Background:Pulmonary metastases occur in approximately 20–40% of patients with solid malignancies, with colorectal cancer representing the most frequent primary source. Surgical resection remains a potentially curative strategy for selected patients, and wedge metastasectomy has long been considered the standard of care. However, increasing attention has been paid to the role of anatomical resections such as segmentectomy and lobectomy, particularly for centrally located or technically challenging metastases.Methods:We performed a narrative literature review across PubMed, Embase, and Scopus databases covering the period 2010–2025, using the keywords “pulmonary metastasectomy”, “anatomical resection”, “segmentectomy”, “lobectomy”, and “pneumonectomy”. Articles included original series, comparative studies, meta-analyses, and systematic reviews. Special attention was given to technical indications, oncological outcomes, minimally invasive techniques, histological differences, and postoperative functional results.Results:Evidence suggests that anatomical resections are most often indicated not purely on oncological grounds, but due to technical considerations such as central localization, size greater than 2 cm, involvement of segmental or lobar bronchi or vessels, or the presence of multiple metastases confined to one lobe. Comparative studies indicate that segmentectomy provides superior local control compared to wedge resection, while lobectomy ensures complete clearance in complex cases, with five-year overall survival approaching 50% in carefully selected colorectal cancer patients.Conclusions:While wedge resection and metastasectomies remain the gold standard for small, peripheral metastases, anatomical resections represent a valuable extension of the surgical armamentarium in secondary lung cancer. Their role should be understood primarily as a technical necessity to ensure radical clearance while minimizing loss of lung parenchyma. The integration of minimally invasive approaches and emerging adjuncts, such as 3D reconstruction and fluorescence-guided surgery, is likely to further refine patient selection and optimize outcomes.
背景：约20–40%的实体恶性肿瘤患者会发生肺转移，其中结直肠癌是最常见的原发来源。对于特定患者，手术切除仍是一种潜在治愈策略，楔形转移灶切除术长期被视为标准治疗方案。然而，解剖性切除术（如肺段切除术和肺叶切除术）的作用日益受到关注，尤其对于位于中央或技术上具有挑战性的转移灶。 方法：我们在PubMed、Embase和Scopus数据库中，使用“肺转移灶切除术”“解剖性切除术”“肺段切除术”“肺叶切除术”“全肺切除术”等关键词，对2010–2025年期间的文献进行了叙述性综述。纳入文献包括原始系列研究、比较研究、荟萃分析和系统评价，重点关注技术适应症、肿瘤学结局、微创技术、组织学差异及术后功能结果。 结果：证据表明，解剖性切除术的适应症通常并非纯粹基于肿瘤学考量，而是出于技术因素，如转移灶位于中央、直径大于2厘米、侵犯段或叶支气管或血管，或同一肺叶内存在多个转移灶。比较研究显示，与楔形切除术相比，肺段切除术能提供更好的局部控制；而在复杂病例中，肺叶切除术可确保完全切除，经严格筛选的结直肠癌患者五年总生存率接近50%。 结论：虽然楔形切除术仍是治疗小型周围性转移灶的金标准，但解剖性切除术作为继发性肺癌外科治疗体系的重要延伸，其作用应主要理解为确保根治性切除同时最大限度保留肺实质的技术必要手段。微创手术与新兴辅助技术（如三维重建和荧光引导手术）的整合，有望进一步完善患者筛选并优化治疗结局。
肿瘤(癌症)患者之家