Fourquier P, Regnard J F, Rea S, Levi J F, Levasseur P
Marie Lannelongue Hospital, Le Plessis Robinson, France.
Eur J Cardiothorac Surg. 1997 Jan;11(1):17-21. doi: 10.1016/s1010-7940(96)01013-5.
The research was designed to evaluate the results of surgical resection of renal lung metastases.
Between 1960 and 1994, 50 consecutive patients underwent resection for pulmonary metastases from renal cell carcinoma. Mean age was 59 years (range: 40-78 years). Mean time between nephrectomy and pulmonary resection was 3 years (range: 0-18 years). Nineteen patients had solitary metastase, 13 multiple unilateral, and 18 bilateral. Wedge excision was performed in 28 patients, segmentectomy in 3, lobectomy in 17, sleeve lobectomy in 1, pneumonectomy in 5 and biopsy in 3. Twelve patients had repeat resection for recurrent metastases.
The resection was complete in 45 patients. Three patients also had a complete resection of limited extra-pulmonary disease. There was one postoperative death and 3 complications. Mean follow-up was 42 months without loss of follow-up. The cause of death was always metastatic recurrent disease. Five-year survival in complete resection was 44%. Only one long survivor was observed in the case of incomplete resection in a patient who had a complete response after adjuvant immunotherapy. Five-year survival for the 12 patients with repeat resections was similar to the overall survival rate (42%).
Resection of renal lung metastases is a safe and effective treatment. No factor influenced the 5-year survival in this series except the complete resection. Extra-pulmonary metastases does not contra-indicate pulmonary resection. In selected patients, repeat resection for recurrent disease is warranted.
本研究旨在评估肾肺转移瘤手术切除的结果。
1960年至1994年间，50例连续患者接受了肾细胞癌肺转移瘤切除术。平均年龄59岁（范围：40 - 78岁）。肾切除术与肺切除术之间的平均时间为3年（范围：0 - 18年）。19例患者有单个转移灶，13例为多个单侧转移灶，18例为双侧转移灶。28例患者行楔形切除术，3例行肺段切除术，17例行肺叶切除术，1例行袖状肺叶切除术，5例行全肺切除术，3例行活检。12例患者因复发性转移瘤接受了再次切除术。
45例患者手术切除完全。3例患者还对局限性肺外疾病进行了完全切除。术后有1例死亡和3例并发症。平均随访42个月，无失访情况。死亡原因均为转移性复发性疾病。完全切除患者的5年生存率为44%。在不完全切除的患者中，仅1例长期存活者在辅助免疫治疗后有完全缓解。12例接受再次切除术患者的5年生存率与总体生存率相似（42%）。
肾肺转移瘤切除术是一种安全有效的治疗方法。除了完全切除外，本系列中没有因素影响5年生存率。肺外转移并不妨碍肺切除术。对于选定的患者，复发性疾病再次切除是必要的。
