Macherey Sascha, Bruns Christiane, Alakus Hakan, Doerr Fabian, Heldwein Matthias, Quaas Alexander, Wahlers Thorsten, Hekmat Khosro
Medizinische Fakultät, Universität zu Köln, Deutschland.
Allgemein-, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Deutschland.
Zentralbl Chir. 2018 Apr;143(2):193-204. doi: 10.1055/s-0043-114734. Epub 2017 Sep 25.
Patients with colorectal cancer are often affected by liver and lung metastases. Besides systemic therapies, lung metastasectomy is a suitable treatment option after complete resection of primary colorectal carcinoma and even concomitant liver metastases.
We have performed a systematical literature research of all studies published after 01. 01. 2010. Studies reporting on at least 100 patients undergoing lung metastasectomy after 01. 01. 2000 have been included in our final analysis. Operative data, survival data and prognostic factors have been extracted.
Eleven study cohorts reporting on 2,891 patients could be included in the final analysis. Complete resection could be achieved in most cases and thoracic surgeons preferred subsegmental resections. Pathological examination revealed thoracic lymph node involvement in 2.3 to 18.2% of patients. The postoperative mortality varied from 0 to 0.5%. The median follow up ranged between 27.5 and 65.1 months. Pulmonary metastasectomy resulted in 5-year survival rates of 53 to 75.5% and 5-year progression-free survival rates of 33 to 50.9%. Intrathoracic recurrence occurred in 25.2 to 42.9% of patients with complete resection and five-year survival rates ranged from 49 to 75.5% after repeat pulmonary metastasectomy. Analysis of prognostic factors revealed that number, size and distribution of lung metastases are minor important prognostic factors. Moreover, current data suggest disadvantageous post-metastasectomy survival for patients with elevated pre-metastasectomy serum CEA level or intrathoracic lymph node metastases in comparison with the control groups. Nevertheless, even in these patients, lung metastasectomy might be a beneficial procedure.
In patients with colorectal cancer and resectable isolated lung or combined liver and lung metastases pulmonary resection should be the treatment of choice. Pulmonary metastasectomy should be combined with thoracic lymph node resection to remove potential lymph node metastases. Repeat metastasectomy should be offered to patients suffering from isolated intrathoracic recurrence.
结直肠癌患者常受肝肺转移影响。除全身治疗外，在原发性结直肠癌甚至合并肝转移完全切除后，肺转移瘤切除术是一种合适的治疗选择。
我们对2010年1月1日之后发表的所有研究进行了系统的文献检索。纳入最终分析的研究报告了2000年1月1日之后至少100例行肺转移瘤切除术的患者。提取了手术数据、生存数据和预后因素。
最终分析纳入了11个研究队列，共2891例患者。大多数病例可实现完全切除，胸外科医生更倾向于亚段切除。病理检查显示2.3%至18.2%的患者有胸段淋巴结受累。术后死亡率为0至0.5%。中位随访时间为27.5至65.1个月。肺转移瘤切除术的5年生存率为53%至75.5%，5年无进展生存率为33%至50.9%。完全切除的患者中有25.2%至42.9%发生胸内复发，再次肺转移瘤切除术后5年生存率为49%至75.5%。预后因素分析显示，肺转移瘤的数量、大小和分布是次要的重要预后因素。此外，目前的数据表明，与对照组相比，转移前血清癌胚抗原（CEA）水平升高或胸内淋巴结转移的患者转移后生存不利。然而，即使在这些患者中，肺转移瘤切除术也可能是一种有益的手术。
对于结直肠癌且可切除的孤立肺转移或合并肝肺转移的患者，肺切除术应是首选治疗方法。肺转移瘤切除术应与胸段淋巴结切除术相结合，以清除潜在的淋巴结转移。对于孤立性胸内复发的患者，应提供再次转移瘤切除术。
