Analysis of thoracoscopic treatment of 132 cases of single-pulmonary metastatic tumor
Objective To explore the appropriate operation of video-assisted pulmonary metastasectomy(VAPM)for patients with sin-gle-pulmonary metastatic tumor(SPMT).Methods The postoperative pathological results and other clinical data of 132 patients with SPMT who underwent VAPM at our hospital from January 2018 to December 2020 were retrospectively studied.The type of primary tu-mors,lesion size,Ki-67 index,positive resection margin,and local infiltration of the patients were analyzed.Results There were 78 male patients(59.1％)and 54 female patients(40.9％),with an average age of(62.0±6.8)years.Anatomical VAPM was performed in 37 cases(28.0％),and non-anatomical VAPM was performed in 95 cases(72.0％).There were statistically significant differences in operation du-ration and intraoperative blood loss between the two groups(both P＜0.0 1),but no statistically significant differences in hospitalization time(P＞0.05).Postoperative pathological reports showed that PMT originated from thyroid cancer in three cases(2.3％),breast cancer in 19 cas-es(14.4％),digestive system malignant tumors in 39 cases(29.5％),urinary system malignant tumors in 48 cases(36.4％),reproductive sys-tem malignant tumors in 11 cases(8.3％),and soft tissue sarcoma and other tissue malignant tumors in 12 cases(9.1％).A total of 30 cases(22.7％)of local infiltration were observed.There were statistically significant differences in vascular infiltration and pleural infiltration between the patients undergoing two different surgical procedures and among the patients with different primary tumor types(both P＜0.01).The maximum diameter of PMT imaging(OR=4.663,95％CI:3.191-6.325,P＜0.01)and pathological type(OR=2.408,95％CI:1.707-2.917,P＜0.05)were independent influencing factors for the occurrence of local infiltration in PMT.The maximum diameter of PMT imaging(OR=2.294,95％CI:1.271-3.870,P＜0.05)and PMT position(OR=4.358,95％CI:2.294-6.495,P＜0.01)were independent influencing factors for surgical selection.The cut-off value of the maximum diameter of PMT imaging for anatomical VAPM selection was 15.5 mm,with a specificity of 82.1％and a sensitivity of 62.2％.Conclusions VAPM is a safe and effective treatment for patients with SPMT.The maximum diameter of PMT imaging is an important but not the only factor in selecting anatomical or non-anatomical VAPM.The patholog-ical characteristics of primary tumors is an important factor to be considered.
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