Ambrogi Vincenzo, Tamburrini Alessandro, Tajé Riccardo
Thoracic Surgery Unit, Tor Vergata University Polyclinic, Rome, Italy.
Thoracic Surgery Unit, Southampton University Hospital, Southampton, UK.
J Thorac Dis. 2021 Apr;13(4):2669-2685. doi: 10.21037/jtd-19-4064.
Repeat surgical resection (redo) for pulmonary metastases is a questionable, albeit intriguing topic. We performed an extensive review of the literature, to specifically analyze results of redo pulmonary metastasectomies. We reviewed a total of 3,523 papers. Among these, 2,019 were excluded for redundancy and 1,105 because they were not completely retrievable. Out of 399 eligible papers, 183 had missing information or missing abstract, while 96 lacked data on survival. A total of 120 papers dated from 1991 onwards were finally included. Data regarding mortality, major morbidity, prognostic factors and long-term survivals of the first redo pulmonary metastasectomies were retrieved and analyzed. Homogeneity of data was affected by the lack of guidelines for redo pulmonary metastasectomy and the risks of bias when comparing different studies has to be considered. According to the histology sub-types, redo metastasectomies papers were grouped as: colorectal (n=42), sarcomas (n=36), others (n=20) and all histologies (n=22); the total number of patients was 3,015. Data about chemotherapy were reported in half of the papers, whereas targeted or immunotherapy in 9. None of these associated therapies, except chemotherapy in two records, did significantly modify outcomes. Disease-free interval before the redo procedure was the prevailing prognostic factor and nearly all papers showed a significant correlation between patients' comorbidities and prognosis. No perioperative mortality was reported, while perioperative major morbidity was overall quite low. Where available, overall survival after the first redo metastasectomy ranged from 10 to 72 months, with a 5-years survival of approximately 50%. The site of first recurrence after the redo procedure was mainly lung. Despite the data retrievable from literature are heterogeneous and confounding, we can state that redo lung metastasectomy is worthwhile when the lesions are resectable and the perioperative risk is low. At present, there are no "non-surgical" therapeutic options to replace redo pulmonary metastasectomies.
对肺转移瘤进行再次手术切除(redo)是一个颇具争议但又引人入胜的话题。我们对文献进行了广泛回顾,以专门分析再次肺转移瘤切除术的结果。我们共查阅了3523篇论文。其中,2019篇因冗余被排除,1105篇因无法完全获取而被排除。在399篇符合条件的论文中,183篇存在信息缺失或摘要缺失的情况,96篇缺乏生存数据。最终纳入了1991年以后发表的120篇论文。检索并分析了首次再次肺转移瘤切除术的死亡率、主要并发症、预后因素和长期生存率等数据。由于缺乏再次肺转移瘤切除术的指南,数据的同质性受到影响,在比较不同研究时必须考虑偏倚风险。根据组织学亚型,再次转移瘤切除术的论文分为:结直肠癌(n = 42)、肉瘤(n = 36)、其他(n = 20)和所有组织学类型(n = 22);患者总数为3015例。约一半的论文报告了化疗数据,而靶向治疗或免疫治疗的数据在9篇论文中有报告。除了两篇记录中的化疗外,这些相关治疗均未显著改变预后。再次手术前的无病间期是主要的预后因素,几乎所有论文都显示患者的合并症与预后之间存在显著相关性。未报告围手术期死亡率,而围手术期主要并发症总体较低。在可获取数据的情况下,首次再次转移瘤切除术后的总生存期为10至72个月,5年生存率约为50%。再次手术后首次复发的部位主要在肺部。尽管从文献中获取的数据存在异质性且相互混淆,但我们可以说,当病变可切除且围手术期风险较低时,再次肺转移瘤切除术是值得的。目前,尚无“非手术”治疗方案可替代再次肺转移瘤切除术。