Yokoyama Masaru, Ishibashi Keiichiro, Hokama Naoko, Ishiguro Toru, Miyazaki Tatsuya, Matsuki Moriyuki, Ishida Hideyuki, Gika Masatoshi, Yamahata Takeshi, Eguchi Keisuke, Nakayama Mitsuo, Kikuchi Kouji
Dept. of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University.
Gan To Kagaku Ryoho. 2008 Nov;35(12):2198-200.
Surgical resection has been the standard treatment recommended for respectable pulmonary metastasis from colorectal cancer. However, we should evaluate again the indication of bilateral thoracotomy and repeat resection of pulmonary metastatic lesions, because these surgical interventions may deteriorate the patients' quality of life. This retrospective study was performed to address this issue.
The subjects were 39 patients who underwent pulmonary metastatectomy of colorectal cancer between May 1990 and January 2007. The prognosis was evaluated according to the types of thoracotomy, bilateral thoracotomy (n=5), repeat pulmonectomy (n=6), and single thoracotomy (n=28). In addition, the impact of new anticancer drugs (5-fluorouracil+Leucovorin, S-1, irinotecan, and oxaliplatin) on survival after thoracotomy was examined.
The patients undergoing bilateral thoracotomy showed a significantly shorter survival after the last thoracotomy than those in other groups (p=0.03). The survival time after the initial thoracotomy was not different between patients who received new anticancer drugs (n=11) and those without (n=28, p=0.58).
Bilateral pulmonary metastatectomy from colorectal cancer appears to have little benefit on survival, while a repeat metastatectomy may cause a long-term survival. A further collection of cases is needed to conclude whether the new anticancer drugs would be useful for prolonging the patients' survival after pulmonary metastatectomy.
手术切除一直是推荐用于可切除的结直肠癌肺转移的标准治疗方法。然而，我们应该重新评估双侧开胸手术和重复切除肺转移灶的适应症，因为这些手术干预可能会使患者的生活质量恶化。进行这项回顾性研究以解决这一问题。
研究对象为1990年5月至2007年1月间接受结直肠癌肺转移瘤切除术的39例患者。根据开胸类型评估预后，包括双侧开胸手术（n = 5）、重复肺切除术（n = 6）和单侧开胸手术（n = 28）。此外，还研究了新型抗癌药物（5-氟尿嘧啶+亚叶酸、S-1、伊立替康和奥沙利铂）对开胸术后生存的影响。
接受双侧开胸手术的患者在最后一次开胸术后的生存期明显短于其他组（p = 0.03）。接受新型抗癌药物治疗的患者（n = 11）与未接受治疗的患者（n = 28）初次开胸术后的生存时间无差异（p = 0.58）。
结直肠癌双侧肺转移瘤切除术对生存似乎益处不大，而重复转移瘤切除术可能带来长期生存。需要进一步收集病例以确定新型抗癌药物是否有助于延长肺转移瘤切除术后患者的生存期。
