Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Thorac Cardiovasc Surg. 2023 Mar;71(2):130-137. doi: 10.1055/s-0042-1755555. Epub 2022 Aug 20.
To date, many studies investigated results and prognostic factors of pulmonary metastasectomy (PM) in renal cell cancer (RCC). However, reports concerning repeated resection for patients with recurrent pulmonary metastases (RPM) are limited. In this study, we analyzed safety, efficacy, and prognostic factors for survival after PM focusing on RPM for RCC.
Clinical, operative, and follow-up data of patients who underwent PM or RPM for RCC in our institution were retrospectively collected and correlated with each other from January 2005 to December 2019.
Altogether 154 oncological pulmonary resections in curative intention as PM or RPM were performed in 82 and 26 patients. Postoperative complications were similar in both groups ( = 22 [26.8%] vs. 4 [15.4%], = 0.2). Zero mortality was documented up to the 30th postoperative day. RPM was not associated with decreased 5-year-survival compared with PM (66.2 vs. 57,9%, = 0.5). Patients who underwent RPM for recurrent lung metastases had a better overall survival in comparison with the other treatments including chemotherapy, radiotherapy, immunotherapy, and best supportive care ( = 0.04). In the multivariate analysis, disease-free survival was identified as an independent prognostic factor for survival (hazard ratio: 0.969, 0.941-0.999, = 0.04).
RPM is a safe and feasible procedure. The resection of recurrent lung metastases shows to prolong survival in comparison with the other therapeutic options for selected patients with RCC.
迄今为止，许多研究调查了肾细胞癌（RCC）肺转移瘤切除术（PM）的结果和预后因素。然而，关于复发性肺转移（RPM）患者重复切除的报道有限。在这项研究中，我们分析了针对 RCC 患者 PM 重点为 RPM 的安全性、疗效和生存预后因素。
回顾性收集了 2005 年 1 月至 2019 年 12 月期间在我院接受 PM 或 RPM 治疗的 RCC 患者的临床、手术和随访数据，并对其进行了相互关联分析。
82 例患者共行 154 例根治性肺切除术，其中 PM 或 RPM 分别为 82 例和 26 例。两组术后并发症相似（分别为 22 例[26.8%]和 4 例[15.4%]，=0.2）。术后 30 天内无死亡病例。与 PM 相比，RPM 并未降低 5 年生存率（66.2% vs. 57.9%，=0.5）。与化疗、放疗、免疫治疗和最佳支持治疗等其他治疗方法相比，RPM 复发性肺转移患者的总生存时间更长（=0.04）。多因素分析显示，无病生存期是生存的独立预后因素（风险比：0.969，0.941-0.999，=0.04）。
RPM 是一种安全可行的手术方法。与其他治疗选择相比，RPM 切除复发性肺转移可延长部分 RCC 患者的生存时间。
