Macherey Sascha, Hekmat Khosro, Zarghooni Kourosh, Doerr Fabian, Heldwein Matthias, Wahlers Thorsten
Medizinische Fakultät, Uniklinik Köln.
Klinik und Poliklinik für Herz- und Thoraxchirurgie, Uniklinik Köln.
Z Orthop Unfall. 2017 Oct;155(5):567-574. doi: 10.1055/s-0043-110010. Epub 2017 Jun 21.
Advanced soft tissue or osteosarcoma is often associated with lung metastases. Curative pulmonary metastasectomy is appropriate for patients with successfully resected primary cancer who show no evidence of extrapulmonary metastases, with proven functional operability and completely resectable metastases. Systematic literature research and qualitative analysis of studies on patients undergoing lung metastasectomy after resection of primary sarcoma published since 01.01.2010. We assessed operative findings, survival data and prognostic factors. Pulmonary metastasectomy results in a median postmetastasectomy survival of 8.76 to 69.9 months. Five year survival rates after metastasectomy vary between 21.7 and 56.8%. The patients' prognosis depends particularly on complete resection of all suspected metastases. Intrapulmonary recurrence could be treated by repeated resection, but this procedure requires careful decision for indication. Re-metastasectomy might result in a favourable outcome in selected cases. Pulmonary metastasectomy should be considered as treatment of choice in selected patients with isolated lung metastases from osteosarcoma. Optimal indication might lead to an advantage in patients with metastasectomy of isolated lung metastases from soft tissue.
晚期软组织肉瘤或骨肉瘤常伴有肺转移。对于原发性癌症已成功切除且无肺外转移证据、经证实具有功能可切除性且转移灶可完全切除的患者，根治性肺转移瘤切除术是合适的。对2010年1月1日以来发表的关于原发性肉瘤切除术后接受肺转移瘤切除术患者的研究进行系统文献检索和定性分析。我们评估了手术结果、生存数据和预后因素。肺转移瘤切除术导致转移瘤切除术后的中位生存期为8.76至69.9个月。转移瘤切除术后的五年生存率在21.7%至56.8%之间。患者的预后尤其取决于所有可疑转移灶的完全切除。肺内复发可通过再次切除进行治疗，但该手术需要谨慎决定适应症。在某些选定病例中，再次转移瘤切除术可能会带来良好的结果。对于骨肉瘤孤立性肺转移的选定患者，应将肺转移瘤切除术视为首选治疗方法。最佳适应症可能会使软组织肉瘤孤立性肺转移瘤切除术患者受益。
