Saltzman D A, Snyder C L, Ferrell K L, Thompson R C, Leonard A S
Department of Surgery, University of Minnesota Hospital and Clinics, University of Minnesota, Minneapolis.
Am J Surg. 1993 Nov;166(5):543-7. doi: 10.1016/s0002-9610(05)81150-x.
Pulmonary metastases are the primary cause of death due to bone and soft tissue sarcomas. We have previously shown that an aggressive approach and a new technique of multiple pulmonary metastasectomies have resulted in improved survival for patients with pulmonary metastases. In this follow-up study, an expanded database of patients was retrospectively analyzed to determine survivability as well as to evaluate potential prognostic indicators. Forty-nine patients, 26 of whom had osteogenic sarcoma (OGS), were evaluated. A number of patients had been referred from other institutions where their disease had been considered inoperable because it was extensive or recurrent. Using lateral thoracotomies exclusively, employment of a laser technique, and excision of minimal pulmonary parenchymal tissue, we performed aggressive metastasectomy. A mean of 3.0 thoracotomies was performed, in which an average of 10.2 nodules per thoracotomy were excised. Operative morbidity and mortality were minimal. The disease-free interval, the number of nodules resected, the number of thoracotomies performed, and the size of the nodules were evaluated as potential prognostic indicators. Statistically significant correlation could be established only for the size of the nodules resected. The 5-year survival rate for all patients was 39%; it was 24% for patients with OGS and 71% for those without OGS. Aggressive surgical resection of pulmonary metastases from bone and soft tissue sarcoma should be considered when there is control of local disease, no evidence of extrapulmonary metastasis, and adequate post-resection pulmonary reserve. The presence of bilateral, extensive, or recurrent disease is not a contraindication to thoracotomy. Aggressive resection of multiple nodules and improved chemotherapy appear to prolong survival of these patients when compared with survival rates of historical control subjects.
肺转移是骨肉瘤和软组织肉瘤导致死亡的主要原因。我们之前已经表明，积极的治疗方法和一种新的多次肺转移瘤切除术技术已使肺转移患者的生存率得到提高。在这项随访研究中，对一个扩大的患者数据库进行了回顾性分析，以确定生存率并评估潜在的预后指标。对49例患者进行了评估，其中26例患有骨肉瘤（OGS）。许多患者是从其他机构转诊而来的，在那些机构中，由于疾病广泛或复发，他们的病情被认为无法手术。我们仅采用侧胸壁切开术，运用激光技术，并切除最少的肺实质组织，进行了积极的转移瘤切除术。平均进行了3.0次胸壁切开术，每次胸壁切开术平均切除10.2个结节。手术并发症和死亡率极低。将无病间期、切除的结节数量、进行的胸壁切开术数量以及结节大小作为潜在的预后指标进行了评估。仅切除结节的大小能建立起具有统计学意义的相关性。所有患者的5年生存率为39%；OGS患者为24%，非OGS患者为71%。当局部疾病得到控制、无肺外转移证据且切除后肺储备充足时，应考虑对骨肉瘤和软组织肉瘤的肺转移进行积极的手术切除。双侧、广泛或复发性疾病的存在并非胸壁切开术的禁忌证。与历史对照对象的生存率相比，积极切除多个结节和改进化疗似乎能延长这些患者的生存期。
