Ueda T, Uchida A, Kodama K, Doi O, Nakahara K, Fujii Y, Komatsubara Y, Ono K
Department of Orthopaedic Surgery, Center for Adult Diseases, Osaka, Japan.
Cancer. 1993 Sep 15;72(6):1919-25. doi: 10.1002/1097-0142(19930915)72:6<1919::aid-cncr2820720621>3.0.co;2-d.
To evaluate the efficacy of aggressive pulmonary metastasectomy for treating soft tissue sarcomas, the clinical data on the surgical management of 23 patients with extensive pulmonary metastases from soft tissue sarcomas were reviewed.
Between January 1973 and April 1991, 9 male patients and 14 female patients were treated. Their ages ranged from 13-68 years (median, 42 years). Twenty-one patients (91%) had bilateral and multiple metastases, and two patients had solitary metastasis. The number of resected metastatic nodules ranged from 1-110 (mean, 30.5). As an initial surgical approach, median sternotomy was used on 18 patients and lateral thoracotomy on 5 patients. Eleven patients underwent two or more explorations for recurrent metastases using lateral thoracotomy. The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser was adopted in 10 patients since 1986.
The actuarial 2-year and 5-year survival rates after the first pulmonary resection were 49.7% and 24.8%, respectively. Histologic type (alveolar soft part sarcoma versus synovial sarcoma, P < 0.025), histologic grade (G1 and G2 versus G3, P < 0.01), and metastatic localization (subpleural versus extrapleural, P < 0.005) were the most significant prognostic factors for aggressive pulmonary metastasectomy of soft tissue sarcomas. Application of laser surgery, absence of local recurrences, and absence of extrapulmonary metastases before pulmonary resection also correlated with better prognosis with borderline significance.
Aggressive pulmonary metastasectomy for soft tissue sarcomas is a recommended procedure, even in the case of extensive metastases. The combination of median sternotomy and Nd:YAG laser-assisted surgery is a useful technique, especially in bilateral multiple pulmonary metastases.
为评估积极的肺转移瘤切除术治疗软组织肉瘤的疗效，回顾了23例软组织肉瘤广泛肺转移患者手术治疗的临床资料。
1973年1月至1991年4月，共治疗9例男性患者和14例女性患者。年龄范围为13 - 68岁（中位数42岁）。21例患者（91%）有双侧及多发转移，2例患者有孤立转移。切除的转移结节数为1 - 110个（平均30.5个）。作为初始手术入路，18例患者采用胸骨正中切开术，5例患者采用侧胸壁切开术。11例患者因复发性转移采用侧胸壁切开术进行了两次或更多次探查。自1986年起，10例患者采用了钕:钇铝石榴石（Nd:YAG）激光。
首次肺切除术后的精算2年和5年生存率分别为49.7%和24.8%。组织学类型（肺泡软组织肉瘤与滑膜肉瘤，P < 0.025）、组织学分级（G1和G2与G3，P < 0.01）以及转移部位（胸膜下与胸膜外，P < 0.005）是软组织肉瘤积极肺转移瘤切除术最重要的预后因素。激光手术的应用、肺切除术前无局部复发以及无肺外转移也与较好的预后相关，具有临界显著性。
即使在广泛转移的情况下，积极的软组织肉瘤肺转移瘤切除术也是推荐的手术方式。胸骨正中切开术与Nd:YAG激光辅助手术相结合是一种有用的技术，尤其是在双侧多发肺转移的情况下。
