Surgical Treatment of Liver and Pulmonary Metastases of Colorectal Carcinoma

Česká verzia

Authors: T. Skalický; V. Třeška; V. Špidlen; V. Vodička; A. Sutnar; V. Liška; J. Klečka; V. Šimánek; J. Šafránek; J. Fichtl; M. Polák
Authors place of work: Chirurgická klinika LFUK a FN v Plzni, přednosta prof. MUDr. V. Třeška DrSc.
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 4, s. 253-255.
Category: Monothematic special - Original

Summary

The aim:
The aim of the work was to evaluate the set of 10 patients, who were operated on hepatic and pulmonary metastases of colorectal carcinoma at the Surgical Clinic of Medical Faculty of Charles University and Faculty Hospital in Plzeň in years from 2005 till 2009. With regard to limited experience with the patients who underwent hepatic as well as pulmonary resection, we focused on the evaluation of a long-term survival of the patients and their mortality and morbidity.

The set of the patients:
In years from 2005 till 12/2009 we operated 10 patients during whose affection there occurred hepatic and pulmonary metastases of colorectal carcinoma and these were solved surgically. This concerned 5 men and 5 women at an average age of 62.4 years (42–71 years). In 10% it was hepatic resection in the first period after the operation of primary carcinoma, it was the first performance on the hepatic parenchyma in 90%.

The results:
Morbidity of the set was 20.1% regarding hepatic resections and 5.6% regarding pulmonary resections. A 30-day postoperative mortality was 0%. In three cases a hepatic involvement was bilateral, in two cases in the left lung and 5 patients had an involvement of the right pulmonary lobe. In 4 cases primary carcinoma was in the rectum and in 6 cases in the large intestine. The period of three months was an average time between hepatic and pulmonary resection. Resection on liver parenchyma was the most often performance and metastasectomy with the help of laser on the pulmonary parenchyma. Rectal carcinoma spread into lungs in 50%. An average time of a 5-year survival in the patients after resection of hepatic and pulmonary metastases of colorectal carcinoma was 26%.

The conclusion:
Hepatic and pulmonary resection in the selected patients with generalized colorectal carcinoma extends the period of a survival and does not worsen the quality of the life. The patients after resection of both – hepatic and pulmonary metastases have got a worse long-term survival than the patients being only after hepatic resections.

Key words:
colorectal carcinoma – liver metastases – pulmonary metastases

Zdroje

1. Vigneswaran, W. T. Management of pulmonary metastases from colorectal cancer. Semin. Surg. Oncol., 1996; 12: 264–266.

2. McAfee, M. K., Allen, M. S., Trastek, V. F., Ilstrup, D. M., Deschamps, C., Pairolero, P. C. Colorectal lung metastases: results of surgical excision. Ann. Thorac. Surg., 1992; 53: 780–786.

3. Okumura, S., Kondo, H., Tsuboi, M., et al. Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients. J. Thorac. Cardiovasc. Surg., 1996; 112: 867–874.

4. Murata, S., Moriya, Y., Akasu, T., Fujita, S., Sugihara, K. Resection of both hepatic and pulmonary metastases in patients with colorectal carcinoma. Cancer, 1998; 83: 1086–1093.

5. Ambiru, S., Miyazaki, M., Ito, H., et al. Resection of hepatic and pulmonary metastases in patients with colorectal carcinoma. Cancer, 1998; 82: 274–278.

6. Sugihara, K., Hojo, K., Moriya, Y., Yamasaki, S., Kosuge, T., Takayama, T. Pattern of recurrence after hepatic resection for colorectal metastases. Br. J. Surg., 1993; 80: 1032–1035.

7. McCormack, P. M, Ginsberg, K. B., Bains, M. S., et al. Accuracy of lung imaging in metastases with implications for the role of thoracoscopy. Ann. Thorac. Surg., 1993; 56: 863–865.

8. McCormack, P. M., Baines, M. S., Begg, C. B., et al. Role of videoassisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial. Ann. Thorac. Surg., 1996; 62: 213–216.

9. Fernandez, Trigo V., Shamsa, F., Sugerbaker, P. H. Repeat liver resections from colorectal metastases. Surgery, 1995; 117: 296–304.

10. Mirka, H., Ferda, J., Ohlídalová, K., Ferdová, E., Třeška, V., Skalický, T., Sutnar, A. Zobrazování jaterních nádorů po radiofrekvenční ablaci. Ces. radiol., 1, 2008, roč. 62, s. 51–59.

11. Ferda, J., Mirka, H., Kastner, J., Ohlídalová, K., Ferdová, E., Vondráková, R., Třeška, V., Skalický, T., Sutnar, A. Detekce metastáz kolorektálního karcinomu v játrech: porovnání magnetické rezonance s podáním kontrastní látky a peroperační ultrasonografie.

12. Neeff, H., Horth, W., Makowiec, F., et al. Outcome after Resection of Hepatic and Pulmonary Metastases of Colorectal Cancer. J. Gastrointest. Surg., 2009, Quick Shot-on line, Springer.