开胸或电视辅助胸腔镜手术切除结直肠癌肺转移后同侧部位复发的发生率。
Incidence of Ipsilateral Side Recurrence After Open or Video-Assisted Thoracic Surgery Resection of Colorectal Lung Metastases.
机构信息
Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
出版信息
Ann Thorac Surg. 2020 May;109(5):1591-1597. doi: 10.1016/j.athoracsur.2019.11.031. Epub 2020 Jan 15.
BACKGROUND
There is still controversy whether full lung palpation is required for patients undergoing pulmonary metastasectomy. We aimed to compare pulmonary ipsilateral recurrence (IR) after video-assisted thoracic surgery (VATS) or open surgery.
METHODS
A retrospective study of all patients who underwent surgery for colorectal cancer lung metastases between 2003 and 2012 was performed. IR rate was compared between the 2 groups after adjusting for a propensity score matching based on age, sex, disease-free interval, number of metastases, type of resection, presence of a cardiovascular risk factor, presence of a respiratory risk factor, as well as the interaction between the number of metastases and the disease-free interval. The propensity score was used for matched and weighted comparisons of VATS and open patients.
RESULTS
A total of 211 patients underwent surgery for colorectal cancer lung metastases. Of these, 75 (35.5%) were performed via VATS and 136 (64.5%) via open surgery. Before matching, 118 (55.9%) were male and the median age at the time of metastases diagnosis was 61 (range, 49.8-72.2) years. Median disease free-interval was 20 (19.7 ± 28.3) months; 22 (21.6 ± 28.5) months in VATS and 19 (19.0 ± 28.3) months in open surgery. In total, 19 (25.3%) developed IR in VATS, and 39 (28.7%) in open surgery. Five-year overall survival was 53.1% (61.9% VATS; 49.2% open). In the matched sample, IR was 23.6% in VATS vs 26.2% in open surgery (95% confidence interval for risk reduction with VATS: -22.6% to 17.5%; P = .80).
CONCLUSIONS
No significant difference was observed in IR rates between VATS and open surgery in the treatment of colorectal cancer lung metastases.
背景
对于接受肺转移切除术的患者，是否需要进行全肺触诊仍存在争议。我们旨在比较电视辅助胸腔镜手术（VATS）和开放性手术的同侧肺复发（IR）率。
方法
对 2003 年至 2012 年间接受结直肠癌肺转移手术的所有患者进行了回顾性研究。在调整年龄、性别、无病间隔、转移数量、切除类型、心血管危险因素存在、呼吸危险因素存在以及转移数量与无病间隔的相互作用的倾向评分匹配后，比较两组之间的 IR 率。使用倾向评分对 VATS 和开放性患者进行匹配和加权比较。
结果
共有 211 例患者接受了结直肠癌肺转移手术。其中，75 例（35.5%）采用 VATS 进行，136 例（64.5%）采用开放性手术。在匹配之前，118 例（55.9%）为男性，转移诊断时的中位年龄为 61 岁（范围为 49.8-72.2）。中位无病间隔时间为 20（19.7±28.3）个月；VATS 为 22（21.6±28.5）个月，开放性手术为 19（19.0±28.3）个月。共有 19 例（25.3%）在 VATS 中出现 IR，39 例（28.7%）在开放性手术中出现 IR。5 年总生存率为 53.1%（VATS 为 61.9%；开放性手术为 49.2%）。在匹配样本中，VATS 中 IR 为 23.6%，开放性手术中 IR 为 26.2%（VATS 风险降低的 95%置信区间为-22.6%至 17.5%；P=0.80）。
结论
在治疗结直肠癌肺转移中，VATS 和开放性手术的 IR 率之间未观察到显著差异。
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