McCormack P M, Bains M S, Begg C B, Burt M E, Downey R J, Panicek D M, Rusch V W, Zakowski M, Ginsberg R J
Department of Diagnostic Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Ann Thorac Surg. 1996 Jul;62(1):213-6; discussion 216-7. doi: 10.1016/0003-4975(96)00253-6.
A retrospective review revealed a 42% error rate between computed tomographic scan reports and thoracotomy findings; therefore, a prospective study was designed to compare the value of computed tomographic scans, video-assisted thoracoscopic exploration, and open thoracotomy in the management of pulmonary metastases.
Eligibility included any patient with only one or two ipsilateral pulmonary metastases identified on computed tomographic scan who was being considered for surgical resection. Initially video-assisted thoracic surgery was performed and all lesions identified were resected. A thoracotomy adequate for complete lung palpation was then carried out and any additional lesions found were removed.
Eighteen patients of a planned 50 were treated before closure of the study. Four patients (22%) had no additional lesions found at thoracotomy. The primary sites of tumor were colon (10), breast (3), and one patient each skin (squamous), cervix, kidney, melanoma, and sarcoma. Four patients (22%) did have additional lesions at thoracotomy, which were benign. In the remaining 10 patients (56%) additional malignant lesions were found at thoracotomy after video-assisted thoracoscopic exploration. After 18 patients were entered, analysis of the early results disclosed a 56% failure rate of a computed tomographic scan and video-assisted thoracic surgery to detect all lesions. Being within the 95% confidence interval (32% to 78%), the study was abandoned.
We conclude that video-assisted thoracic surgery should be used only as a diagnostic tool in managing lung metastasis. A thoracotomy is required to achieve complete resection, which is the major survival prognosticator for satisfactory long-term results.
一项回顾性研究显示，计算机断层扫描报告与开胸手术结果之间的错误率为42%；因此，设计了一项前瞻性研究，以比较计算机断层扫描、电视辅助胸腔镜探查和开胸手术在肺转移瘤治疗中的价值。
纳入标准为计算机断层扫描发现仅一两个同侧肺转移瘤且考虑手术切除的任何患者。首先进行电视辅助胸腔镜手术，切除所有发现的病灶。然后进行足以完全触诊肺的开胸手术，切除发现的任何其他病灶。
计划纳入的50例患者中有18例在研究结束前接受了治疗。4例患者（22%）开胸手术未发现其他病灶。肿瘤原发部位为结肠（10例）、乳腺（3例），皮肤（鳞状细胞癌）、宫颈、肾脏、黑色素瘤和肉瘤各1例。4例患者（22%）开胸手术确实发现了其他病灶，均为良性。其余10例患者（56%）在电视辅助胸腔镜探查后开胸手术发现了其他恶性病灶。纳入18例患者后，早期结果分析显示计算机断层扫描和电视辅助胸腔镜手术检测所有病灶的失败率为56%。由于在95%置信区间（32%至78%）内，该研究被终止。
我们得出结论，电视辅助胸腔镜手术仅应用作肺转移瘤治疗的诊断工具。需要开胸手术以实现完全切除，这是获得满意长期结果的主要生存预后因素。
