Contemporary operative management of pulmonary metastases of colorectal origin

Abstract

The management of patients with metastatic disease from primary carcinoma of the colon and rectum is still controversial. To evaluate the results of resection of pulmonary metastases from patients with colorectal primaries, a retrospective study of all patients who underwent such resection was carried out at the teaching hospitals of McGill University and Université de Montréal. A total of 345 patients admitted with pulmonary metastases; 27 of them underwent pulmonary resection with the extent of the resection varying from wedge excision of the metastatic nodule to pneumonectomy. In 25 of the 27 patients the resection was considered curative. Eight of the 27 patients had resection of two metastatic lesions while the remaining 19 patients had resection of solitary lesions. The interval between resection of the primary colorectal malignancy and the resection of the metastatic lesion (disease-free interval) varied from 2 to 77 months with a median interval of 35 months. The five-year survival following resection of pulmonary metastases was 21 percent. A prolonged interval between treatment of the primary and resection of the pulmonary metastasis was associated with a longer survival. This retrospective study demonstrates that prolonged survival can be achieved following resection of pulmonary metastases from colorectal carcinoma.

Stereotactic Body Radiation Therapy Using Three Fractions for Isolated Lung Recurrence from Colorectal Cancer

“…Surgical resection remains the preferred option for pulmonary and liver metastases. Previous studies on colorectal pulmonary metastasis treated surgically have reported 5-year survival rates of 24–56% [4,5,6,7,8,9,10,11] and have investigated prognostic factors. Koga et al [21] identified 4 independent favorable factors, i.e., 3 tumors or less, metachronous metastasis, negativity for hilar and/or mediastinal lymph node metastasis and a normal prethoracotomy serum carcinoembryonic antigen level.…”

“…Surgical resection plays a prominent role in the management of these cases, and metastasectomy for pulmonary lesions, which is indicated for selected patients, has been reported to result in 5-year survival rates of 40% [1,4,5,6,7,8,9,10,11]. Resectability is determined based on the numbers and sites of metastatic pulmonary lesions, and on the presence of other forms of systemic metastasis [7,8,9,10].…”

CEA, CA 242, CA 19-9, CA 72-4 and hCGβ in the Diagnosis of Recurrent Colorectal Cancer

“…Approximately 25% of these patients are candidates for hepatic resection, and the 5-year survival for patients who undergo liver surgery is 21-48% [1,2]. Brister et al [3] reported a 5-year survival of 21% in patients who had undergone resection for solitary lung metastases. It is generally believed that CEA is the best available noninvasive test for identifying recurrences during follow-up of patients after surgery for colorectal cancer [4][5][6].…”

“…In these patients, neither CA Logarithmic transformation of the marker serum concentrations at the time of clinical recurrence or during postoperative follow-up in the disease-free patients. 3 Colon or rectum.…”

Chirurgische und interventionelle Therapiemöglichkeiten bei Fernmetastasen kolorektaler Karzinome

“…Fong et al [7] zeigten in einer der größten Serien mit 1001 Patienten, dass nicht nur die Patienten mit einer R0-Resektion von der Operation profitieren (5-Jahres-Überleben 37%), sondern dass auch nach einer R1-Resektion bis zu 20% der Patienten 5 Jahre nach der Operation noch leben. Lungenmetastasen und kombinierte Leber-und Lungenmetastasen Ungefähr 10% der Patienten mit einem kolorektalen Karzinom entwickeln Lungenmetastasen [41,42]. Allerdings sind nur in 2-4% der Patienten die Metastasen auf die Lunge beschränkt.…”