Zisis Charalambos, Tsakiridis Kosmas, Kougioumtzi Ioanna, Zarogoulidis Paul, Darwiche Kaid, Machairiotis Nikolaos, Zaric Bojan, Katsikogiannis Nikolaos, Kesisis Georgios, Stylianaki Aikaterini, Li Zhigang, Zarogoulidis Konstantinos
Department of Thoracic and Vascular Surgery, 'Evangelismos' Hospital, Athens, Greece;
J Thorac Dis. 2013 Sep;5 Suppl 4(Suppl 4):S383-8. doi: 10.3978/j.issn.2072-1439.2013.06.23.
Pulmonary metastases from colorectal cancer present as systemic manifestation of the disease. As a general principle, the presence of metastases predispose to a poor prognosis. However, the application of some criteria of "operability" permitted the surgical resection resulting in prolonged survival (reported 5-year survival up to 50%), in better quality of life and in the cure of some patients. When the primary tumor site is controlled, and the metastatic disease is limited in lungs without extrapulmonary location (except for resectable or resected hepatic lesion) surgical removal is indicated. As significant prognostic factors in metastasectomies have been reported the synchronous or metachronous caracter of the metastases, the disease free survival, the complete removal of the metastases, the thoracic lymph node invasion, the CEA level before metastasectomy and 1 month after, the solitary vs. multiple pulmonary metastatic locations, the induction chemotherapy, the histological type and differentiation grade, as well as the vascular emboli in histopathological examination. Thorough preoperative evaluation of the patient includes oncological assessment and respiratory functional tests. Alternatively, when the patient is not a good surgical candidate, radiofrequency ablation is an option. Many surgical accesses have been validated, as posterolateral or lateral or even posterior thoracotomy, sternotomy, clamshell incision, and thoracoscopic techniques that offer the advantages of less pain, fast recovery, and less morbidity. Though thoracoscopic metastasectomies have been questioned concerning to the completeness of metastatic removal, no statistical difference in survival has been revealed in many series comparing thoracotomy to thoracoscopic techniques. As a conclusion, there are many advances in the management of pulmonary metastases from colorectal cancer during last decade, the results have been essentially optimized, the role of surgery has been established, and the multimodality approach has been recognized as the cornerstone of a successful outcome.
结直肠癌肺转移是该疾病的全身表现。一般来说，转移的存在预示着预后不良。然而，应用一些“可切除性”标准允许进行手术切除，从而延长生存期（报道的5年生存率高达50%），提高生活质量，并使一些患者得到治愈。当原发肿瘤部位得到控制，且转移病灶局限于肺部而无肺外转移（可切除或已切除的肝脏病灶除外）时，应考虑手术切除。据报道，在肺转移瘤切除术中，转移灶的同时性或异时性、无病生存期、转移灶的完全切除、胸段淋巴结侵犯、肺转移瘤切除术前及术后1个月的癌胚抗原水平、孤立性与多发性肺转移部位、诱导化疗、组织学类型和分化程度，以及组织病理学检查中的血管栓塞等是重要预后因素。对患者进行全面的术前评估包括肿瘤学评估和呼吸功能测试。另外，当患者不是手术的理想候选人时，可以选择射频消融。许多手术入路已得到验证，如后外侧或外侧甚至后外侧开胸、胸骨切开、蛤壳状切口以及胸腔镜技术，这些技术具有疼痛轻、恢复快、并发症少等优点。尽管胸腔镜下肺转移瘤切除术对于转移灶切除的彻底性存在疑问，但在许多比较开胸手术和胸腔镜技术的系列研究中，并未发现生存率有统计学差异。总之，在过去十年中，结直肠癌肺转移的治疗取得了许多进展，结果得到了实质性优化，手术的作用已得到确立，多模式治疗方法已被公认为成功治疗的基石。
