Osei-Agyemang T, Palade E, Haderthauer J, Ploenes T, Yaneva V, Passlick B
Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Deutschland.
Zentralbl Chir. 2013 Oct;138 Suppl 1:S45-51. doi: 10.1055/s-0033-1350873. Epub 2013 Oct 22.
Resection of lung metastasis is an important component in the therapy of patients with metastatic solid tumours. The aim of this analysis was to compare the technical and oncological outcomes of laser-assisted pulmonary metastasectomy with those of standard resection techniques such as electrocautery and stapling.
PATIENTS/MATERIAL AND METHODS: We retrospectively analysed all patients who had undergone curative intended pulmonary metastasectomy in our department between January 2005 and June 2010. Follow-up was accomplished by visits in the outpatient department of our medical centre or by questionnaires of the primary physicians.
301 patients were identified. In 62 patients (20.6 %) the Nd-YAG laser was used for resection. Despite a significantly higher number of resected lesions in the laser-assisted resection group in comparison to the group with wedge and anatomic resections (median: 7.0 vs. 2.0; p < 0.01), there was no significant difference in surgical and overall morbidity except for a higher rate of pneumonia (11.3 vs. 2.9 %; p < 0.01). Follow-up was completed for 85.4 % of the patients. After a median follow-up of 27.2 months (range: 2.3 to 60.6 months) 42.5 % of the patients suffered from recurrence and 29.2 % had died. Mean disease-free interval was 12.9 months (range: 0 to 60.6 months). Although a higher number of metastases was resected in the laser group, we did not see a significant correlation between surgical technique and long-term survival (p < 0.8). Regression analysis confirmed the number of metastases to be a significant factor influencing survival (p < 0.02), but subgroup analysis of laser-assisted resections no longer showed significance in respect to the number of metastases.
The number of metastases has an influence on prognosis but seems to be of secondary importance, particularly if complete technical resectability with the aid of the laser is given.
肺转移瘤切除术是实体瘤转移患者治疗的重要组成部分。本分析的目的是比较激光辅助肺转移瘤切除术与电灼术和吻合器等标准切除技术的技术和肿瘤学结果。
患者/材料与方法：我们回顾性分析了2005年1月至2010年6月期间在我科接受根治性肺转移瘤切除术的所有患者。通过在我们医疗中心的门诊部就诊或由初级医师填写问卷来完成随访。
共识别出301例患者。其中62例患者（20.6%）使用钕钇铝石榴石激光进行切除。尽管与楔形切除和解剖性切除组相比，激光辅助切除组切除的病灶数量显著更多（中位数：7.0对2.0；p<0.01），但除肺炎发生率较高外（11.3%对2.9%；p<0.01），手术和总体发病率无显著差异。85.4%的患者完成了随访。中位随访27.2个月（范围：2.3至60.6个月）后，42.5%的患者出现复发，29.2%的患者死亡。平均无病生存期为12.9个月（范围：0至60.6个月）。尽管激光组切除的转移瘤数量更多，但我们未发现手术技术与长期生存之间存在显著相关性（p<0.8）。回归分析证实转移瘤数量是影响生存的重要因素（p<0.02），但激光辅助切除的亚组分析在转移瘤数量方面不再具有显著性。
转移瘤数量对预后有影响，但似乎是次要的，特别是在借助激光实现完全技术可切除性的情况下。
