Kanzaki Ryu, Kimura Toru, Kawamura Tomohiro, Funaki Soichiro, Shintani Yasushi, Minami Masato, Yamasaki Makoto, Mori Masaki, Doki Yuichiro, Okumura Meinoshin
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Interact Cardiovasc Thorac Surg. 2017 Mar 1;24(3):418-424. doi: 10.1093/icvts/ivw358.
The objective of this study is to analyse the short- and long-term results of surgery for malignant pulmonary nodules in patients with a history of oesophageal cancer (EC) in order to assess the significance of surgery in these patients.
The data of 28 consecutive patients with a history of EC who underwent pulmonary resection for malignant pulmonary nodules were reviewed. The perioperative and long-term results were analysed.
The histological type of oesophageal cancer was squamous cell carcinoma in all of the patients. The preceding treatments for EC were surgery with or without neoadjuvant therapy in 21, chemoradiotherapy in 4 and endoscopic resection in 3. The patients were smokers, with low body mass indices, and had high incidences of a history of malignancy besides EC and other comorbidities. Complete resection was achieved in 27 patients (96%). There was no perioperative mortality and 7 patients (25%) developed postoperative complications. Based on the pathological and clinical criteria, 14 patients (50%) were diagnosed with primary lung cancer, 10 patients (35%) with pulmonary metastases from EC and 4 patients (25%) with pulmonary metastasis from another cancer. The 5-year disease-free and overall survival rates of all patients were 48% and 60%, respectively.
Surgery for malignant pulmonary nodules in patients with a history of EC can be performed with acceptable surgical risk despite the high rate of comorbid illness in these patients. Proactive surgical management should be considered for treating malignant pulmonary nodules in patients with a previous history of EC as this strategy provides favourable long-term results.
本研究的目的是分析有食管癌（EC）病史患者的恶性肺结节手术的短期和长期结果，以评估手术在这些患者中的意义。
回顾了28例有EC病史且因恶性肺结节接受肺切除术的连续患者的数据。分析围手术期和长期结果。
所有患者的食管癌组织学类型均为鳞状细胞癌。EC的先前治疗方式为：21例接受了有或无新辅助治疗的手术，4例接受了放化疗，3例接受了内镜切除术。患者均为吸烟者，体重指数较低，除EC外有恶性肿瘤病史及其他合并症的发生率较高。27例患者（96%）实现了完全切除。无围手术期死亡，7例患者（25%）发生术后并发症。根据病理和临床标准，14例患者（50%）被诊断为原发性肺癌，10例患者（35%）为EC肺转移，4例患者（25%）为其他癌症肺转移。所有患者的5年无病生存率和总生存率分别为48%和60%。
有EC病史患者的恶性肺结节手术尽管这些患者合并症发生率高，但手术风险仍可接受。对于有EC既往史的患者，应考虑积极的手术治疗恶性肺结节，因为该策略可提供良好的长期结果。
