Kandioler D, Krömer E, Tüchler H, End A, Müller M R, Wolner E, Eckersberger F
Department of Cardio-Thoracic Surgery, University of Vienna Medical School, Austria.
Ann Thorac Surg. 1998 Apr;65(4):909-12. doi: 10.1016/s0003-4975(98)00019-8.
Although surgical resection is accepted widely as first-line therapy for pulmonary metastases, few data exist on the surgical treatment of recurrent pulmonary metastatic disease. In a retrospective study, we analyzed patients who were operated on repeatedly for recurrent metastatic disease of the lung with curative intent over a 20-year period.
From 1973 to 1993, 396 metastasectomies were performed in 330 patients. The study population included patients with any histologic tumor type who had undergone at least two (range, 2 to 4) complete surgical procedures because of recurrent metastatic disease. Surgical and functional resectability of the recurrent lung metastases and control of the primary lesion served as objective criteria for reoperation. A subgroup of 35 patients that included patients with histologic findings such as epithelial cancer and osteosarcoma then was analyzed retrospectively to calculate prognosis and define selection criteria for repeated pulmonary metastasectomy.
The 5- and 10-year survival rates after the first metastasectomy were 48% and 28%, respectively. The overall median survival was 60 months. A mean disease-free interval (calculated for all intervals, with a minimum of two) of greater than 1 year was significantly associated with a survival advantage beyond the last operation. Univariate analysis failed to show size, number, increase or decrease in number or size, or distribution of metastases as factors related significantly to survival.
Although patients with different histologic tumor types were included, the study population appeared to be homogeneous in terms of survival benefit and prognostic factors, and it probably represented the selection of biologically favorable tumors in which histology, size, number, and laterality are of minor importance. We conclude that patients who are persistently free of disease at the primary location but who have recurrent, resectable metastatic disease of the lung are likely to benefit from operation a second, third, or even fourth time.
虽然手术切除被广泛接受为肺转移瘤的一线治疗方法，但关于复发性肺转移疾病的外科治疗数据较少。在一项回顾性研究中，我们分析了在20年期间因复发性肺转移疾病而接受多次手术且有治愈意图的患者。
1973年至1993年，对330例患者进行了396次肺转移瘤切除术。研究人群包括任何组织学肿瘤类型的患者，这些患者因复发性转移疾病接受了至少两次（范围为2至4次）完整的外科手术。复发性肺转移瘤的手术及功能可切除性和原发灶的控制作为再次手术的客观标准。然后对包括上皮癌和骨肉瘤等组织学表现的35例患者亚组进行回顾性分析，以计算预后并确定重复肺转移瘤切除术的选择标准。
首次肺转移瘤切除术后的5年和10年生存率分别为48%和28%。总体中位生存期为60个月。无病间期（计算所有间期，至少为两次）大于1年与最后一次手术后的生存优势显著相关。单因素分析未显示转移瘤的大小、数量、数量或大小的增加或减少或分布与生存有显著相关因素。
虽然纳入了不同组织学肿瘤类型的患者，但研究人群在生存获益和预后因素方面似乎具有同质性，可能代表了生物学上有利的肿瘤选择，其中组织学、大小、数量和部位不太重要。我们得出结论，原发部位持续无病但有复发性、可切除的肺转移疾病的患者可能从第二次、第三次甚至第四次手术中获益。
