospectively analyzed 143 consecutive patients undergoing pulmonary resection for metastasis from colorectal cancer, either through thoracotomy or thoracoscopy from 1987 to 2005. Patients with incomplete resection were excluded. Patients were divided into two groups, based on whether or not they underwent thoracoscopy (n=72) or open thoracotomy (n=71) at the first pulmonary metastasectomy. Two patients undergoing thoracoscopy died postoperatively (one from pulmonary thromboembolism and one from gastrointestinal bleeding). Factors influencing postoperative recurrence-free or overall survival were multiple pulmonary metastasis and history of liver metastasis by univariate analysis, and multiple pulmonary metastasis, hilar or mediastinal nodal metastasis, larger diameter of the pulmonary metastasis, and surgery by wedge resection by multivariate analysis. Five-year recurrence-free rates after the first pulmonary metastasectomy were 34.4% in thoracoscopy and 21.1% in thoracotomy, respectively (P=0.047). Overall 5-year survival rates were 49.3% in thoracoscopy and 39.5% in thoracotomy, respectively (not significant). We found no significant difference in the survival rates between the thoracotomy and thoracoscopy groups, even with elimination of the patients with multiple pulmonary metastases in both groups. We suggest that thoracoscopic surgery for pulmonary metastasectomy from colorectal cancer may be justified if the surgical treatment is indicated.
我们回顾性分析了1987年至2005年间143例因结直肠癌转移而接受肺切除术的连续患者，手术方式包括开胸手术或胸腔镜手术。排除切除不完全的患者。根据首次肺转移瘤切除术时是否接受胸腔镜手术（n = 72）或开胸手术（n = 71），将患者分为两组。两名接受胸腔镜手术的患者术后死亡（一名死于肺血栓栓塞，一名死于胃肠道出血）。单因素分析显示，影响术后无复发生存或总生存的因素为多发肺转移和肝转移史；多因素分析显示，影响因素为多发肺转移、肺门或纵隔淋巴结转移、肺转移瘤直径较大以及楔形切除术。首次肺转移瘤切除术后的5年无复发生存率在胸腔镜手术组为34.4%，在开胸手术组为21.1%（P = 0.047）。总体5年生存率在胸腔镜手术组为49.3%，在开胸手术组为39.5%（无显著性差异）。即使剔除两组中多发肺转移的患者，我们发现开胸手术组和胸腔镜手术组的生存率仍无显著差异。我们认为，如果有手术指征，胸腔镜手术用于结直肠癌肺转移瘤切除术可能是合理的。
