Abstract:Background: Pulmonary metastases (PM) are the most frequent extra-abdominal metastases from colorectal cancer. Lung resection and imaging-guided thermal ablation (IGTA) are used as curative-intent treatment. We compared the outcomes of patients with PM, treated with resection or ablation.Methods: We retrospectively analyzed data from patients who underwent surgery or IGTA for colorectal PM between April 2011 and November 2020. Surgery was performed for peripheral PM and IGTA for deep-located PM not in contact … Show more
“…Another retrospective study looks at curative-intent treatment for colorectal pulmonary metastases including 65 surgeries (open approach or video-assisted thoracic surgery whenever technically possible) for peripheral metastases and 81 thermal ablations for deep-located metastases not in contact with major vessels. 36 After PSM analysis, each group contained 46 patients. Thermal ablation patients had a lower morbidity rate and a shorter length of stay.…”
SummaryLocal treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non‐resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image‐guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five‐years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one‐year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.
“…Another retrospective study looks at curative-intent treatment for colorectal pulmonary metastases including 65 surgeries (open approach or video-assisted thoracic surgery whenever technically possible) for peripheral metastases and 81 thermal ablations for deep-located metastases not in contact with major vessels. 36 After PSM analysis, each group contained 46 patients. Thermal ablation patients had a lower morbidity rate and a shorter length of stay.…”
SummaryLocal treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non‐resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image‐guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five‐years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one‐year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.
“…But such was the strength of the growing consensus about surgical metastasectomy that teams elected to operate on the majority. For the 263 patients, selected for operation, there was 69% 5-year survival 4 (Figure 1 Karam et al 1 chose data to support their argument as we are all inclined to do. They quoted 38% from the preliminary PulMiCC report and deemed it "quite poor compared to previously published 5-year [overall survival] ranging from 40 to 68%" 1 The cited paper 5 was an invited contribution to the European Society of Thoracic Surgeons Lung Metastasectomy Project 6 when PulMiCC was mooted.…”
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confidence: 99%
“…For the 263 patients, selected for operation, there was 69% 5-year survival 4 (Figure 1 Karam et al 1 chose data to support their argument as we are all inclined to do. They quoted 38% from the preliminary PulMiCC report and deemed it "quite poor compared to previously published 5-year [overall survival] ranging from 40 to 68%" 1 The cited paper 5 was an invited contribution to the European Society of Thoracic Surgeons Lung Metastasectomy Project 6 when PulMiCC was mooted. 7 Citing it more fully, Pfanschmidt wrote "For a subset of highly selected patients, the overall results of a 5-year actuarial survival rate after complete resection ranged between 40 and 68%.…”
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confidence: 99%
“…From their propensity score matching analysis, recently published in the Journal of Surgical Oncology, Karam 1 and colleagues draw the conclusion that surgical metastasectomy and image guided thermal ablation (IGTA) may be followed by similar overall survival (OS). This is in line with a now generally held belief that for local treatments of colorectal cancer (CRC) lung metastases, cancer teams can choose between surgery, IGTA and stereotactic radiotherapy techniques according to technical considerations and the availability of expertize.…”
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confidence: 99%
“…10 This applies similarly to surgery and IGTA. 1 PulMiCC indicates that survival is predominantly a feature of expert selection of those with a better prognosis plus the effect of guarantee time bias. As Karam et al 1 have shown IGTA may be as effective as surgery in locally controlling individual lung metastases but this does not mean that either treatment actually prolongs patients' lives.…”
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