Department of Thoracic Surgery, Istanbul University, Istanbul, Turkey.
Ann Surg Oncol. 2010 Jul;17(7):1912-6. doi: 10.1245/s10434-010-0960-0. Epub 2010 Feb 12.
Extended resections may be necessary to achieve tumor-free borders for secondary pulmonary malignancies. This study was performed to analyze the outcomes that result from extended resections of pulmonary metastases.
Between February 1991 and December 2008, a total of 25 extended pulmonary resections (resection of the chest wall and diaphragm, vascular procedures, sleeve resections, pneumonectomies, atrial resections, and completion pneumonectomies) were performed on 250 patients undergoing 319 metastasectomy procedures. The extended resection group was analyzed in terms of disease-free interval, type of resection, operative morbidity, mortality, and survival and was then compared with patients who underwent lobar or sublobar resections.
The extended resection group consisted of 14 male and 11 female patients. The mean disease-free interval was 36.02 (minimum 6, maximum 132) months. The extended resection rate was 10%. After 30 days, all patients were alive. For all extended metastasectomy groups, actuarial 5-year survival rates from the time of the extended metastasectomy were 16.3%. Mean survival times of patients who underwent extended resection and lobar or sublobar resection were 40 months (SD = 11) (95% confidence interval, 19-61) and 20 months (SD = 3) (95% confidence interval, 14-26), respectively. This difference was not statistically significant (P = 0.09) (Fig. 2). In the subgroup analysis, survival in the extended resections and lobar or sublobar resections groups was not statistically significant (osteosarcoma, P = 0.758; epithelial tumor, P = 0.11).
Extended resections, which can be performed during pulmonary metastasectomies of patients with tumor-free surgical borders, may establish curative benefits, with low rates of mortality and morbidity.
为了达到继发性肺恶性肿瘤无肿瘤边界的要求，可能需要进行扩大切除术。本研究旨在分析肺转移瘤扩大切除术的结果。
1991 年 2 月至 2008 年 12 月，对 250 例接受 319 例转移瘤切除术的患者进行了 25 例肺扩大切除术（切除胸壁和膈肌、血管手术、袖状切除术、全肺切除术、心房切除术和全肺切除术）。对扩大切除术组进行无病间隔、切除类型、手术发病率、死亡率和生存率分析，并与行肺叶或亚肺叶切除术的患者进行比较。
扩大切除术组包括 14 例男性和 11 例女性，平均无病间隔为 36.02 个月（最短 6 个月，最长 132 个月）。扩大切除术率为 10%。30 天后，所有患者均存活。对于所有扩大转移瘤切除术组，从扩大转移瘤切除术开始的 5 年生存率为 16.3%。接受扩大切除术和肺叶或亚肺叶切除术的患者的平均生存时间分别为 40 个月（SD=11）（95%置信区间，19-61）和 20 个月（SD=3）（95%置信区间，14-26）。差异无统计学意义（P=0.09）（图 2）。在亚组分析中，扩大切除术组和肺叶或亚肺叶切除术组的生存情况无统计学差异（骨肉瘤，P=0.758；上皮性肿瘤，P=0.11）。
在无肿瘤边界的患者进行肺转移瘤切除术时，可进行扩大切除术，可获得根治性疗效，死亡率和发病率低。
