結(jié)直腸癌肺轉(zhuǎn)移患者手術(shù)治療選擇指南回顧手術(shù)指征臨床實(shí)踐回顧研究結(jié)論指南回顧--NCCN對可切除的轉(zhuǎn)移灶建議進(jìn)行完整切除并保留充足的肺功能指南回顧--ESMO對可實(shí)現(xiàn)R0切除掉的肺轉(zhuǎn)移灶進(jìn)行切除手術(shù)指征原發(fā)腸癌已R0切除肺轉(zhuǎn)移灶可實(shí)現(xiàn)R0切除，同時保留足夠的肺功能多發(fā)轉(zhuǎn)移灶位于雙側(cè)肺，可考慮分期切除，彌漫多發(fā)病灶不建議手術(shù)可切除的肺外轉(zhuǎn)移灶，并非手術(shù)禁忌√×臨床實(shí)踐肺葉vs

亞肺葉2008.3—2010.232CentersinSpain522cases

including100lobectomy;4pneumonectomy;

418sub-lobarresectionAnnOncol.

2016May;27(5)HernándezJetal.肺葉vs.亞肺葉5-yearDFS59.8%vs.31.7%Log-rankP<0.001臨床實(shí)踐肺段vs

楔形？2004.1—2008.12553cases

including98Segmentectomy；455WedgeresectionEuropeanJournalofCardio-ThoracicSurgery1(2016)1–7;SatoshiShionoetal.肺段vs.楔形5-yearRFS48.8%vs.36.0%HR0.63(0.44-0.87)P=0.005肺段vs.楔形5-yearOS80.1%vs.68.5%HR0.65(0.38-1.05)P=0.08臨床實(shí)踐以往的研究表明：充分的手術(shù)切除范圍十分重要情景假設(shè)：1.2cm結(jié)節(jié)---肺葉切除？？？267例（2008.01-2016.12）入組標(biāo)準(zhǔn)：1.單發(fā)病灶，且最終病理確認(rèn)為腸癌肺轉(zhuǎn)移灶2.腸癌已控制，且肺內(nèi)病灶可實(shí)現(xiàn)R0切除3.患者術(shù)后均接受了規(guī)范化療回顧研究小切口40.1%腔鏡59.9%肺葉34.8%亞肺葉65.2%（肺段124.5%）清掃+活檢39.7%無60.3%回顧研究5-yeatrRFS42.7%5-yeatrOS65.4%回顧研究2008.01-2016.12267例腸癌肺轉(zhuǎn)移單發(fā)病灶無復(fù)發(fā)生存與總生存回顧回顧研究LobectomySublobarResectionLog-rankP5-yearRFS33.3%41.2%0.755-yearOS100%80.6%0.37病灶直徑<1.5cm（N=87）N=9N=78回顧研究病灶直徑≥1.5cm

(

N=180

)LobectomySublobarResectionLog-rankP5-yearRFS44.9%29.8%0.035-yearOS61.2%70.1%0.45N=84N=96回顧研究LymphnodesDissectionYESNOLog-rankP5-yearRFS52.7%35.4%0.195-yearOS65.4%58.7%0.12N=93N=87病灶直徑≥1.5cm

(

N=180