Surgical Treatment of Lung Metastases of Colorectal Carcinoma – Survival and Prognostic Factors

Česká verzia

Authors: Anton Dzian ; M. Uhnák; J. Hamžík
Authors place of work: Klinika hrudníkovej chirurgie JLF UK a UN Martin, Slovenská republika
Published in the journal: Klin Onkol 2015; 28(5): 345-351
Category: Původní práce
doi: https://doi.org/10.14735/amko2015345

Summary

Backround:
Colorectal carcinoma has the third highest incidence of all tumor diseases in the world. In the long term, Slovak republic is among countries with highest occurrence of this disease. About 25% of patients have distant metastases at the time of diagnosis, and about 50% of patients progress. The first possibility of colorectal carcinoma lung metastases treatment is metastasectomy which may have a curative character.

Materials and Methods:
In this paper, the authors retrospectively evaluated 50 patients who had undergone surgical treatment to establish the diagnosis of colorectal carcinoma lung metastases at the Clinic of thoracic surgery of JLF UK and UH Martin between 2003 and 2014.

Results:
Altogether, 27 men and 23 women were operated (average age: 62 and 61 years). 52% of patients had solitary metastasis.We chose thoracotomy as a surgical access for majority of the surgeries (76%), and the most common type of surgical procedure was a wedge resection (74%). 3-year survival of patients after complete metastasectomy was 55.5%, and 5-year survival was 31.8% with a median survival of 42 months. We did not record any statistically significant influence of number of metastases (p = 0.3297) and length of disease-free interval (p = 0.4423) on the long-term survival, but we confirmed a significant difference of survival in different prognostic groups according to the International registry of lung metastases (p = 0.049).

Conclusion:
A surgical removal of colorectal carcinoma lung metastases in selected patients is an important curative modality that might prolongsurvival, improve the prognosis and at the same time have minimum complications. The results show that the strongest predicative indicator of prognosis is incorporation of the patients to the prognostic groups determined by the International Registry of Lung Metastases

Key words:
colorectal carcinoma – lung metastases – metastasectomy – survival

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Submitted:
20. 7. 2015

Accepted:
23. 8. 2015

Zdroje

1. Ferlay J, Soerjomataram I, Ervik M et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [monograph on the Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http:/ / globocan.iarc.fr.

2. Rama N, Monteiro A, Bernardo JE et al. Lung metastases from colorectal cancer: surgical resection and prognostic factors. Eur J Cardiothorac Surg 2009; 35(3): 444– 449. doi: 10.1016/ j.ejcts.2008.10.047.

3. Pastorino U, Buyse M, Friedel G et al. Long‑term results of lung metastasectomy: prognostic analyses based on 5,206 cases. J Thorac Cardiovasc Surg 1997; 113(1): 37– 39.

4. Van Cutsem EV, Cervantes A, Nordlinger B et al. Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow‑up. Ann Oncol 2014; 25 (Suppl 4): iii1– iii9. doi: 10.1093/ annonc/ mdu260.

5. Zisis C, Tsakiridis K, Kougioumtzi I et al. The management of the advanced colorectal cancer: management of the pulmonary metastases. J Thor Dis 2013; 5 (Suppl 4): 383– 388. doi: 10.3978/ j.issn.2072‑ 1439.2013.06.23.

6. Chao YK, Chang HC, Wu YC et al. Management of lung metastases from colorectal cancer: video‑ assisted thoracoscopic surgery versus thoracotomy – a case‑ matched study. J Thorac Cardiovascular Surg 2012; 60(6): 398– 404. doi: 10.1055/ s‑ 0031‑ 1295574.

7. Nakajima J, Murakawa T, Fukami T et al. Is thoracoscopic surgery justified to treat pulmonary metastasis from colorectal cancer? Interact Cardiovasc Thor Surg 2008; 7(2): 212– 217.

8. Carballo M, Maish MS, Jaroszewski DE et al. Video‑ assisted thoracic surgery (VATS) as a safe alternative for the resection of pulmonary metastases: a retrospective cohort study. J Cardiothorac Surg 2009; 4(13): 398– 404. doi: 10.1186/ 1749‑ 8090‑ 4‑ 13.

9. Poletti GB, Toro IF, Alves TF et al. Descriptive analysis of and overall survival after surgical treatment of lung metastases. J Bras Pneumol 2013; 39(6): 650– 658. doi: 10.1590/ S1806‑ 37132013000600003.

10. Su X, Ma G, Zhang X et al. Surgical approach and outcomes for treatment of pulmonary metastases. Ann Thorac Med 2013; 8(13): 160– 164. doi: 10.4103/ 1817‑ 1737.114300.

11. Internullo E, Cassivi SD, Van Raemdonck D et al. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008; 2(11): 1257– 1266. doi: 10.1097/ JTO.0b013e31818bd9da.

12. Pfannschmidt J, Muley T, Hoffmann H et al. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. J Thorac Cardiovasc Surg 2003; 126(3): 732– 739.

13. Welter S, Jacobs J, Krbek T et al. Long‑term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg 2007; 84(1): 203– 210.

14. Hamaji M, Cassivi SD, Shen KR et al. Is lymph node dissection required in pulmonary metastasectomy for colorectal adenocarcinoma? Ann Thorac Surg 2012; 64(6): 1796– 1800. doi: 10.1016/ j.athoracsur.2012.04.049.

15. Monteiro A, Arce N, Bernardo J et al. Surgical resection of lung metastases from epithelial tumors. Ann Thorac Surg 2004; 77(2): 431– 437.

16. Girard P, Baldeyrou P, Grunenwald D et al. Lung metastases from colorectal cancer: results of surgery. Presse Med 1995; 24(22): 1028– 1032.

17. Saito Y, Omiya H, Kohno K et al. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg 2002; 124(5): 1007– 1013.

18. Rena O, Casadio C, Viano F et al. Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty‑year experience. Eur J Cardiothorac Surg 2002; 21(5): 906– 912.

19. Van Schaik VP, Kouwenhoven EA, Bolhuis RJ et al. Pulmonary resection for metastases from colorectal cancer. J Thorac Oncol 2007; 2(7): 652– 656.

20. Zampino MG, Maisonneuve P, Ravenda PS et al. Lung metastases from colorectal cancer: analysis of prognostic factors in a single institution study. Ann Thorac Surg 2014; 98(14): 1238– 1245. doi: 10.1016/ j.athoracsur.2014.05.048.