Chung Jae Ho, Lee Sung Ho, Yi Eunjue, Lim Ju Yong, Jung Jae Seung, Son Ho Sung, Sun Kyung
Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Anam Hospital, Seoul, South Korea.
J Thorac Dis. 2019 May;11(5):1879-1887. doi: 10.21037/jtd.2019.05.12.
To evaluate the influence of tumor depth on preoperative computed tomography (CT) image, and resection margin length on local recurrence after pulmonary metastasectomy of colorectal cancer.
Patients undergoing thoracoscopic pulmonary wedge resection for single pulmonary metastasis of colorectal cancer origin from 2007 to 2017 were analyzed. Factors such as resection margin, tumor size and depth were analyzed. The local recurrences of two subgroups based on the pulmonary resection margin (Group 1: resection margin 1-10 mm or shorter than the tumor size, Group 2: resection margin >10 mm or at least greater than the tumor size) were analyzed.
Sixty-five patients were included in this study. The local recurrence rate was 12/65 (18.5%). Median follow up period was 33 months. Median tumor size and depth on preoperative CT were 1.1 and 1.6 cm. Median length of resection margin was 0.5 cm (group 1: 0.4 cm, group 2: 1.0 cm, P<0.001). No difference was noted in 3-year local recurrence-free survival (80.8% 76.7%, P=0.756) between the two subgroups. No significant correlation was noted between the length of resection margin and the tumor size and depth. However, tumor depth was an independent factor related to higher local recurrence on multivariate analysis.
Extent of resection margin in pulmonary metastasectomy does not seem to affect significantly on the local recurrence if complete resection is accomplished. However, preoperative tumor depth on CT image and postoperative distant metastasis seem to affect on local recurrence after pulmonary metastasectomy.
评估肿瘤深度对术前计算机断层扫描（CT）图像的影响，以及结直肠癌肺转移瘤切除术后切缘长度对局部复发的影响。
分析2007年至2017年因结直肠癌单发肺转移接受胸腔镜肺楔形切除术的患者。分析切缘、肿瘤大小和深度等因素。对基于肺切除切缘的两个亚组（第1组：切缘1 - 10毫米或短于肿瘤大小，第2组：切缘>10毫米或至少大于肿瘤大小）的局部复发情况进行分析。
本研究纳入65例患者。局部复发率为12/65（18.5%）。中位随访期为33个月。术前CT上肿瘤大小和深度的中位数分别为1.1厘米和1.6厘米。切缘长度的中位数为0.5厘米（第1组：0.4厘米，第2组：1.0厘米，P<0.001）。两个亚组之间的3年无局部复发生存率无差异（80.8%对76.7%，P = 0.756）。切缘长度与肿瘤大小和深度之间未发现显著相关性。然而，在多因素分析中，肿瘤深度是与较高局部复发相关的独立因素。
如果实现了完整切除，肺转移瘤切除术中切缘范围似乎对局部复发没有显著影响。然而，术前CT图像上的肿瘤深度和术后远处转移似乎对肺转移瘤切除术后的局部复发有影响。
