Department of Thoracic Surgery, Cancer Center, Sun Yet-Sen University, State Key Laboratory of Oncology, Southern China, China.
Ann Thorac Med. 2013 Jul;8(3):160-4. doi: 10.4103/1817-1737.114300.
To investigate the surgical approach and outcomes, as well as prognostic factors for pulmonary metastasectomy.
Clinical data of 201 patients treated by pulmonary metastasectomy between January 1990 and December 2009 were retrospectively reviewed. One hundred thirty three patients were received an approach of thoracotomy while 68 with video-assisted thoracoscopic surgery (VATS). There were 54 lobectomies, 139 wedge resections and 8 pneumonectomies. Hilar or mediastinal lymph nodes dissection or sampling was carried out in 38 patients with lobectomy. The Kaplan-Meier method was used for the survival analysis. Cox proportional hazards model was used for multivariate analysis.
The 5 years survival rate of patients after metastasectomy was 50.5%, and the median survival time was 65.9 months. The median survival time of patients with hilar or mediastinal lymph nodes metastasis was 23 months. By univariate analysis, significant prognostic factors included disease-free interval (DFI), number of metastases, number of affected lobe, surgical approach (open vs. VATS) and pathology types. DFI, number of metastases, and pathology types were revealed by Cox multivariate analysis as independent prognostic factors.
Surgical resection of pulmonary metastases is safe and effective. Palpation of the lung is still seen as necessary to detect the occult nodule. More accurate and sensitive pre-operative mediastinal staging are required.
探讨肺转移瘤切除术的手术方法和疗效，以及预后因素。
回顾性分析 1990 年 1 月至 2009 年 12 月期间接受肺转移瘤切除术的 201 例患者的临床资料。133 例患者行开胸手术，68 例行电视辅助胸腔镜手术（VATS）。54 例行肺叶切除术，139 例行楔形切除术，8 例行全肺切除术。38 例行肺叶切除术患者行肺门或纵隔淋巴结清扫或采样。采用 Kaplan-Meier 法进行生存分析，Cox 比例风险模型进行多因素分析。
肺转移瘤切除术后患者 5 年生存率为 50.5%，中位生存时间为 65.9 个月。有肺门或纵隔淋巴结转移的患者中位生存时间为 23 个月。单因素分析显示，无病间期（DFI）、转移灶数量、受累肺叶数量、手术方式（开胸与 VATS）和病理类型是影响预后的显著因素。Cox 多因素分析显示，DFI、转移灶数量和病理类型是独立的预后因素。
肺转移瘤切除术是安全有效的。术中触诊仍然被认为是发现隐匿性结节的必要手段。需要更准确和敏感的术前纵隔分期。
