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Prenafeta Claramunt N, Hwang D, de Perrot M, Yasufuku K, Darling G, Pierre A, Donahoe L, Yeung J, Tomlinson G, Englesakis M, Keshavjee S, Waddell T, Cypel M. Incidence of Ipsilateral Side Recurrence After Open or Video-Assisted Thoracic Surgery Resection of Colorectal Lung Metastases. Ann Thorac Surg 2020; 109:1591-1597. [PMID: 31953045 DOI: 10.1016/j.athoracsur.2019.11.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is still controversy whether full lung palpation is required for patients undergoing pulmonary metastasectomy. We aimed to compare pulmonary ipsilateral recurrence (IR) after video-assisted thoracic surgery (VATS) or open surgery. METHODS A retrospective study of all patients who underwent surgery for colorectal cancer lung metastases between 2003 and 2012 was performed. IR rate was compared between the 2 groups after adjusting for a propensity score matching based on age, sex, disease-free interval, number of metastases, type of resection, presence of a cardiovascular risk factor, presence of a respiratory risk factor, as well as the interaction between the number of metastases and the disease-free interval. The propensity score was used for matched and weighted comparisons of VATS and open patients. RESULTS A total of 211 patients underwent surgery for colorectal cancer lung metastases. Of these, 75 (35.5%) were performed via VATS and 136 (64.5%) via open surgery. Before matching, 118 (55.9%) were male and the median age at the time of metastases diagnosis was 61 (range, 49.8-72.2) years. Median disease free-interval was 20 (19.7 ± 28.3) months; 22 (21.6 ± 28.5) months in VATS and 19 (19.0 ± 28.3) months in open surgery. In total, 19 (25.3%) developed IR in VATS, and 39 (28.7%) in open surgery. Five-year overall survival was 53.1% (61.9% VATS; 49.2% open). In the matched sample, IR was 23.6% in VATS vs 26.2% in open surgery (95% confidence interval for risk reduction with VATS: -22.6% to 17.5%; P = .80). CONCLUSIONS No significant difference was observed in IR rates between VATS and open surgery in the treatment of colorectal cancer lung metastases.
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Affiliation(s)
- Nuria Prenafeta Claramunt
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Hwang
- Department of Laboratory Medicine & Molecular Diagnostics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Gail Darling
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pierre
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Yeung
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Mt. Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Waddell
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, University Health Network, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Menna C, Berardi G, Tierno SM, Andreetti C, Maurizi G, Ciccone AM, D’Andrilli A, Cassiano F, Poggi C, Diso D, Venuta F, Rendina EA, Ibrahim M. Do Repeated Operations for Recurrent Colorectal Lung Metastases Result in Improved Survival? Ann Thorac Surg 2018; 106:421-427. [DOI: 10.1016/j.athoracsur.2018.02.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/16/2018] [Accepted: 02/26/2018] [Indexed: 02/06/2023]
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Anile M, Mantovani S, Pecoraro Y, Carillo C, Gherzi L, Pagini A, Rendina EA, Venuta F, Diso D. Pulmonary metastasectomy in uterine malignancies: outcome and prognostic factors. J Thorac Dis 2017; 9:S1273-S1277. [PMID: 29119014 DOI: 10.21037/jtd.2017.07.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background This retrospective study is designed to evaluate factors affecting survival in a population of patients receiving pulmonary metastasectomy after gynecologic cancers. Methods Nineteen patients with isolated lung metastases (one or two) were surgically treated with R0 resection. Four of them underwent lobectomies. Results Six patients (31.6%) received adjuvant therapy and 11 (58%) experienced recurrences after metastasectomy. Five- and ten-year survival were 40.9% and 31.4%, respectively. Five-year survival in patients receiving adjuvant therapy was 52.4%. At multivariate analysis factors negatively influencing survival were a disease-free interval (DFI) of less than 24 months and recurrence after pulmonary metastasectomy. Conclusions Pulmonary resection for metastatic gynecologic cancer is feasible and effective; adequate selection of patients is mandatory to achieve satisfactory results and long-term survival.
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Affiliation(s)
- Marco Anile
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Sara Mantovani
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Ylenia Pecoraro
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Carolina Carillo
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Lorenzo Gherzi
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Andreina Pagini
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Erino Angelo Rendina
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Federico Venuta
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
| | - Daniele Diso
- University of Rome Sapienza, Policlinico Umberto I Viale del Policlinico, Rome, Italy
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Franceschini D, Cozzi L, De Rose F, Navarria P, Franzese C, Comito T, Iftode C, Tozzi A, Di Brina L, Ascolese AM, Clerici E, D'Agostino G, Fogliata A, Scorsetti M. Role of stereotactic body radiation therapy for lung metastases from radio-resistant primary tumours. J Cancer Res Clin Oncol 2017; 143:1293-1299. [PMID: 28258344 DOI: 10.1007/s00432-017-2373-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES A retrospective analysis was performed on patients treated for lung oligo-metastatic disease from radio-resistant histology groups. METHODS The primary end point was local control (LC), secondary end points were overall survival (OS) and progression free survival (PFS). Toxicity was scored according to CTCAE 4.03. RESULTS 200 patients were analyzed: 49.5% of the cases derived from colorectal primary tumors, 20.5% from sarcomas, 12.0% from renal cell carcinoma and the rest from other mixed origin. The mean follow-up was 24.2 months. LC at 1 and 2 years was 91, 84.9%. Primary histology and the presence of extra-pulmonary disease had a significant impact on LC. OS at 1 and 2 years was 88.7, 65.4%. Primary histology, disease free interval, presence of extra-pulmonary disease, number of irradiated lung lesions and age showed a correlation with prognosis at univariate analysis. PFS at 1 and 2 years was 84, 57.7%. The presence of extra-pulmonary disease and the number of irradiated lung lesions correlated with prognosis. Treatment was well tolerated with no G3-4 acute or late toxicity recorded. CONCLUSION Colorectal metastases showed a higher rate of local relapse. However, the factors mostly influencing prognosis were the presence of extra-pulmonary disease and the number of lung lesions.
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Affiliation(s)
- Davide Franceschini
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Luca Cozzi
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Piera Navarria
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Tiziana Comito
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Cristina Iftode
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Angelo Tozzi
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Lucia Di Brina
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Anna Maria Ascolese
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giuseppe D'Agostino
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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Wild AT, Yamada Y. Treatment Options in Oligometastatic Disease: Stereotactic Body Radiation Therapy - Focus on Colorectal Cancer. Visc Med 2017; 33:54-61. [PMID: 28612018 DOI: 10.1159/000454685] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improvements in systemic therapy for metastatic colorectal cancer (CRC) have markedly extended survival, rendering local control of metastases to critical organs of increasing importance, especially in the oligometastatic setting where the disease may not yet have acquired the ability to widely disseminate. While surgical resection remains the gold standard for oligometastases in many organs, stereotactic body radiation therapy (SBRT) presents a non-invasive alternative for achieving local control. METHODS A literature review was performed to identify and summarize the findings of key prospective and retrospective studies that have shaped the field of SBRT for oligometastases to the lung, liver, and spine with a focus on oligometastases from CRC in particular. RESULTS Modern dose-escalated SBRT regimens can achieve 1-year local control rates of 77-100%, 90-100%, and 81-95% for oligometastases involving the lung, liver, and spine, respectively. Rates of grade 3 or greater toxicity with contemporary SBRT techniques are consistently low at <10% in the lung, <5% in the liver, and <2%/8% for neurologic/non-neurologic toxicity in the spine, respectively. CONCLUSION SBRT appears safe and effective for treating oligometastases involving the lung, liver, and spine. Randomized trials comparing SBRT to surgical resection and other local therapeutic modalities for the treatment of CRC oligometastases bear consideration.
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Affiliation(s)
- Aaron T Wild
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Takeda A, Sanuki N, Tsurugai Y, Oku Y, Aoki Y. Stereotactic body radiotherapy for patients with oligometastases from colorectal cancer: risk-adapted dose prescription with a maximum dose of 83-100 Gy in five fractions. JOURNAL OF RADIATION RESEARCH 2016; 57:400-5. [PMID: 26983981 PMCID: PMC4973648 DOI: 10.1093/jrr/rrw029] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/11/2016] [Indexed: 05/09/2023]
Abstract
We previously reported that the local control of pulmonary metastases from colorectal cancer (CRC) following stereotactic body radiotherapy (SBRT) with moderate prescription dose was relatively worse. We investigated the treatment outcomes and toxicities of patients with oligometastases from CRC treated by SBRT using risk-adapted, very high- and convergent-dose regimens. Among patients referred for SBRT from August 2011 to January 2015, those patients were extracted who had liver or pulmonary metastases from CRC, and they were treated with a total dose of 50-60 Gy in five fractions prescribed to the 60% isodose line of the maximum dose covering the surface of the planning target volume. Concurrent administration of chemotherapy was not admitted during SBRT, while neoadjuvant or adjuvant chemotherapy was allowed. A total of 21 patients (12 liver, 9 lung) with 28 oligometastases were evaluated. The median follow-up duration was 27.5 months (range: 6.5-43.3 months). Four patients were treated with SBRT as a series of initial treatments, and 17 patients were treated after recurrent oligometastases. The local control rates at 1 and 2 years from the start of SBRT were 100%. The disease-free and actuarial overall survival rates were 62% and 55%, and 79% and 79%, respectively. No severe toxicities (≥grade 3) occurred during follow-up. The outcomes following high-dose SBRT were excellent. This treatment can provide an alternative to the surgical resection of oligometastases from CRC. Prospective studies are needed to validate the effectiveness of SBRT.
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Affiliation(s)
- Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Yohei Oku
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Yousuke Aoki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
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Takeda A, Kunieda E, Ohashi T, Aoki Y, Koike N, Takeda T. Stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer and other primary cancers in comparison with primary lung cancer. Radiother Oncol 2012; 101:255-9. [PMID: 21641064 DOI: 10.1016/j.radonc.2011.05.033] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 05/08/2011] [Accepted: 05/12/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE To analyze local control of oligometastatic lung tumors (OLTs) compared with that of primary lung cancer after stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS Retrospective record review of patients with OLTs who received SBRT with 50Gy in 5 fractions. Local control rates (LCRs), toxicities, and factors of prognostic significance were assessed. RESULTS Twenty-one colorectal OLTs, 23 OLTs from other origins, and 188 primary lung cancers were included. Multivariate analysis revealed only tumor origin was prognostically significant (p<0.05). The 1-year/2-year LCRs in colorectal OLTs and OLTs from other origins were 80%/72% and 94%/94%, respectively. The LCR in colorectal OLTs was significantly worse than that in OLTs from the other origins and primary lung cancers with pathological and clinical diagnosis (p<0.05, p<0.0001 and p<0.005). Among 44 OLT patients, Grades 2 and 3 radiation pneumonitis were identified in 2 and 1 patients, respectively. No other toxicities of more than Grade 3 occurred. CONCLUSION SBRT for OLTs is tolerable. The LCR for OLTs from origins other than colorectal cancer is excellent. However, LCR for colorectal OLTs is worse than that from other origins. Therefore dose escalation should be considered to achieve good local control for colorectal OLTs.
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Tacconi F, Ambrogi V, Pompeo E, Sellitri F, Mineo TC. Substernal hand-assisted videothoracoscopic lung metastasectomy: Long term results in a selected patient cohort. Thorac Cancer 2011; 2:45-53. [DOI: 10.1111/j.1759-7714.2010.00038.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Planned pulmonary resection for metastatic pulmonary tumor with video-assisted thoracoscopic surgery using multidetector row angiography. Gen Thorac Cardiovasc Surg 2011; 59:25-9. [DOI: 10.1007/s11748-010-0686-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 08/05/2010] [Indexed: 10/18/2022]
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Kondo R, Hamanaka K, Kawakami S, Eguchi T, Saito G, Hyougotani A, Shiina T, Kurai M, Yoshida K. Benefits of video-assisted thoracic surgery for repeated pulmonary metastasectomy. Gen Thorac Cardiovasc Surg 2010; 58:516-23. [DOI: 10.1007/s11748-010-0614-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Zheng Y, Fernando HC. Surgical and Nonresectional Therapies for Pulmonary Metastasis. Surg Clin North Am 2010; 90:1041-51. [DOI: 10.1016/j.suc.2010.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Obeso Carillo GA, Rivo Vázquez JE, Cañizares Carretero MA, García Fontán E, Blanco Ramos M, García Tejedor JL. [Solitary pulmonary nodule: primary, metastatic, or both]. Arch Bronconeumol 2009; 45:567-9. [PMID: 19450915 DOI: 10.1016/j.arbres.2009.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 03/18/2009] [Indexed: 11/25/2022]
Abstract
The lung is the most common site for metastasis from colorectal cancer, which is among the most common neoplasms in developed countries. Simultaneous occurrence of pulmonary metastasis of colorectal origin and primary carcinoma has been reported. We describe the case of a 65-year-old man who underwent low anterior resection for colorectal adenocarcinoma in 2007. Follow-up computed tomography revealed a pulmonary nodule that was classified as metastatic. The patient was referred to our thoracic surgery department, where the nodule was resected. The pathology confirmed that the nodule was neoplastic, and histologic and immunohistochemical examination showed the presence of colorectal metastasis and lung adenocarcinoma. Evidence of metastasis was also found in 2 of the lymph nodes analyzed, 1 with features identical to the primary pulmonary adenocarcinoma, and 1 with features identical to the colorectal metastasis.
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Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases. Eur J Surg Oncol 2008; 35:307-12. [PMID: 18657377 DOI: 10.1016/j.ejso.2008.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Revised: 06/11/2008] [Accepted: 06/12/2008] [Indexed: 12/13/2022] Open
Abstract
AIMS Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy. METHODS Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data. RESULTS Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2-10) days for the pulmonary and 7 (1-23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8-87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%. CONCLUSION We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.
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Evaluation of video-assisted thoracoscopic surgery for pulmonary metastases: 11-years of experience. Surg Endosc 2008; 23:55-61. [PMID: 18437482 DOI: 10.1007/s00464-008-9895-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Accepted: 02/25/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although video-assisted thoracoscopic surgery (VATS) has been applied to pulmonary resection for pulmonary metastases, the clinical validity of this approach remains controversial. The purpose of this study was to evaluate the validity and problems of VATS for pulmonary metastasectomy. METHODS From January 1993 to December 2003, VATS for pulmonary metastasectomy was performed in 53 resections for 48 patients at our institution. The medical records of these patients were retrospectively reviewed. RESULTS The primary tumor was colorectal cancer in 23 patients, renal cell carcinoma in 6, breast cancer in 6, germ cell tumor in 5, head and neck cancer in 2, and others in 6. Thirty-six cases had a solitary lesion, 8 had unilateral multiple lesions, and 9 had bilateral multiple lesions. The following procedures were performed: 7 lobectomies, 5 segmentectomies, and 41 wedge resections. There was no major postoperative morbidity related to VATS. At a median follow-up period of 29.0 months, 13 patients were alive without recurrences. The 3-year overall survival rate and the 3-year intrathoracic disease-free survival rate were 59.8% and 33.4%, respectively. Five cases had recurrence at the surgical stump or at the port sites, but these recurrences have not been found in the recent period since June 1997. Intrathoracic recurrences within 3 months after VATS occurred in four. CONCLUSION VATS for pulmonary metastases is not superior to the conventional open thoracotomy and is not recommended as a standard procedure. Further studies with a larger number of cases performed by skilled surgeons familiar with VATS are needed.
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Ludwig C, Zeitoun M, Stoelben E. Video-assisted thoracoscopic resection of pulmonary lesions. Eur J Surg Oncol 2004; 30:1118-22. [PMID: 15522561 DOI: 10.1016/j.ejso.2004.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2004] [Indexed: 11/30/2022] Open
Abstract
AIMS To determine the role of video-assisted thoracoscopic resection in the diagnosis of benign or malignant peripheral pulmonary lesions. PATIENTS AND METHOD In 157 patients, between 1996 and 2001, video-assisted thoracoscopy was used to remove a pulmonary lesion. Conversion rate, complications and histology are presented. RESULTS In 21 patients, conversion to a thoracotomy was necessary, four times because the pulmonary lesion was malignant and seventeen times due to technical difficulties. In patients without any previous history of malignant disease (n=100), 80% of the lesions were benign. In patients with malignant pulmonary lesions (n=21), curative resection was possible, 3 through VATS and 4 through thoracotomy. Pulmonary lesions in patients with a previous history of malignant disease were malignant in 42 patients. Curative VATS resection of a solitary lesion was performed in 9 patients, in 10 patients thoracotomy was necessary to remove multiple lesions. CONCLUSIONS With a pre-operative selection of the patients the rate of secondary thoracotomies due to bronchial carcinoma is low (4%). In patients with a previous history of malignant disease, 22% of the pulmonary lesions are benign. VATS is a safe diagnostic method, with little discomfort for the patient.
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Affiliation(s)
- C Ludwig
- Department of Thoracic Surgery, University Hospital, Freiburg, Germany.
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Davidson RS, Nwogu CE, Brentjens MJ, Anderson TM. The surgical management of pulmonary metastasis: current concepts. Surg Oncol 2001; 10:35-42. [PMID: 11719027 DOI: 10.1016/s0960-7404(01)00013-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lung metastases have been found in 25-30% of all patients with cancer at autopsy. Those patients satisfying criteria for surgical resection represent a much smaller subgroup. Given the potentially curative nature of pulmonary metastasectomy in the absence of disseminated disease, it has become widely accepted as an important treatment option for a variety of malignancies with metastasis to the lungs. A standardized approach remains unfounded however, given limited numbers of patients, various histologic subtypes and few published studies utilizing randomized prospective methodology.Ultimately, the development of metastasis represents a major determinant of survival for patients with cancer. Pulmonary metastasectomy is an important treatment modality for patients with metastatic pulmonary disease. The indications for pulmonary metastasectomy and the surgeon's role in pulmonary metastatic disease continue to evolve. Future prospective studies and the compilation of comparable data yielding prognostic factors for specific histologies will better define indications for resection.
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Affiliation(s)
- R S Davidson
- Department of Surgical Oncology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA
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Lin JC, Landreneau RJ. The Role of Video-Assisted Thoracic Surgery for Pulmonary Metastasectomy. Clin Lung Cancer 2001; 2:291-6. [PMID: 14720363 DOI: 10.3816/clc.2001.n.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Management of isolated metastatic deposits to the lungs and the role of surgical resection, specifically video-assisted thoracic surgery (VATS) techniques, have been controversial. The inability to perform a detailed bimanual palpation of the lung for occult lesions has been considered an inherent weakness in this approach. We have performed VATS resection for 205 patients with pulmonary metastatic disease and potentially curative VATS resec-tion for 119 patients. VATS resection was successfully performed for all VATS diagnostic and therapeutic patients, with no perioperative deaths. Longitudinal follow-up demonstrated a mean survival of 20 months in the diagnostic group and 32 months in the therapeutic group. In the VATS therapeutic group, 44 (37%) patients remain free of disease at a mean follow-up of 37 months. Of the 69 recurrences, 6% were local, 25% were regional, and 67% were distant. In this review, the present role of VATS pulmonary metastasectomy will be examined.
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Affiliation(s)
- J C Lin
- Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, PA 15212, USA
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Reguart N, Maurel J, Gascón P. [Complementary and alternative treatment to surgery in liver metastases of colorectal cancer]. GASTROENTEROLOGIA Y HEPATOLOGIA 2001; 24:210-7. [PMID: 11333661 DOI: 10.1016/s0210-5705(01)70152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- N Reguart
- Servicio de Oncología Médica. Hospital Clínic Universitari de Barcelona, Spain
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Pinedo HM, van den Eertwegh AJ. Aggressive combination therapy to cure patients with metastatic cancer. Lancet Oncol 2000; 1:72-3. [PMID: 11905669 DOI: 10.1016/s1470-2045(00)00072-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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