Joosten J, Bertholet J, Keemers-Gels M, Barendregt W, Ruers T
Department of Surgery, C22, Canisius Wilhelmina Hospital, P.O. Box 9015, 9500 GS, Nijmegen, The Netherlands.
Department of Surgery, C22, Canisius Wilhelmina Hospital, P.O. Box 9015, 9500 GS, Nijmegen, The Netherlands.
Eur J Surg Oncol. 2008 Aug;34(8):895-899. doi: 10.1016/j.ejso.2008.01.009. Epub 2008 Feb 15.
In selected patients with isolated colorectal lung or liver metastases resection can provide an increase in overall survival and even cure. Here, we evaluate whether also patients with combined or sequential metastatic disease to liver and lung may still be candidates for surgical resection.
From 1997 till 2006 39 patients underwent pulmonary metastasectomy. Two subgroups were identified: resection of pulmonary metastases only (PM) and resection of hepatic and later pulmonary metastases (LPM).
Patient characteristics were identical in both groups. Median follow-up in group PM was 35 months and 38 months in group LPM. Two-year survival in group PM was 61%, and in group LPM 81% (p=NS). Five-year survival was 30% and 20% in PM and LPM groups, respectively (p=NS). The median disease free survival was 12 months in the PM group and 13 months in the LPM group. The extent of pulmonary resection had no impact on survival. Complications occurred in seven patients in the PM group and two patients in the LPM group. Complication rate and severity were related to the extent of pulmonary resection. A small group of patients underwent repeated pulmonary resection without serious complications.
Resection of pulmonary colorectal metastases may improve survival, even in patients who underwent hepatic resection for colorectal liver metastases at an earlier stage.
在部分孤立性结直肠癌肺或肝转移患者中，手术切除可提高总生存率甚至实现治愈。在此，我们评估那些同时或先后出现肝肺转移的患者是否仍可作为手术切除的候选对象。
1997年至2006年期间，39例患者接受了肺转移瘤切除术。确定了两个亚组：仅行肺转移瘤切除术（PM）和先行肝转移瘤切除，随后行肺转移瘤切除术（LPM）。
两组患者的特征相同。PM组的中位随访时间为35个月，LPM组为38个月。PM组的两年生存率为61%，LPM组为81%（p值无统计学意义）。PM组和LPM组的五年生存率分别为30%和20%（p值无统计学意义）。PM组的无病生存期中位数为12个月，LPM组为13个月。肺切除范围对生存率无影响。PM组有7例患者发生并发症，LPM组有2例患者发生并发症。并发症发生率和严重程度与肺切除范围有关。一小部分患者接受了再次肺切除，未出现严重并发症。
结直肠癌肺转移瘤切除术可提高生存率，即使是那些早期因结直肠癌肝转移已接受肝切除的患者。
