Regnard J F, Nicolosi M, Coggia M, Spaggiari L, Fourquier P, Levi J F, Levasseur P
Service de Chirurgie Thoracique et Vasculaire, Centre Chirurgical Marie-Lannelongue.
Gastroenterol Clin Biol. 1995 Apr;19(4):378-84.
The aim of this work was to determine the long term results and the prognostic factors after surgical resection of pulmonary metastases from colorectal cancers.
Clinical status after surgery and survival were studied in 101 consecutive patients undergoing lung resection for pulmonary metastases from colorectal carcinoma between 1970 and 1993. Prognostic factors were evaluated according to surgical design. Mean interval between colon resection and lung resection was 44 months. Fifty-nine patients had a solitary lesion, 17 had multiple unilateral lesions and 25 multiple bilateral lesions. Eighteen patients had undergone previous surgery for localized extrapulmonary metastases. A wedge resection was performed in 47 patients, lobectomy or bilobectomy in 40, pneumonectomy in 11 and biopsy in 3.
There was no postoperative mortality and 5-year survival in complete resection was 21%; all patients with incomplete resection or biopsy died within 3 years. Significant prognostic factors were: complete resection, metachronous disease (vs synchronous metastases) and absence of lymph node involvement. The extent of the colorectal disease and the number of resected metastases did not influence prognosis. Survival for patients with resected extrapulmonary disease was not significantly different as compared with patients with only pulmonary metastases. Eleven patients had repeat pulmonary resections, 6 of these patients are currently alive, 3 of them more than 3 years after the second pulmonary resection.
We conclude that resection of colorectal lung metastases is safe and effective, that resectable extrapulmonary disease does not contra-indicate pulmonary resection and that repeat thoracotomy is warranted in selected patients with recurrent lung metastases.
本研究旨在确定结直肠癌肺转移灶手术切除后的长期疗效及预后因素。
对1970年至1993年间连续101例因结直肠癌肺转移而接受肺切除手术的患者的术后临床状况及生存情况进行研究。根据手术设计评估预后因素。结肠切除与肺切除的平均间隔时间为44个月。59例患者为孤立性病灶，17例为多发单侧病灶，25例为多发双侧病灶。18例患者曾因局限性肺外转移接受过手术。47例行楔形切除术，40例行肺叶切除术或双肺叶切除术，11例行全肺切除术，3例行活检。
无术后死亡病例，完全切除后的5年生存率为21%；所有不完全切除或活检的患者均在3年内死亡。显著的预后因素为：完全切除、异时性疾病（相对于同时性转移）及无淋巴结受累。结直肠疾病的范围及切除转移灶的数量不影响预后。切除肺外疾病患者的生存率与仅肺转移患者相比无显著差异。11例患者接受了再次肺切除，其中6例目前仍存活，3例在第二次肺切除后存活超过3年。
我们得出结论，结直肠癌肺转移灶切除安全有效，可切除的肺外疾病并非肺切除的禁忌证，对于部分复发性肺转移患者，再次开胸手术是必要的。
