Chao Yin-Kai, Chang Hao-Cheng, Wu Yi-Cheng, Liu Yun-hen, Hsieh Ming-Ju, Chiang Jy-Ming, Liu Hui-Ping
Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Thorac Cardiovasc Surg. 2012 Sep;60(6):398-404. doi: 10.1055/s-0031-1295574. Epub 2012 Jan 7.
The benefits of video-assisted thoracoscopic surgery (VATS) for performing pulmonary metastasectomy are considered controversial. This case-matched study aimed to compare long-term outcomes after surgical resection of pulmonary metastases from colorectal cancer using different approaches (VATS vs. thoracotomy).
Between 1997 and 2008, 143 patients with colorectal cancer who had received their first pulmonary metastasectomy were selected. Fifty-three patients underwent a surgical procedure that utilized a thoracotomy approach (Group 1), and 90 patients underwent a surgical procedure that used a VATS-based approach (Group 2). After being matched for tumor number, diameter (measured by computed tomography), and surgical procedure (wedge resection or lobectomy), 35 pairs of patients were finally enrolled. Study endpoints included tumor recurrence and survival.
There was no hospital mortality in both groups. Within the mean follow-up period of 50 months, 47.1% patients developed a recurrence (52% at the pulmonary level and 48% at systemic level), and 52.9% of the patients were alive at the time of analysis. There was no difference between Groups 1 and 2 in terms of overall recurrences (54 vs. 40%, p = 0.23), all pulmonary recurrences (25.7 vs. 22.9%, p = 0.78), and same side lung recurrences (14.3 vs. 20%, p = 0.75). The 5-year overall survival (OS) after lung resection was 43 and 51% in Groups 1 and 2, respectively (p = 0.21).
Our case-matched study showed that survival outcome of pulmonary metastasectomy using VATS is not inferior to that of open thoracotomy in selected cases.
电视辅助胸腔镜手术（VATS）用于肺转移瘤切除术的益处存在争议。本病例对照研究旨在比较采用不同方法（VATS与开胸手术）切除结直肠癌肺转移瘤后的长期疗效。
选取1997年至2008年间首次接受肺转移瘤切除术的143例结直肠癌患者。53例患者接受了开胸手术（第1组），90例患者接受了基于VATS的手术（第2组）。在对肿瘤数量、直径（通过计算机断层扫描测量）和手术方式（楔形切除术或肺叶切除术）进行匹配后，最终纳入35对患者。研究终点包括肿瘤复发和生存情况。
两组均无医院死亡病例。在平均50个月的随访期内，47.1%的患者出现复发（肺内复发率为52%，全身复发率为48%），52.9%的患者在分析时仍存活。第1组和第2组在总体复发率（54%对40%，p = 0.23）、所有肺内复发率（25.7%对22.9%，p = 0.78）和同侧肺复发率（14.3%对20%，p = 0.75）方面无差异。第1组和第2组肺切除术后的5年总生存率（OS）分别为43%和51%（p = 0.21）。
我们的病例对照研究表明，在特定病例中，采用VATS进行肺转移瘤切除术的生存结局并不逊于开胸手术。
