Is finger palpation at operation indispensable for pulmonary metastasectomy in colorectal cancer?
Is finger palpation at operation indispensable for pulmonary metastasectomy in colorectal cancer?
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DOI：
10.1016/j.athoracsur.2007.06.005
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发表时间：
2007-11-01
影响因子：
4.6
通讯作者：
Takamoto, Shinichi
中科院分区：
文献类型：
--
作者：
Nakajima, Jun;Murakawa, Tomohiro;Takamoto, Shinichi
背景胸腔镜技术用于肺转移瘤切除术是有争议的，因为小的转移灶可能会被遗漏，而不彻底的手指触诊肺。我们回顾性分析了术前螺旋CT检查结果和开胸手术（包括胸骨正中切开术或胸腔镜手术）获得的肺结节病理结果，这些患者被认为患有结直肠癌肺转移。从1999年到2005年，我们对102例患者进行了122次肺动脉切除术（开胸43次，胸腔镜79次）。排除重复输精管切除术。术前评估发现219个肺结节疑似肺转移，250个结节被切除，但病理检查显示47个（18.8%）没有转移。当肺结节直径较小时，转移率也明显降低。最后，4例开胸手术（9.3%）和5例胸腔镜手术（6.3%）患者在手术中发现了额外的肺转移瘤。在肺部手术后2年内，79例胸腔镜手术中有27例（34.2%）和43例开胸手术中有27例（62.8%）在同侧发现了复发性肺转移瘤（p = 0.0023）。这些转移灶可能在肺切除术时被遗漏。通过计算机断层扫描和手术技术（包括开放开胸术和双手触诊）进行术前评估，检测结直肠癌患者肺转移的能力受到限制。通过开胸手术或胸腔镜进行的肺叶切除术可能是去除肺部转移灶的次优干预措施。
Background. The use of thoracoscopic techniques for pulmonary metastasectomy is controversial because small metastatic foci might be missed without thorough finger palpation of the lung.Methods. We retrospectively examined preoperative findings of helical computed tomography and pathologic findings of pulmonary nodules obtained by open thoracotomy, including median sternotomy or thoracoscopy, in patients thought to have pulmonary metastasis from colorectal cancer.Results. We performed 122 pulmonary metastasectomies (43 thoracotomies and 79 thoracoscopies) in 102 patients from 1999 to 2005. Repeat metastasectomies were excluded. Preoperative evaluation revealed 219 pulmonary nodules suspicious for pulmonary metastasis, and 250 nodules were resected; however, pathologic examination revealed that 47 (18.8%) of 250 nodules were not metastases. When the diameters of the pulmonary nodules were small, the rates of metastasis were also significantly lower. Finally, 4 thoracotomy (9.3%) and 5 thoracoscopy patients (6.3%) were found to have additional pulmonary metastases at operation. Recurrent pulmonary metastases were found at the ipsilateral side of the metastasectomy in 27 (34.2%) of 79 thoracoscopies and 27 (62.8%) of 43 open thoracotomies (p = 0.0023) within 2 years after the pulmonary surgery. These metastatic foci might have been missed at the time of pulmonary metastasectomy.Conclusions. The ability to detect pulmonary metastases in patients with colorectal cancer is limited by preoperative evaluation with computed tomography and surgical techniques, including open thoracotomy with bimanual palpation. Pulmonary metastasectomy by open thoracotomy or thoracoscopy may be a suboptimal intervention to remove metastatic foci in the lungs.