Thoracic and Vascular Surgery Department, SLK Lung Medical Center Löwenstein, Löwenstein, Germany.
Pulmonary Medicine Department, SLK Lung Medical Center Löwenstein, Löwenstein, Germany.
Sci Rep. 2024 Mar 12;14(1):5988. doi: 10.1038/s41598-024-56566-5.
Pulmonary metastasectomy (PM) is consensually performed in a parenchyma-sparing manner to preserve functionally healthy lung tissue. However, this may increase the risk of local recurrence at the surgical margin. Laser assisted pulmonary metastasectomy (LPM) is a relatively recent innovation that is especially useful to resect multiple metastatic pulmonary nodules. In this study we investigated the rate of local recurrence after LPM and evaluated the influence of various clinical and pathological factors on local recurrence. Retrospectively, a total of 280 metastatic nodules with different histopathological entities were studied LPM from 2010 till 2018. All nodules were resected via diode-pumped neodymium: yttrium-aluminum-garnet (Nd:YAG) 1,318 nm laser maintaining a safety margin of 5 mm. Patients included were observed on average for 44 ± 17 months postoperatively. Local recurrence at the surgical margin following LPM was found in 9 nodules out of 280 nodules (3.21%). Local recurrence at the surgical margin occurred after 20 ± 8.5 months post operation. Incomplete resection (p = < 0.01) and size of the nodule (p = < 0.01) were associated with significantly increased risk of local recurrence at the surgical margin. Histology of the primary disease showed no impact on local recurrence. Three and five-year survival rates were 84% and 49% respectively. Following LPM, the rate of local recurrence is low. This is influenced by the size of the metastatic nodules and completeness of the resection. Obtaining a safety margin of 5 mm seems to be sufficient, larger nodules require larger safety margins.
肺转移瘤切除术（PM）是一种共识性的、以保护功能健康肺组织为目的的节段性切除术。然而，这可能会增加手术切缘局部复发的风险。激光辅助肺转移瘤切除术（LPM）是一种相对较新的创新技术，特别适用于切除多个肺转移瘤。在这项研究中，我们调查了 LPM 后局部复发的发生率，并评估了各种临床和病理因素对局部复发的影响。回顾性地，研究了 2010 年至 2018 年间共 280 个具有不同组织病理学特征的转移性结节的 LPM。所有结节均通过二极管泵浦钕：钇铝石榴石（Nd：YAG）1318nm 激光切除，保持 5mm 的安全边缘。患者平均术后观察 44±17 个月。在 280 个结节中有 9 个（3.21%）发现 LPM 后手术切缘局部复发。局部复发发生在术后 20±8.5 个月。不完全切除（p<0.01）和结节大小（p<0.01）与手术切缘局部复发的风险显著增加相关。原发疾病的组织学没有显示出对局部复发的影响。3 年和 5 年生存率分别为 84%和 49%。LPM 后局部复发率较低。这受到转移瘤大小和切除完整性的影响。获得 5mm 的安全边缘似乎是足够的，较大的结节需要更大的安全边缘。
