Kanemitsu Y, Kondo H, Katai H, Nakayama H, Asamura H, Tsuchiya R, Naruke T
Department of Surgical Oncology, National Cancer Center Hospital, Tokyo, Japan.
J Surg Oncol. 1998 Nov;69(3):147-50. doi: 10.1002/(sici)1096-9098(199811)69:3<147::aid-jso5>3.0.co;2-h.
There are no reports concerning surgical treatment on pulmonary metastases from gastric cancer. The aims of this study were to characterize patients with pulmonary metastasis from gastric cancer and to determine the efficacy of surgical therapy.
Between 1977 and 1993, 3,076 patients underwent curative resection for gastric cancer. Among them, four patients (0.1%) with pulmonary metastases from gastric cancer underwent pulmonary resection.
All four patients had advanced gastric cancers involving regional lymph nodes far from the primary gastric lesion. The median tumor-free interval after the initial gastrectomy was 32.0 months (range: 19-48 months). All patients underwent a lobectomy for a solitary pulmonary lesion. Although transthoracic fine-needle aspiration cytology revealed adenocarcinoma in all cases, none of them were definitely diagnosed as metastasis from gastric cancer preoperatively. The diagnosis was obtained after pulmonary resection. All patients received postoperative chemotherapy or radiotherapy, or both. However, they all subsequently developed systematic metastases. The time interval to recurrence after pulmonary resection ranged from 6 to 36 months and they were all dead at a median follow-up of 24.3 months after the pulmonary resection.
An aggressive surgical approach was not warranted in patients with isolated resectable pulmonary metastases from gastric cancer. However, the possibility of surgical treatment could not be eliminated because surgery is the only diagnostic method for a solitary pulmonary nodule when there is some doubt about the diagnosis of primary or secondary lung cancer in patients with gastric cancer.
尚无关于胃癌肺转移外科治疗的报道。本研究的目的是明确胃癌肺转移患者的特征，并确定外科治疗的疗效。
1977年至1993年间，3076例患者接受了胃癌根治性切除术。其中，4例（0.1%）胃癌肺转移患者接受了肺切除术。
所有4例患者均为进展期胃癌，伴有远离原发性胃病变的区域淋巴结转移。初次胃切除术后无瘤间期的中位数为32.0个月（范围：19 - 48个月）。所有患者均因孤立性肺病变接受了肺叶切除术。尽管经胸细针穿刺细胞学检查在所有病例中均显示为腺癌，但术前均未明确诊断为胃癌转移。诊断是在肺切除术后获得的。所有患者术后均接受了化疗或放疗，或两者皆有。然而，他们随后均出现了全身转移。肺切除术后复发的时间间隔为6至36个月，在肺切除术后中位随访24.3个月时，他们均死亡。
对于孤立性可切除的胃癌肺转移患者，不建议采取积极的手术方法。然而，手术治疗的可能性不能排除，因为当对胃癌患者原发性或继发性肺癌的诊断存在疑问时，手术是孤立性肺结节的唯一诊断方法。
