Prisciandaro Elena, Ceulemans Laurens J, Van Raemdonck Dirk E, Decaluwé Herbert, De Leyn Paul, Bertolaccini Luca
Department of Thoracic Surgery, Universitaire Ziekenhuizen Leuven, Leuven, Belgium.
Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Katholieke Universiteit Leuven, Leuven, Belgium.
J Thorac Dis. 2022 Jul;14(7):2677-2688. doi: 10.21037/jtd-22-239.
Pulmonary metastasectomy (PM) with curative intent has become a widely accepted treatment for lung metastases from solid tumours in selected patients, with low perioperative morbidity and mortality. In particular, PM is strongly recommended in selected patients with secondary lesions from colorectal cancer (CRC), due to its excellent postoperative prognosis. Nevertheless, the impact of the extent of PM on recurrence and survival remains controversial. This review aimed at assessing differences in short- and long-term postoperative outcomes depending on the extent of lung resection for lung metastases.
A systematic literature review of studies comparing anatomical and non-anatomical resections of lung metastases was performed (Prospective Register of Systematic Reviews Registration: 254931). A literature search for articles published in English between the date of database inception and January 31, 2021 was performed in EMBASE (via Ovid), MEDLINE (via PubMed) and Cochrane CENTRAL. Retrospective studies, randomised and non-randomised controlled trials were included. The Cochrane Collaboration tool was used to determine the risk of bias for the primary outcome for included studies.
Out of 432 papers, three retrospective non-randomised studies (1,342 patients) were selected for systematic reviewing. Although our search design did not exclude any primary tumour histology, all selected studies investigated surgical resection of lung metastases from CRC. Because of variations in the compared surgical approaches to pulmonary metastases, a meta-analysis proved unfeasible. There was a tendency to perform anatomical resections for larger metastases. Multivariate analyses revealed that anatomical resections were protective for recurrence-free survival (RFS), while the impact of such procedures on overall survival (OS) remained uncertain. A significantly higher incidence of resection-margin recurrences was observed in patients who underwent non-anatomical resections.
Anatomical resections of lung metastases from CRC seem to be associated with improved RFS. However, well-constructed comparative clinical trials focusing on the extent of PM are needed.
根治性肺转移瘤切除术（PM）已成为在特定患者中广泛接受的实体瘤肺转移治疗方法，围手术期发病率和死亡率较低。特别是，由于其术后预后良好，强烈推荐对特定的结直肠癌（CRC）继发性病变患者进行PM。然而，PM范围对复发和生存的影响仍存在争议。本综述旨在评估根据肺转移瘤肺切除范围不同，术后短期和长期结果的差异。
对比较肺转移瘤解剖性和非解剖性切除的研究进行系统文献综述（系统评价前瞻性注册：254931）。在EMBASE（通过Ovid）、MEDLINE（通过PubMed）和Cochrane CENTRAL中对数据库建立之日至2021年1月31日期间以英文发表的文章进行文献检索。纳入回顾性研究、随机和非随机对照试验。使用Cochrane协作工具确定纳入研究主要结局的偏倚风险。
在432篇论文中，选择了三项回顾性非随机研究（1342例患者）进行系统评价。尽管我们的检索设计未排除任何原发性肿瘤组织学类型，但所有入选研究均调查了CRC肺转移瘤的手术切除情况。由于比较肺转移瘤手术方法存在差异，荟萃分析证明不可行。对于较大的转移瘤，倾向于进行解剖性切除。多变量分析显示，解剖性切除对无复发生存期（RFS）有保护作用，而此类手术对总生存期（OS）的影响仍不确定。接受非解剖性切除的患者切除边缘复发的发生率显著更高。
CRC肺转移瘤的解剖性切除似乎与改善RFS相关。然而，需要开展重点关注PM范围的精心设计的比较临床试验。
