Objective:Colorectal pulmonary metastasis is the most common resected metastatic disease of the lung. Pulmonary metastasectomy (PM) for colorectal oligometastases is a well-established intervention with curative intent. Local recurrence at the resection site in the lung is a problem, with an impact on survival. The use of a 1320 nm neodymium:yttrium aluminum garnet (Nd:YAG) laser causes the vaporization and coagulation at the resection line and thereby increases safety margins around the nodule. We aimed to evaluate the local recurrence rate after laser-assisted pulmonary metastasectomy (LPM) for colorectal metastases.Methods:We conducted a retrospective analysis of 49 patients treated with laser-assisted pulmonary metastasectomy for 139 metastatic nodules from colorectal cancer from 2010 to 2018. All nodules were resected using Nd:YAG 1320 nm laser, aiming for a safety margin of five mm. The minimum follow-up time after PM was 24 months.Results:Local intrapulmonary recurrence developed at 7 of the 139 (5.0%) resection sites in 5 of the 49 patients (10.2%). Microscopically incomplete resection was a significant risk factor for recurrence (p= 0.023). Larger nodule size (>12 mm) negatively impacted local recurrence (p= 0.024). Nodules larger or equal to 12 mm in size also lowered the patients’ probability of survival by 67.29% (HR: 0.3271, 95% CI: 0.1265–0.846,p= 0.018).Conclusions:The rate of local recurrence at the resection site after LPM for colorectal metastases is low. Complete resection is a positive predictor of survival without local recurrence. Microscopic complete resection with the addition of vaporization and coagulation at the resection margin seems to be sufficient to prevent local recurrence. However, larger nodules may require larger safety margins.
目的：结直肠肺转移是肺部最常见的可切除转移性疾病。针对结直肠寡转移的肺转移瘤切除术是一种成熟的根治性干预手段。肺切除部位的局部复发是影响生存率的关键问题。使用1320 nm钕:钇铝石榴石激光可在切除线处产生汽化与凝固效应，从而扩大结节周围的安全边界。本研究旨在评估激光辅助肺转移瘤切除术治疗结直肠转移后的局部复发率。 方法：我们对2010年至2018年间接受激光辅助肺转移瘤切除术的49例结直肠癌肺转移患者（共139个转移结节）进行回顾性分析。所有结节均采用1320 nm Nd:YAG激光切除，目标安全边界为5毫米。术后最短随访时间为24个月。 结果：在49例患者中，5例（10.2%）于139个切除部位中的7处（5.0%）发生肺内局部复发。显微镜下切除不完全是复发的显著危险因素（p=0.023）。较大结节尺寸（>12 mm）对局部复发产生负面影响（p=0.024）。直径≥12 mm的结节使患者生存概率降低67.29%（风险比：0.3271，95%置信区间：0.1265–0.846，p=0.018）。 结论：激光辅助肺转移瘤切除术治疗结直肠转移后的切除部位局部复发率较低。完全切除是无局部复发生存的积极预测因素。通过显微镜下完全切除并辅以切除边缘的汽化凝固处理，似乎足以预防局部复发。但对于较大结节，可能需要更广泛的安全边界。
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