Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, 1800, Ooazaaoyagi, Yamagata, 990-2292, Japan.
Division of General Thoracic Surgery, School of Medicine, Teikyo University, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2021 Jun;69(6):950-959. doi: 10.1007/s11748-020-01560-7. Epub 2021 Jan 3.
Pulmonary metastasectomy is a common treatment for selected patients with pulmonary metastases. Among pulmonary resections, wedge resection is considered sufficient for pulmonary metastases. However, a major problem with wedge resection is the risk of local recurrence, especially at the surgical margin. The aim of this prospective study was to explore the frequency of and the risk factors for recurrence at the surgical margin in patients who underwent wedge resection for pulmonary metastases.
Between September 2013 and March 2018, 177 patients (220 lesions) with pulmonary metastases from 15 institutions were enrolled. We studied 130 cases (169 lesions) to determine the frequency of and risk factors associated with recurrence at the surgical margin in patients who underwent wedge resection. Moreover, we evaluated the recurrence-free rate and disease-free survival after wedge resection.
A total of 81 (62.3%) patients developed recurrence. Recurrence at the surgical margin was observed in 11 of 130 (8.5%) cases. The 5-year recurrence-free rate was 89.1%. Per patient, multivariable analysis revealed that the presence of multiple pulmonary metastases was a significant risk factor for recurrence. Per tumor, distance from the surgical margin and tumor/margin ratio were risk factors for local recurrence. The 5-year disease-free survival rate was 34.7%, and the presence of multiple pulmonary metastases and small surgical margin were risk factors for disease-free survival by univariable analysis.
Among patients who undergo wedge resection for pulmonary metastasis, patients with multiple pulmonary metastases tend to develop recurrence at the surgical margin.
肺转移瘤切除术是治疗特定肺转移患者的常用方法。在肺切除术中，楔形切除术被认为足以治疗肺转移瘤。然而，楔形切除术的一个主要问题是局部复发的风险，尤其是在手术切缘处。本前瞻性研究旨在探讨行楔形切除术治疗肺转移瘤患者手术切缘复发的频率和相关危险因素。
2013 年 9 月至 2018 年 3 月，177 例（220 处病变）来自 15 家机构的肺转移瘤患者被纳入本研究。我们对 130 例（169 处病变）患者进行了研究，以确定行楔形切除术的患者手术切缘复发的频率和相关危险因素，并评估楔形切除术后的无复发生存率和无病生存率。
共有 81 例（62.3%）患者出现复发。130 例患者中有 11 例（8.5%）发生手术切缘复发。5 年无复发生存率为 89.1%。多变量分析显示，多发肺转移瘤是复发的显著危险因素。每例患者中，手术切缘距离和肿瘤/切缘比是局部复发的危险因素。5 年无病生存率为 34.7%，单变量分析显示多发肺转移瘤和小手术切缘是无病生存的危险因素。
在接受楔形切除术治疗肺转移瘤的患者中，多发肺转移瘤患者的手术切缘更易发生复发。
