1
|
Yamada K, Ozawa D, Onozato R, Suzuki M, Fujita A, Ojima H. Optimal timing for the resection of pulmonary metastases in patients with colorectal cancer. Medicine (Baltimore) 2020; 99:e19144. [PMID: 32118717 PMCID: PMC7478587 DOI: 10.1097/md.0000000000019144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aims to clarify the surgical treatment time of pulmonary metastasis in patients with colorectal cancer.Early relapse after resection of pulmonary metastasis is often encountered when the interval from the detection of pulmonary metastasis to pulmonary metastasectomy was short.In this retrospective analysis, data of patients with colorectal cancer who underwent surgical treatment of pulmonary metastasis at the Gunma Prefectural Cancer Center, Gunma, from April 2001 through September 2018 were evaluated. The patients were divided into 2 groups. We examined the interval period from the diagnosis of pulmonary metastasis to pulmonary metastasectomy. This period was divided into every 3 months, and the prognosis of each group was compared with clarify the appropriate timing of pulmonary metastasectomy.The primary endpoints were 5-year overall survival and recurrence-free survival rates.The most significant difference was observed when the cutoff value was 9 months (5-year recurrence-free survival 45.8% vs 85.6%, P < .01). No significant difference was found in any background factors between the 2 groups. Twenty-five patients (34.7%) experienced recurrence after pulmonary metastasectomy. The most common site of recurrence was the lung (48%). Among the 12 cases of recurrence of pulmonary metastasis, 11 cases belonged to the <9 months group. A multivariable survival analysis found that the interval period of <9 months was a significant predictor of recurrence.Our study suggests that clinical follow-up for 9 months prior pulmonary metastasectomy in colorectal patients would improve the prognosis.
Collapse
Affiliation(s)
| | | | - Ryouichi Onozato
- Department of general thoracic surgery, Gunma Prefectural Cancer Center, Oota-shi, Gunma, Japan
| | | | - Atsushi Fujita
- Department of general thoracic surgery, Gunma Prefectural Cancer Center, Oota-shi, Gunma, Japan
| | | |
Collapse
|
2
|
Salah S, Watanabe K, Welter S, Park JS, Park JW, Zabaleta J, Ardissone F, Kim J, Riquet M, Nojiri K, Gisabella M, Kim SY, Tanaka K, Al-Haj Ali B. Colorectal cancer pulmonary oligometastases: pooled analysis and construction of a clinical lung metastasectomy prognostic model. Ann Oncol 2012; 23:2649-2655. [PMID: 22547539 DOI: 10.1093/annonc/mds100] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although resecting colorectal cancer (CRC) pulmonary metastasis is associated with long-term survival, identification of prognostic groups is needed for future randomized trials, and construction of a lung metastasectomy prognostic model (LMPM) is warranted. PATIENTS AND METHODS We searched the PubMed database for retrospective studies evaluating prognostic factors following resecting CRC lung metastasis. Individual patient data were analyzed. Independent prognostic factors were used to construct an LMPM. RESULTS Between 1983 and 2008, 1112 metastasectomies were carried out on 927 patients included in eight studies. Five-year survival rate was 54.3% following the first lung resection. Multivariate analysis identified three independently poor prognostic factors: pre-thoracotomy carcinoembryonic antigen ≥5 ng/ml, disease-free interval <36 months, and more than one metastatic lesion. Patients with good-, intermediate-, and high-risk groups according to the LMPM had a 5-year survival of 68.2%, 46.4%, and 26.1%, respectively (P < 0.001). Perioperative chemotherapy and previously resected liver metastasis had no influence on survival. CONCLUSIONS The low- and intermediate-risk groups have a good chance of long-term survival following metastasectomy. However, more studies are needed to investigate whether surgery offers any advantage over systemic therapy for the poor-risk group.
Collapse
Affiliation(s)
- S Salah
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan.
| | - K Watanabe
- Department of Surgery, Tohoku University, Sendai; Department of Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - S Welter
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, Essen, Germany
| | - J S Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - J W Park
- Center for Colorectal Cancer, National Cancer Center. Gyeonggi-do, Korea
| | - J Zabaleta
- Thoracic Surgery Service, Hospital Donostia, San Sebastian, Spain
| | - F Ardissone
- Department of Clinical and Biological Sciences, Thoracic Surgery Unit, University of Turin, San Luigi Hospital, Orbassano (Torino) Italy
| | - J Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - M Riquet
- Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris-Descartes University, Paris, France
| | - K Nojiri
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama City, Japan
| | - M Gisabella
- Department of Clinical and Biological Sciences, Thoracic Surgery Unit, University of Turin, San Luigi Hospital, Orbassano (Torino) Italy
| | - S Y Kim
- Center for Colorectal Cancer, National Cancer Center. Gyeonggi-do, Korea
| | - K Tanaka
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama City, Japan
| | - B Al-Haj Ali
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan
| |
Collapse
|
3
|
Vincze K, Balogh G, Bátor G, Kecskés L, Patak K, Muskát J. [Pulmonary metastasectomy after pneumonectomy]. Magy Seb 2008; 60:257-61. [PMID: 17984017 DOI: 10.1556/maseb.60.2007.5.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED INTRODUCTION, OBJECTIVES: Authors of two thoracic surgical departments from the above named hospitals discuss their practices of pulmonary metastasectomy after pneumonectomy for malignant disease. MATERIAL AND METHODS Six patients were operated after pneumonectomy for metastatic spread in the residual lung. The average age of the three male and three female patients was 52.5 years. The applied preoperative diagnostical methods were the following: chest-x-ray, CT scan, MRI, PET-CT scan, perfusion lung scintigraphy, bronchological examinations, functional respiratory tests, ECG, cardiac echo, arterial blood gases (ABGs) and other laboratory analyses. Patient selection for operation was based on strict oncological and cardiorespiratory criteria. Finally, the authors describe the applied operative technique; atypical mechanical resection with stapler. RESULTS Mean length of postoperative intensive care was between 3 to 7 days, while that of hospitalization altogether was 13 to 18 days (average 15.2 days). Ventilation needed for one patient for 5 days approximately. Two of the six patients' survival was 18 and 25 months after pulmonary metastasectomy. Four patients are still alive, their average postoperative survival is 33.5 months. They are followed up regularly and their quality of life is satisfactory. CONCLUSIONS The key factors that determine the successful outcome of metastasectomies are careful and personalized evaluation of the patients, their condition and fitness for thoracotomy, stabile cardiopulmonary functions and the capacity of the residual lung. Multidisciplinary teamwork involving anaesthetists and intensive care specialists along with surgeons using the quick atypical resection technique are the key elements to improved survival of these patients.
Collapse
Affiliation(s)
- Károly Vincze
- Kaposi Mór Oktató Kórház, Altalános Sebészeti, Er- és Mellkassebészeti Osztály, 7400 Kaposvár, Tallián Gyula u. 20-32.
| | | | | | | | | | | |
Collapse
|