Ito Hiroyuki, Nakayama Haruhiko
Division of Thoracic Surgery, Kanagawa Cancer Center.
Gan To Kagaku Ryoho. 2010 Feb;37(2):200-3.
Because lung metastasis from a solid malignant tumor is a distant and hematogenous metastasis, its prognosis is generally dismal. Therefore, the indications of local therapy such as surgical resections of lung metastasis remain very controversial. However, in some cases, the metastasis of tumor cells from the primary site can be confined to the lungs before systemic and disseminated disease. Surgical resection could be a curative treatment at this stage of lung metastasis. A smaller number of metastases, long disease-free survival time, and no lymph node metastasis are the predictive factors for good prognosis after resection of lung metastasis. However, there have been no criteria for the indications of lung metastasectomies. Indications and outcomes of surgical resection for lung metastasis depend on each primary malignancies. Wedge resection of the lung is thought to be an appropriate procedure for the resection of metastatic lung tumors. Video assisted thoracoscopic resection is now widely used, however, controversy persists about whether this technique is appropriate approach for the patients undergoing metastasectomy with curative intent because the lack of palpation may be a cause of missing small metastatic lung tumors despite the advent of high resolution CT. There is no randomized trial assessing whether there is any difference in survival after metastasectomy with versus without manual lung palpation. Recent progress of chemotherapy, such as FOLFOX for colorectal cancer, could change the indications and outcome of surgical resection of metastatic lung tumors. In addition, newly developed radiofrequency ablation came to be performed as local therapy in some centers. We should decide the timing of resection considering the schedule of chemotherapy, so close corporation of surgeons and physicians is essential for managing metastatic lung tumors.
由于实体恶性肿瘤的肺转移属于远处血行转移，其预后通常较差。因此，诸如肺转移瘤手术切除等局部治疗的适应证仍存在很大争议。然而，在某些情况下，肿瘤细胞从原发部位转移至肺部后，在出现全身播散性疾病之前可局限于肺部。在此阶段，手术切除可能是一种治愈性治疗方法。转移灶数量较少、无病生存期长以及无淋巴结转移是肺转移瘤切除术后预后良好的预测因素。然而，目前尚无肺转移瘤切除术的适应证标准。肺转移瘤手术切除的适应证和结果取决于每种原发恶性肿瘤。肺楔形切除术被认为是切除肺转移瘤的合适术式。电视辅助胸腔镜切除术目前已广泛应用，然而，对于该技术是否适用于有治愈意图的肺转移瘤切除术患者仍存在争议，因为尽管有高分辨率CT，但缺乏触诊可能会导致遗漏小的肺转移瘤。目前尚无随机试验评估肺触诊与否对肺转移瘤切除术后生存率是否有差异。化疗的最新进展，如用于结直肠癌的FOLFOX方案，可能会改变肺转移瘤手术切除的适应证和结果。此外，一些中心开始采用新开发的射频消融作为局部治疗方法。我们应根据化疗方案来决定切除时机，因此外科医生和内科医生密切合作对于管理肺转移瘤至关重要。
