Surgical therapy of pulmonary metastases of colorectal cancer - ten-year results
Authors:
J. Vodička 1; V. Špidlen 1; V. Šimánek 1; J. Šafránek 1; V. Třeška 1; T. Skalický 1; A. Sutnar 1; J. Fichtl 1; P. Mukenšnabl 2
Authors place of work:
Chirurgická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Plzni, přednosta: Prof. MUDr. Vladislav Třeška, DrSc.
1; Šiklův patologicko-anatomický ústav Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice v Plzni, přednosta: Prof. MUDr. Michal Michal
2
Published in the journal:
Rozhl. Chir., 2012, roč. 91, č. 2, s. 81-86.
Category:
Original articles
Summary
Introduction:
Nowadays, surgical therapy of pulmonary metastases of colorectal cancer is a generally accepted therapeutic approach that has been proven to extend long term patient survival with acceptable perioperative morbidity and mortality rates. The aim of the study is to retrospectively analyse a group of patients who underwent surgery for pulmonary metastases of colorectal cancer over a period of ten years.
Materials and methods:
From 2000 to 2009, 39 patients with pulmonary metastases of colorectal cancer underwent surgical therapy at the site of the authors, out of whom 21 were males (53.8%), with a mean age of 60.4 years. Out of the total, 24 patients (61.5%) presented with solitary metastases, multiple metastases were found in the remaining patients. 8 patients (20.5%) bileral affection was detected. 34 patients (87.2%) underwent adjuvant oncological therapy of a radically surgically curable primary tumor before metastasectomy and 6 patients (15.4%) underwent surgery for liver metastases. Five patients in the group (12.8%) had both pulmonary and secondary liver affections at the same time. The median disease-free period after the primary tumor surgery was 27 months in the whole group.
Results:
In total, we performed 31 unilateral (79.5%) and 8 bilateral (20.5%) one- or two- step surgeries. The most common type of surgery included anatomical pulmonary resections (18 procedures), laser excisions (13 procedures) and wedge resections (9 procedures). In total, we performed 73 radical resections of metastases and 5 metastases were treated by radiofrequency ablation (RFA). Metastatic affection of hilar lymph nodes was found in three patients (7.7%). Perioperative morbidity reached 12.8%, mortality was zero, and two re-operations were required because of complications (5.1%). 53.8% of patients with metastasectomy are still alive, the median survival time is 38 months. The three- year survival rate is 52% and the five- year survival rate is 41% five years. Pre-operatively increased value of tissue polypeptid specific antigen (TPS) was the only statistically significant factor that had a negative impact on the overall survival. 30.7% of patients with metastasectomy show no disease progression, the median disease- free interval is 14 months. There is a statistically significant correlation between DFI (Disease Free Interval) following metastasectomy and the type of surgery and the lowest value of DFI was achieved with radiofrequency ablation. The risk of disease progression is 3.4-times higher in patients with two and more metastases of colorectal cancer up to 3.9-times higher in subjects with three and more metastases.
Conclusion:
The positive effect of pulmonary metastasectomy on the long-term survival is evident. However, careful selection of patients with individual evaluation of each single case is required. In particular, indication for metastasectomy should be carefuly considered in cases of multiple affection, which are associated with higher risk of disease progression. The essential requirement is to achieve complete resection of the pathological focus, with a maximum effort aimed at sparing healthy pulmonary tissue, which allows for potential necessary reoperations in case of the disease recurrence. Systematic mediastinal lymphadenectomy (SMLA) should be an integral part of any pulmonary metastasectomy.
Key words:
Colorectal cancer – pulmonary metastasis – metastasectomy – laser – lymphadenectomy
Zdroje
1. Davidson RS, Nwogu CE, Brentjens MJ, Anderson TM.The surgical management of pulmonary metastasis: current concepts. Surg Oncol 2001;10:35–42.
2. Čapov I, et al. Chirurgie orgánových metastáz. Praha, Galén, 2008.
3. Horák P, Pospíšil R, Polouček P. Přednosti klasického operačního přístupu v chirurgické léčbě plicních metastáz. Rozhl Chir 2011;90:162–165.
4. Dominguez-Ventura A, Nichols FC. Lymphadenectomy in metastasectomy. Thorac Surg Clin 2006;16:139–143.
5. Kondo H, Okumura T, Ohde Y, Nakagawa K. Surgical treatment for metastatic malignancies. Pulmonary metastasis: indications and outcomes. Int J Clin Oncol 2005;10:81–85.
6. de Haas RJ, Wicherts DA, Adam R. Resection of colorectal liver metastases with extrahepatic disease. Dig Surg 2008;25:461–466.
7. Labow DM, Buell JE, Yoshida A, Rosen S, Posner MC. Isolated pulmonary recurrence after resection of colorectal hepatic metastases – is resection indicated? Cancer J 2002;8:342–347.
8. Inoue M, Ohta M, Iuchi K, Matsumura A, Ideguchi K, Yasumitsu T, Nakagawa K, Fukuhara K, Maeda H, Takeda S, Minami M, Ohno Y, Matsuda H. Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg 2004;78:238–244.
9. Limmer S, Oevermann E, Killaitis C, Kujath P, Hoffmann M, Bruch HP. Sequential surgical resection of hepatic and pulmonary metastases from colorectal cancer. Langenbecks Arch Surg, 2010;395:1129–1138.
10. Marudanayagam R, Ramkumar K, Shanmugam V, Langman G, Rajesh P, Coldham C, Bramhall SR, Mayer D, Buckels J, Mirza DF. Long-term outcome after sequential resections of liver and lung metastases from colorectal carcinoma. HPB 2009;11:671–676.
11. Pfannschmidt J, Bade S, Hoheisel J, Muley T, Dienemann H, Herpel E. Identification of immunohistochemical prognostic markers for survival after resection of pulmonary metastases from colorectal carcinoma. Thorac Cardiovasc Surg 2009;57:403–408.
12. Pfannschmidt J, Dienemann H. Current surgical management of pulmonary metastases. Zentralbl Chir 2009;134:418–424.
13. Yano T, Shoji F, Maehara Y. Current status of pulmonary metastasectomy from primary epithelial tumors. Surg Today 2009;39:91–97.
14. Internullo E, Cassivi SD, Van Raemdonck D, Friedel G, Treasure T. Pulmonary metastasectomy: a survey of current practice amongst members of the European Society of Thoracic Surgeons. J Thorac Oncol 2008;3:1257–1266.
15. Hwang MR, Park JW, Kim DY, Chang HJ, Kim SY, Choi HS, Kim MS, Zo JI, Oh JH. Early intrapulmonary recurrence after pulmonary metastasectomy related to colorectal cancer. Ann Thorac Surg 2010;90:398–404.
16. Chen F, Sakai H, Miyahara R, Bando T, Okubo K, Date H. Repeat resection of pulmonary metastasis is beneficial for patients with colorectal carcinoma. World J Surg 2010;34:2373–2378.
17. Takakura Y, Miyata Y, Okajima M, Okada M, Ohdan H. Short disease-free interval is a significant risk factor for intrapulmonary recurrence after resection of pulmonary metastases in colorectal cancer. Colorectal Dis 2010;12:e68–75.
18. Mongil Poce R, Pagés Navarrete C, Ruiz Navarrete JA, et al. Survival analysis of resection of lung metastases from colorectal cancer. Arch Bronconeumol 2009;45:235–239.
19. Pereszlenyi A, Rolle A, Koch R, Schilling A, Baier B, Bis B. Resection of multiple lung metastases - where are the limits? Bratisl Lek Listy 2005;106:262–265.
20. Sakamoto T, Tsubota N, Iwanaga K, Yuki T, Matsuoka H, Yoshimura M. Pulmonary resection for metastases from colorectal cancer. Chest 2001;119:1069–1072.
21. Molnar TF, Gebitekin C, Turna A. What are the considerations in the surgical approach in pulmonary metastasectomy? J Thorac Oncol 2010;5:S140–144.
22. Loehe F, Kobinger S, Hatz RA, Helmberger T, Loehrs U, Fuerst H. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy. Ann Thorac Surg 2001;72:225–229.
23. Mutsaerts EL, Zoetmulder FA, Meijer S, Baas P, Hart AA, Rutgers EJ. Outcome of thoracoscopic pulmonary metastasectomy evaluated by confirmatory thoracotomy. Ann Thorac Surg 2001;72:230–233.
24. Erhunmwunsee L, DęAmico TA. Surgical management of pulmonary metastases. Ann Thorac Surg 2009;88:2052–2060.
25. Lin JC, Wiechmann RJ, Szwerc MF, Hazelrigg SR, Ferson PF, Naunheim KS, Keenan RJ, Yim AP, Rendina E, DeGiacomo T, Coloni GF, Venuta F, Macherey RS, Bartley S, Landreneau RJ. Diagnostic and therapeutic video-assisted thoracic surgery resection of pulmonary metastases. Surgery 1999;126:636–641.
26. Park JS, Kim HK, Choi YS, et al. Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer. Ann Oncol 2010;21:1285–1289.
27. Jungraithmayr W, Schäfer O, Stoelben E, Hasse J, Passlick B. Radiofrequency ablation of malignant lung tumours. Judicious approach? Chirurg 2005;76:887–893.
28. Schultheis KH, Schroeder-Finckh R, Schultheis A, Kappes R, Sommerer F, Tannapfel A. Effectiveness of radiofrequency ablation of lung tumours. Chirurg 2008;79:963–966.
29. Doležel J, Veverková L, Jedlička V, Čapov I, Szkorupa M, Vodička J. Mediastinal lymphadenectomy in surgery of pulmonary metastasis. Rozhl Chir 2009;88:259–261.
30. García-Yuste M, Cassivi S, Paleru C. Thoracic lymphatic involvement in patiens having pulmonary metastasectomy: incidence and the effect on prognosis. J Thorac Oncol 2010;5:S166–169.
31. Szöke T, Kortner A, Neu R, et al. Is the mediastinal lymphadenectomy during pulmonary metastasectomy of colorectal cancer necessary? Interact Cardiovasc Thorac Surg 2010;10:694–698.
32. Riquet M, Foucault C, Cazes A, et al. Pulmonary resection for metastases of colorectal adenocarcinoma. Ann Thorac Surg 2010;89:375–380.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2012 Číslo 2
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Nuss miniinvasive procedure for pectus excavatum in adolescents and adults
- The importance of early surgical intervention in the treatment of necrotizing vasculitis
- Burkitt´s lymphoma of the caecum as a rare cause of acute abdomen: a case report
- Single-incision thoracoscopic surgery – SITS