Shiono Satoshi, Okumura Takehiro, Boku Narikazu, Hishida Tomoyuki, Ohde Yasuhisa, Sakao Yukinori, Yoshiya Katsuo, Hyodo Ichinosuke, Mori Keita, Kondo Haruhiko
Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
Department of Surgery, School of Medicine, University Hospital Mizonokuchi, Teikyo University, Kanagawa, Japan.
Eur J Cardiothorac Surg. 2017 Mar 1;51(3):504-510. doi: 10.1093/ejcts/ezw322.
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.
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。
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