Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Abstract

Background: Surgery is considered an effective therapeutic option for patients with lung metastasis (MTS) of colorectal cancer (CRC). The purpose of the study was to evaluate efficacy and feasibility of lung metastasectomy in CRC patients and to explore factors of prognostic relevance. Methods: This is a retrospective study of patients operated for lung MTS of CRC from 2004 to 2012 in a single Institution. Overall survival (OS) was the primary endpoint. Secondary endpoints were progression free survival (PFS) in resection status R0 and OS in in patients submitted to re-resections. In order to evaluate prognostic factors, a multivariable Cox proportional hazard model was performed.Results: One-hundred eighty-eight consecutive patients were included in the final analysis. The median follow-up (FU) was 45 months. The 5-year OS and PFS were 53% (95% CI: 44-60%) and 33% (95% CI: 25-42%), respectively. Two-and 5-year survival after re-resection were 79% (95% CI: 63-89%) and 49% (95% CI: 31-65%), respectively. Multivariate adjusted analysis showed that primary CRC pathological TNM stages (P=0.019), number of resected MTS ≥5 (P=0.009) and lymph nodal involvement (P<0.0001) are independent predictors of poor prognosis. Conclusions: Patients operated and re-operated for lung MTS from CRC cancers showed encouraging survival rates. Our results indicated that primary CRC stage, number of MTS and lymph nodal involvement are strong predictive factors. Prognosis after surgery remained comforting up to four resected MTS. Adjuvant chemotherapy seems to have a benefit on survival in patients affected by multiple metastases.Finally, according to the high rate of unidentified lymph node involvement in pre-operative setting, lymph node sampling should be advisable for a correct staging. randomized trial and the undefined role of metastasectomy remained the unsolved problem in the management of patients with pulmonary metastasis (MTS) of CRC (5).The purpose of the study was to evaluate the efficacy and the feasibility of lung metastasectomy in colorectal cancer (CRC) in our institution. Moreover, we aimed at exploring prognostic factors for survival and evaluating survival pattern in patients submitted to re-resections. MethodsWe included all consecutive patients who underwent lung metastectomy for pulmonary metastases from CRC at Department of Thoracic Surgery, University of Torino, Italy-from 2004 to 2012. Data were retrospective collected from the surgical registry of our Department. Follow-up (FU) data were acquired by routine visits, telephone contacts or from administrative data (outpatient regional registry). FU was completed over July 2014. Our Institutional Review Board approved the study. Inclusion criteria for lung metastasectomy comprised locally controlled primary CRC, no evidence of extra-thoracic lesions excluding hepatic metastases, single or multiple pulmonary nodules suitable for a radical resection. Stage of primary CRC was assigned according to the Union Internationale Contre le Cancer (UICC) staging system. Pre-op...

Opposing effects of low versus high concentrations of water soluble vitamins/dietary ingredients Vitamin C and niacin on colon cancer stem cells (CSCs)

“…Colorectal cancers have very high rates of relapses (Guerrera et al, 2016). However, minimal interventions are available, in response to, possible relapse of the cancers.…”

“…It is mostly a relapsed cancer that is responsible for the major deaths of the cancer patients. Colorectal cancers have very high rates of relapses (Guerrera et al, 2016). Moreover, it is now known that cancer stem cells-CSCs/tumour initiating cells-TICs are the ones that form the bulk of a relapsed tumour (Yu et al, 2016b).…”

Low Accuracy of Computed Tomography and Positron Emission Tomography to Detect Lung and Lymph Node Metastases of Colorectal Cancer

“…Complete palpation was deemed fundamental for the purpose of the study; consequently, patients undergoing video-assisted thoracic surgery were excluded from the cohort for this study. Additional preoperative patient assessment, surgical approach, and surgical technique were accomplished as previously described [9,14]. Concerning lymph node evaluation, N1 and N2 stations were determined according to the International Association for the Study of Lung Cancer lymph nodal map [15].…”

“…Nevertheless, among alternative metastasisdirected local treatments, minimally invasive surgery (video-assisted thoracic surgery), stereotactic body radiotherapy, and radiofrequency ablation, with or without systemic chemotherapy [4,5], are commonly proposed to CRC metastatic patients in routine clinical practice [6]. Furthermore, a copious amount of literature has indicated that, in CRC patients undergoing lung metastasectomy or local treatment, certain factors, including lymph node involvement (LNI) and number of pulmonary metastases, are consistent predictors of the outcome [3,[7][8][9][10][11].…”

Metastasis directed therapy for liver and lung metastases from colorectal cancer—A population‐based study

“…[3][4][5] In Denmark, these three treatment modalities constitute an integral part of the multidisciplinary treatment of mCRC. The majority of literature supporting the use of metastases directed therapy consists of single institution experiences for both resection, 6,7 RFA 8,9 and SBRT 10,11 demonstrating a potential of curability for subsets of patients. Liver resection remains the most extensive studied treatment with a recent meta-analysis of 54 singled arm studies demonstrating a 5-and 10-years overall survival of 38% and 26%, respectively.…”