ObjectiveTo investigate the effectiveness of sublobar resection and lobectomy via uniportal video-assisted thoracoscopic surgery (U-VATS) for lung metastases from colorectal cancer.MethodsRetrospective research was conducted on 42 colorectal cancer patients with lung metastases who underwent U-VATS sublobar resection and lobectomy at the Tongji Hospital, Huazhong University of Science and Technology between April 2016 and May 2019, including 24 males and 18 females with an average age of 58.0±9.9 years. Among them 17 patients received U-VATS sublobar resection and 25 patients received lobectomy. The operation time, intraoperative blood loss, postoperative pulmonary infection, drainage tube indwelling time, drainage volume on the first day after surgery, postoperative hospital stay were analyzed between the two groups, and the relationship between the prognosis and clinical characteristics of the two groups was compared.ResultsSublobar resection patients had less lung metastases (P=0.043) and shorter operation time (P=0.023) compared with the lobectomy patients. There was no significant difference between the lobectomy and sublobar resection groups in intraoperative blood loss (P=0.169), rate of postoperative infection (P=0.982), postoperative drainage duration (P=0.265), drainage volume on the first day after surgery (P=0.402) and postoperative hospital stay (P=0.612). The progression-free survival of the two groups was 25.19 months and 23.63 months (P=0.721), and their overall survival was 29.09 months and 30.64 months (P=0.554).ConclusionConsidering guantity and locations of lung metastases, U-VATS sublobar resection can achieve a similar prognosis to lobectomy for lung metastases from colorectal cancer. Further efficacy of this surgical strategy remains to be proved by longer follow-up.
Abstract： Pulmonary metastasectomy is an option for patients with metastatic tumor of lung. Numerous retrospectivestudies have demonstrated that complete control of primary tumor and complete resection of metastases limited to thelungs may be associated with prolonged survival. Speci?c issues require consideration when planning pulmonary metastasectomy. Regardless of histological type of primary tumor, complete resection is the most important prognostic factor. The other two important prognostic factors are long disease interval and limited number of metastatic tumor of lung. Hand-assisted thoracoscopic surgery for bilateral lung metastasectomy through sternocostal triangle access is recommended. Pulmonary hilar and mediastinal lymph node metastases are some relative contraindications for this surgery. Nowdays preoperative imaging examinations still have limitations in detecting all the lung metastases. Some data emphasize the importance of considering patients for extended resection in metastatic tumor of lung. Repeat resection after previous metastasectomies can be of benefit under certain circumstances so we should remove as little healthy lung tissue as possible. In this review, we discuss about some disputed issues in order to establish a useful criterion for consideration of pulmonary metastasectomy.
Objective To investigate the diagnosis, indications for surgery, operative methods and prognostic factors of surgical resection for pulmonary metastases, and improve the survival rate of patients with pulmonary metastases . Methods A total of 125 patients with pulmonary metastases underwent 138 metastasectomies,116 patients had metastasectomy once while 5 patients underwent a second metastasectomy and 4 patients a third metastasectomy. There were 66 wedge resections,2 segmentectomies, 53 lobectomies,2 en bloc resections of chest wall plus lobectomy,3 pneumonectomies and 12 precision resections. Surgical approaches included 130 thoracotomies and 8 videoassisted thoracic surgery. Results The primary tumor sites were epithelial in 94 patients ,sarcoma in 26 and others in 5. There was no perioperative mortality. A total of 122 patients were followed up , followup time was 1-10 years. The 1-, 3-, and 5-year survival rates were 90.4%, 53.3%, and 34.8% respectively. Better prognoses were found in patients with colorectal cancer, renal cancer and soft tissue sarcoma, the 5-year survival rates were 43.8%, 37.5%, and 33.3% respectively. For the 105 patients whose pulmonary metastases were resected completely, the 5-year survival rate was 38.9%. The 5-year survival rate was only 16.7% for 20 patients with incomplete resection, however. Systematiclymph node dissection had been performed in 89 patients but metastases were identified only in 12 patients. The 5-year survival rates were 14.3% for node positive patients and 41.5% for node negative patients. Conclusion Surgical resection for pulmonary metastases should be performed in properly selected patients and successful outcomes can be achieved. Posterolateral minithoracotomy is the most common surgical approach. The completeness of resection and the status of mediastinal lymph nodes may be important prognostic factors.
目的:探讨前路手术治疗胸椎转移瘤的临床疗效、手术方法及手术适应证。方法:2003年11月至2005年11月收治胸椎转移瘤38例,男21例,女17例;所有患者均伴有不同程度疼痛,伴神经功能障碍29例。结果:术后随访6个月,患者疼痛均有不同程度缓解, 视觉类比评分(VAS)由术前平均7.13降至术后平均1.71。术后患者使用止痛药的级别和用量均明显下降,其中多数患者(15例)无需再使用止痛药。伴神经功能障碍29例患者中,术后27例有改善,其中2例Frankel C级和9例Frankel D级患者感觉、运动基本恢复正常。局部肿瘤无复发,内固定器无松动断裂。结论:前路手术治疗胸椎转移瘤可以充分显露病灶, 有利于减压以及重建脊柱稳定性,从而有效控制疼痛、防治神经功能损害,提高生存质量。
Spine is a common site of metastasis in patients with malignant tumors, and tumor metastasis to the spine can lead to pain, pathological fractures, and nerve compression. In order to optimize the diagnosis and management of patients with spinal metastases and metastatic spinal cord compression (MSCC), the National Institute for Health and Care Excellence (NICE) in the UK proposed the first diagnostic and treatment guidelines for patients with MSCC (or at risk of MSCC) in 2008. In recent years, with the rapid advancement of spinal surgery and radiotherapy technology, the standardized process of MSCC diagnosis and treatment urgently needs to be updated. In 2023, NICE launched new guidelines for spinal metastases and MSCC. Based on a thorough study of the guidelines, this article discusses and interprets pain management, corticosteroid treatment, application of bisphosphonates and denosumab, tools for assessing spinal stability and prognosis, radiation therapy, surgical timing and approach, etc., providing reference for clinical diagnosis and treatment in China.
Abstract： Objective To evaluate the safety and efficacy of total thoracoscopic anatomic pulmonary segmentectomy for the treatment of early-stage peripheral lung carcinoma, pulmonary metastases and benign pulmonary diseases. Methods We retrospectively analyzed 20 patients who received total thoracoscopic anatomic pulmonary segmentectomy in Zhongshan Hospital of Fudan University from March 2008 to November 2011. There were ten male and ten female patients with a mean age of 58.0（14-86）years. Three ports were used. The pulmonary artery and vein of the segment were dealt with Hem-o-lok or stapler. The bronchi of the segment were dealt with staplers. Staplers were used in peripheral lung of intersegmental plane. Results All the twenty patients underwent total thoracoscopic anatomic segmentectomy successfully without any conversion to thoracoctomy or lobectomy. No perioperative morbidity or mortality occurred. Postoperative pathological examinations showed lung cancer in 10 patients, pulmonary metastases in 3 patients and benign pulmonary diseases in 7 patients. The mean operative time was 133.0（90-240）min. The mean blood loss was 85.0（50-200）ml. The chest tubes were maintained in position for 3.2 （2-7） d. The mean postoperative hospitalization time was 6.7 （4-11）d. Conclusion Total thoracoscopic anatomic pulmonary segmentectomy is a feasible and safe technique to be used selectively for Ⅰa stage lung cancer, pulmonary metastases and benign pulmonary diseases that are not appropriate for wedge resection.
ObjectiveTo investigate clinical outcomes and prognostic factors of surgical resection of pulmonary metastases after esophagectomy. MethodsClinical data of 15 patients who underwent surgical resection of pulmonary metastases after esophagectomy from March 1994 to May 2008 were retrospectively analyzed. There were 10 males and 5 females with their age of 43-72 (65.0±8.8) years. Surgical procedures included partial lung resection, pulmonary wedge resection, segmental resection and lobectomy. Follow-up duration was 60 months after surgical resection of pulmonary metastases. The influence of number and size of pulmonary metastases, TNM staging of primary esophageal cancer, and disease-free interval (DFI) after esophagectomy on postoperative survival rate after pulmonary metastasectomy was analyzed. ResultsTwelve, 24 and 60 months survival rates after pulmonary metastasectomy were 80.0%, 66.7% and 6.7%, respec-tively. Median DFI was 30 months. Survival rate after pulmonary metastasectomy of patients whose DFI was longer than 24 months was significantly longer than that of patients whose DFI was shorter than 24 months (χ2=5.144, P=0.023). Survival rate after pulmonary metastasectomy of patients with solitary pulmonary metastasis was significantly longer than that of patients with multiple pulmonary metastases (χ2=3.990, P=0.046).The size of pulmonary metastases and TNM staging of primary esophageal cancer didn't have significant impact on survival rate after pulmonary metastasectomy (P > 0.05). Cox proportional hazards model showed that DFI after esophagectomy was the main factor affecting survival rate after pulmonary metastasectomy (P=0.026). ConclusionSurgical resection is a therapeutic strategy for the treatment of pulmonary metas-tases after esophagectomy, and may achieve good clinical outcomes for patients with solitary pulmonary metastasis and patients whose DFI is longer than 24 months.
Objective To investigate the relation between the sites of colorectal cancer and liver metastatic distribution. Methods The enhanced multiple-slice spiral CT images and clinical data of 105 cases diagnosed colorectalcancer with liver metastases admitted from January 2010 to April 2012 were analyzed retrospectively. Primary site of the tumor， numbers of the metastases on CT images， and the anatomical position of the inferior mesenteric vein （IMV） terminates were recorded. Results ①The ratio of metastases in the right and left hemiliver was 2∶1 for 38 right-sided primary tumors as compared with 1.2∶1 for 67 left-sided primary tumors. The pattern of lobar distribution was significantly different in the two groups （χ2=8.709， P=0.003）. ②In the left-sided colon cancer group， the ratio of metastases in the right and left hemiliver was 65∶98 for 28 patients with IMV terminating in splenic vein （SpV）， 116∶52 for 36 patients with IMV terminating in superior mesenteric vein （SMV）， and 13∶15 for 3 patients with IMV terminating in the junction of SMV and SpV. The pattern of lobar distribution was significantly different among the three groups （χ2=28.575， P=0.000）. Further comparison between the former two groups， the difference was statistically significant （χ2=27.951， P=0.000）. ③In 25 patients with IMV terminating in SpV， the metastases of 19 cases were mainly distributed in the left lobe of liver （P=0.001）；In 34 patients with IMV terminating in SMV， the metastases of 25 cases located mainly in the right hepatic lobe （P=0.000）. Conclusions Right-sided colon cancers selectively involve the right lobe of liver， while left-sided tumors selectively involve the right lobe of liver when its IMV terminates in SMV and involve the left lobe when its IMV terminates in SpV， respectively. The discovery may help shorting the diagnostic workup in patients presenting with liver metastases from an unknown primary site， and may improve the detection rate of metastases in initial diagnosis and follow-up.
Objective To determine feasibility of texture analysis of CT images for the discrimination of hepatic epithelioid hemangioendothelioma (HEHE) and liver metastases of colon cancer. Methods CT images of 9 patients with 19 pathologically proved HEHEs and 18 patients with 38 liver metastases of colon cancer who received treatment in West China Hospital of Sichuan University from July 2012 to August 2016 were retrospectively analyzed. Results Thirty best texture parameters were automatically selected by the combination of Fisher coefficient (Fisher)+classification error probability combined with average correlation coefficients (PA)+mutual information (MI). The 30 texture parameters of arterial phase (AP) CT images were distributed in co-occurrence matrix (22 parameters), run-length matrix (1 parameter), histogram (4 parameters), gradient (1 parameter), and autoregressive model (2 parameters). The distribution of parameters in portal venous phase (PVP) were co-occurrence matrix (18 parameters), run-length matrix (2 parameters), histogram (7 parameters), gradient (2 parameters), and autoregressive model (1 parameter). In AP, the misclassification rates of raw data analysis (RDA)/K nearest neighbor classification (KNN), principal component analysis (PCA)/KNN, linear discriminant analysis (LDA)/KNN, and nonlinear discriminant analysis, and nonlinear discriminant analysis (NDA)/artificial neural network (ANN) was 38.60% (22/57), 42.11% (24/57), 8.77% (5/57), and 7.02% (4/57), respectively. In PVP, the misclassification rates of RDA/KNN, PCA/KNN, LDA/KNN, and NDA/ANN was 26.32% (15/57), 28.07% (16/57), 15.79% (9/57), and 10.53% (6/57), respectively. The misclassification rates of AP and PVP images had no statistical significance on the misclassification rates of RDA/KNN, PCA/KNN, LDA/KNN, and NDA/ANN between AP and PVP (P>0.05). Conclusion The texture analysis of CT images is feasible to identify HEHE and liver metastases of colon cancer.