Vigneswaran W T
Department of Surgery, University of Illinois at Chicago 60612, USA.
Semin Surg Oncol. 1996 Jul-Aug;12(4):264-6. doi: 10.1002/(SICI)1098-2388(199607/08)12:4<264::AID-SSU5>3.0.CO;2-3.
A significant number of patients who undergo complete resection of colorectal carcinoma develop pulmonary metastases. Despite advances in systemic chemotherapy, resection of the metastases localized to lungs remains the only mode of curative treatment. Control of primary disease, ability to resect all gross tumor, and adequate cardiorespiratory reserve are significant factors in selecting patients for resection. Hepatic metastases do not appear to influence long-term survival if completely resected. Patients with solitary metastases experienced the best long-term survival, but patients with as many as three pulmonary metastases, either unilateral or bilateral, could undergo resection with a 40% 5-year survival. The number of nodules does not constitute absolute criteria by which to select patients, and the decision must be individualized, given the set of circumstances. Complete surgical resection is critical to achieving long-term survival and is best achieved by a median sternotomy or "clamshell" incision. Resection of the metastases can be more effectively accomplished in most instances by wedge excision than by lobectomy or pneumonectomy, with minimal operative mortality and morbidity.
相当数量接受结直肠癌根治性切除的患者会发生肺转移。尽管全身化疗取得了进展，但对局限于肺部的转移灶进行切除仍然是唯一的治愈性治疗方式。控制原发疾病、能够切除所有肉眼可见肿瘤以及足够的心肺储备功能是选择患者进行切除的重要因素。如果肝转移灶能被完全切除，似乎并不影响长期生存。单发转移灶的患者长期生存率最佳，但有多达三个肺转移灶（单侧或双侧）的患者也可接受切除，5年生存率为40%。结节数量并非选择患者的绝对标准，必须根据具体情况进行个体化决策。完整的手术切除对于实现长期生存至关重要，通过正中胸骨切开术或“蛤壳式”切口能最好地实现这一点。在大多数情况下，通过楔形切除转移灶比肺叶切除或全肺切除能更有效地完成手术，手术死亡率和发病率极低。
