Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Langenbecks Arch Surg. 2023 Dec 18;409(1):11. doi: 10.1007/s00423-023-03198-4.
Systemic chemotherapy is generally used for metastatic pancreatic cancer; however, pulmonary resection may be a treatment option for lung oligometastases from pancreatic cancer. The current study aimed to clarify the oncological outcomes and clinical benefits of pulmonary resection for lung metastases.
Of 510 patients who underwent pancreatic resection for pancreatic cancer, 44 patients with recurrence of isolated lung metastases and one patient with simultaneous lung metastases were evaluated.
Of the 45 patients, 20 patients were selected as candidates for pulmonary resection based on clinical factors such as recurrence-free interval (RFI) from pancreatectomy to lung metastases, number of lung metastases, and serum CA19-9 level. The post-recurrent survival of patients with pulmonary resection was significantly better than that of patients without pulmonary resection. Fourteen of the 20 patients with pulmonary resection developed tumor recurrence with a median disease-free survival (DFS) of 15 months. Univariate analyses revealed that an RFI from pancreatectomy to lung metastases of ≥28 months was associated with better DFS after pulmonary resection. Of the 14 patients with an RFI of ≥28 months, pulmonary resection resulted in prolonged chemotherapy-free interval in 12 patients. Furthermore, repeat pulmonary resection for recurrent tumors after pulmonary resection led to further cancer-free interval in some cases.
Although many patients had tumor recurrence after pulmonary resection, pulmonary resection for lung metastases from pancreatic cancer may provide prolonged cancer-free interval without the need for chemotherapy. Pulmonary resection should be performed for the patients with a long RFI from pancreatectomy to lung metastases.
转移性胰腺癌一般采用全身化疗；然而，肺切除术可能是胰腺癌肺寡转移灶的一种治疗选择。本研究旨在阐明肺切除术治疗肺转移瘤的肿瘤学疗效和临床获益。
在 510 例行胰腺切除术治疗胰腺癌的患者中，评估了 44 例孤立性肺转移复发患者和 1 例同时性肺转移患者。
在 45 例患者中，根据无复发生存期（RFI）、肺转移灶数量和血清 CA19-9 水平等临床因素，20 例患者被选为肺切除术候选者。肺切除术患者的复发后生存显著优于未行肺切除术的患者。20 例肺切除术患者中有 14 例出现肿瘤复发，中位无疾病生存期（DFS）为 15 个月。单因素分析显示，胰腺切除术后至肺转移的 RFI≥28 个月与肺切除术后 DFS 较好相关。在 RFI≥28 个月的 14 例患者中，肺切除术使 12 例患者的化疗无间隔期延长。此外，肺切除术后复发性肿瘤的再次肺切除术在某些情况下导致进一步的无癌间隔期。
尽管许多患者在肺切除术后出现肿瘤复发，但肺切除术治疗胰腺癌肺寡转移灶可能提供无需化疗的延长无癌间隔期。对于胰腺切除术后至肺转移的 RFI 较长的患者，应进行肺切除术。
