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结直肠癌肺转移行肺段切除术和楔形切除术的疗效

Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer.

作者信息

Shiono Satoshi, Okumura Takehiro, Boku Narikazu, Hishida Tomoyuki, Ohde Yasuhisa, Sakao Yukinori, Yoshiya Katsuo, Hyodo Ichinosuke, Mori Keita, Kondo Haruhiko

机构信息

Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.

Department of Surgery, School of Medicine, University Hospital Mizonokuchi, Teikyo University, Kanagawa, Japan.

出版信息

Eur J Cardiothorac Surg. 2017 Mar 1;51(3):504-510. doi: 10.1093/ejcts/ezw322.


DOI:10.1093/ejcts/ezw322
PMID:27773868
Abstract

OBJECTIVES: Although wedge resection is the most common surgical procedure for pulmonary metastases from colorectal cancer, there are few reports about segmentectomy for colorectal metastasectomy. METHODS: This was a subset analysis of a Japanese nationwide retrospective study of resected pulmonary metastases from colorectal cancer. The study included 553 patients who underwent segmentectomies ( n  = 98) or wedge resections ( n  = 455) without preoperative chemotherapy between January 2004 and December 2008. Recurrence patterns, recurrence-free survival and overall survival were analysed for each procedure. RESULTS: As for the patients' background factors, only the median size of resected metastases was different between patients with segmentectomies (median 18 mm, range 5-50 mm) and wedge resections (14 mm, 5-51 mm) ( P  < 0.001). Prolonged air leak developed more frequently in those undergoing segmentectomy compared with wedge resection (5.1% vs 1.8%) ( P  = 0.048). The resection-margin recurrence rate was higher in patients who underwent wedge resection compared with segmentectomy (7.3% vs 2.0%; P  = 0.035). The 5-year recurrence-free survival was 48.8% in patients with segmentectomy and 36.0% in patients with wedge resections. The 5-year overall survival was 80.1% in patients with segmentectomy and 68.5% in patients with wedge resection. Multivariable analysis revealed that the surgical procedure, segmentectomy, was a significant favourable factor for recurrence (hazard ratio: 0.63, 95% confidence interval: 0.44-0.87, P  = 0.005), but not for overall survival (hazard ratio: 0.65, 95% confidence interval: 0.38-1.05, P  = 0.080). CONCLUSIONS: Segmentectomy demonstrated a good efficacy with less resection-margin recurrence in patients with resectable pulmonary-limited metastasis from colorectal cancer.

摘要

目的:虽然楔形切除术是结直肠癌肺转移最常见的外科手术方式,但关于节段切除术治疗结直肠癌肺转移的报道较少。 方法:这是一项对日本全国范围内结直肠癌肺转移切除病例的回顾性研究的亚组分析。该研究纳入了2004年1月至2008年12月期间553例未接受术前化疗而行节段切除术(n = 98)或楔形切除术(n = 455)的患者。对每种手术方式的复发模式、无复发生存期和总生存期进行分析。 结果:就患者的背景因素而言,节段切除术患者(中位值18 mm,范围5 - 50 mm)与楔形切除术患者(14 mm,5 - 51 mm)之间仅切除转移灶的中位大小存在差异(P < 0.001)。与楔形切除术相比,节段切除术患者发生持续性漏气的频率更高(5.1% 对1.8%)(P = 0.048)。与节段切除术相比,楔形切除术患者的切缘复发率更高(7.3% 对2.0%;P = 0.035)。节段切除术患者的5年无复发生存率为48.8%,楔形切除术患者为36.0%。节段切除术患者的5年总生存率为80.1%,楔形切除术患者为68.5%。多变量分析显示,手术方式节段切除术是复发的显著有利因素(风险比:0.63,95%置信区间:0.44 - 0.87,P = 0.005),但不是总生存期的有利因素(风险比:0.65,95%置信区间:0.38 - 1.05,P = 0.080)。 结论:对于可切除的结直肠癌肺局限性转移患者,节段切除术显示出良好疗效,切缘复发较少。

相似文献

[1]
Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer.

Eur J Cardiothorac Surg. 2017-3-1

[2]
Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience.

Eur J Cardiothorac Surg. 2002-5

[3]
Do Repeated Operations for Recurrent Colorectal Lung Metastases Result in Improved Survival?

Ann Thorac Surg. 2018-3-30

[4]
Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer.

Ann Thorac Surg. 2012-10-11

[5]
Repeat pulmonary resection for recurrent lung metastases from colorectal cancer: an analysis of prognostic factors.

Interact Cardiovasc Thorac Surg. 2016-6

[6]
The prognostic importance of the number of metastases in pulmonary metastasectomy of colorectal cancer.

World J Surg Oncol. 2015-7-25

[7]
Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR).

Ann Oncol. 2016-2-18

[8]
Forty-Two Years' Experience with Pulmonary Resections of Metastases from Colorectal Cancer.

Thorac Cardiovasc Surg. 2017-10

[9]
Does Repeated Lung Resection Provide Long-Term Survival for Recurrent Pulmonary Metastases of Colorectal Cancer? Results of a Retrospective Japanese Multicenter Study.

Ann Thorac Surg. 2017-2

[10]
Surgical margins and risk of local recurrence after wedge resection of colorectal pulmonary metastases.

J Thorac Cardiovasc Surg. 2018-11-26

引用本文的文献

[1]
Pulmonary Metastasectomy for Colorectal Cancer: Evidence and Outcomes-A Narrative Review.

J Clin Med. 2025-6-12

[2]
Low Rates of Intrapulmonary Local Recurrence After Laser Metastasectomy: A Single-Center Retrospective Cohort Study of Colorectal Cancer Metastases.

Cancers (Basel). 2025-2-18

[3]
The advantages of preoperative 3D reconstruction over 2D-CT in thoracoscopic segmentectomy.

Updates Surg. 2024-12

[4]
Robotic thoracic surgery: lessons learned from the first 1,000 procedures.

Front Surg. 2024-9-12

[5]
Prognostic Outcome of Pulmonary Resection for Pulmonary Metastases from Gastric Cancer.

Ann Thorac Cardiovasc Surg. 2024

[6]
Laser assisted pulmonary metastasectomy promises a low local recurrence rate.

Sci Rep. 2024-3-12

[7]
Surgical and Interventional Management of Lung Metastasis: Surgical Assessment, Resection, Ablation, Percutaneous Interventions.

Clin Colon Rectal Surg. 2022-11-29

[8]
The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer.

Curr Oncol. 2023-7-22

[9]
Clinicopathological features and surgical outcomes of lobectomy combined with segmentectomy: a cohort study.

J Thorac Dis. 2023-3-31

[10]
Risk factors for late-onset pulmonary fistula after pulmonary segmentectomy.

J Thorac Dis. 2023-3-31

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