Department of Thoracic Surgery, Paris Descartes University, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris, France.
Ann Thorac Surg. 2010 Feb;89(2):375-80. doi: 10.1016/j.athoracsur.2009.10.005.
Surgery is a safe and effective treatment for patients with lung metastases from colorectal carcinoma. Combining chemotherapy and surgery seems to prolong survival time after metastasectomy. Our purpose was to review the effectiveness of surgery with time and evolving managements.
The records of 127 patients were retrospectively analyzed. The characteristics of primary cancer, lung metastases, resections, and associated therapy were studied according to their incidence on survival.
There were 74 male and 53 female patients (mean age, 65 years); 223 operations were performed and 314 metastases were resected. Completeness of surgery (n = 117) was the main factor for prolonged survival (5- and 10-year survival, 41% and 27%, versus 0%). There was no factor of significantly better prognosis, but a tendency to higher survival rates was observed in cases of single metastasis, in patients undergoing several lung operations, and in patients in whom liver metastases were previously removed. Three of 7 patients with mediastinal lymph node involvement survived more than 5 years; 58 patients were operated on before January 2000, and 59 between January 2000 and December 2007. Five-year survival rates were 35.1% versus 63.5%, respectively (p = 0.0096), probably related to better selection with modern workup, more frequent use of chemotherapy, and repeated pulmonary resections.
Different treatment protocols were reported in the literature and in our series with time, resulting in better survival rates and a more aggressive surgical tendency. The beneficial role of such combined therapy justifies further research, including prospective trials.
手术是治疗结直肠癌肺转移患者的安全有效方法。化疗联合手术似乎可以延长转移瘤切除术后的生存时间。我们的目的是回顾随时间推移和治疗方式演变的手术疗效。
回顾性分析了 127 例患者的资料。根据其对生存的影响，分析了原发肿瘤、肺转移、切除术和相关治疗的特征。
127 例患者中男性 74 例，女性 53 例（平均年龄 65 岁）；共行 223 次手术，切除 314 个转移灶。手术的完整性（n=117）是延长生存的主要因素（5 年和 10 年生存率分别为 41%和 27%，而 0%）。没有明显改善预后的因素，但单转移灶、行多次肺切除术和肝转移已切除的患者的生存率有升高趋势。7 例纵隔淋巴结受累患者中有 3 例存活超过 5 年；58 例患者于 2000 年 1 月之前手术，59 例于 2000 年 1 月至 2007 年 12 月手术。5 年生存率分别为 35.1%和 63.5%（p=0.0096），可能与现代检查手段、更频繁使用化疗和重复肺切除术有关。
随着时间的推移，文献和我们的研究系列中报道了不同的治疗方案，这导致了更好的生存率和更具侵袭性的手术趋势。这种联合治疗的有益作用证明了进一步研究的合理性，包括前瞻性试验。
