Does pulmonary metastasectomy of colorectal metastases translate to
better survival? A systematic review

Lee, Kai Yin; Lau, Jerrald; Siew, Bei En; Chua, Yong Kang; Lim, Yi Xuan; Lim, Xin Yi; Chong, Choon Seng; Tan, Ker Kan

doi:10.47102/annals-acadmedsg.2021255

Cited by 5 publications

(4 citation statements)

References 18 publications

(52 reference statements)

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“…There is also no consensus on chemotherapy and length of surveillance before pneumonectomy. Furthermore, the effect of lung metastasectomy on outcomes is controversial in metastatic CRC (18). Given that there are cases of cured patients such as case 2 in the present report, pneumonectomy should be considered if technically and physically feasible.…”

Section: Discussionmentioning

confidence: 88%

Stage IV and recurrent colorectal cancer cured following multimodal therapy: A case series

Kurata,

Imai,

Hirata

et al. 2024

Oncol Lett

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The treatment strategies for colorectal cancer (CRC) with distant metastasis or metastatic recurrence after resection of the primary tumor are controversial. In the present study, four cases of patients with advanced CRC with distant metastasis who achieved disease-free survival (DFS) for >5 years and were deemed potentially cured were reported. Case 1 was that of a 53-year-old male patient with rectal cancer and liver metastases (pT3N2bM1, pStage IV), and case 2 was that of a 58-year-old female patient with descending colon cancer (pT3N1M1, pStage IV) who had lung metastases at surgery and postoperatively. Both patients achieved DFS for >5 years after simultaneous or staged partial hepatectomy or pneumonectomy followed by chemotherapy. Case 3 was that of a 75-year-old male patient with transverse colon cancer (pT3N1M0, pStage IIIB) and case 4 was that of a 73-year-old male patient with sigmoid colon cancer (pT3N0M0, pStage IIA). These cases developed liver metastases after resection of the primary tumour and were subsequently treated with chemotherapy before or after partial hepatectomy. DFS for >5 years was achieved. All four patients were considered cured. The data revealed that even patients with CRC and distant metastases can potentially be cured following multidisciplinary treatment. In the present case report, the factors that enabled these patients to be considered cured were discussed and the aim was to improve the treatment strategy to cure CRC with distant metastasis or recurrence.

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Section: Discussionmentioning

confidence: 88%

Stage IV and recurrent colorectal cancer cured following multimodal therapy: A case series

Kurata,

Imai,

Hirata

et al. 2024

Oncol Lett

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“…Several retrospective studies support the use of pulmonary metastasectomy as a standard of care in metastatic CRC ( 6 ) but some do not show clear survival benefits at present ( 7 ). Our study found a five-year OS of 33.2%, which is within the range of OS in such cases described in the literature (27%–68%) ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective studies support the use of pulmonary metastasectomy as a standard of care in metastatic CRC (6) but some do not show clear survival benefits at present (7).…”

Section: Discussionmentioning

confidence: 99%

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center

et al. 2022

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PurposeThis study aimed to describe the survival outcomes and factors associated with prognosis in patients undergoing pulmonary metastasectomy with colorectal cancer (CRC) in a cancer center in South America.Material and methodsA retrospective analysis of patients that underwent lung metastasectomy due to CRC at National Cancer Institute (INC), Colombia between 2007 and 2017 was performed and Kaplan-Meier survival analysis along with log-rank test and Cox regression multivariate analysis were completed.ResultsSeventy-five patients with colorectal adenocarcinoma were included in the study. Of them, 57.3% were women with a median age of 62 years [interquartile ranges (IQR): 18.5]. For 45.3% the adenocarcinoma was located in the rectum and 29.3% had stage IV at diagnosis. 56% had a history of controlled extrapulmonary metastasis and 20% of the cases had a history of the metastasis of the liver. The median follow-up was 36.8 months (IQR: 27.4). Three-year and five-year overall survival (OS) was 57.5% [95% confidence interval (CI), 47.0–70.4] and 33.2% (95% CI, 23.4–47.2), respectively. Patients with bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy carcinoembryonic antigen (CEA), history of liver metastasis, and disease-free interval (DFI) ≤12 months had worse OS. Three-year and five-year disease-free survival (DFS) was 30.1% (95% CI, 20.8–43.6) and 21.6% (95% CI, 13.0–35.9), respectively. Bilateral, more than one pulmonary metastasis, and patients with stage IV at diagnosis had the worst DFS. Multivariate analysis in the Cox regression model showed that abnormal postmetastasectomy CEA [Hazard Ratio (HR):1.97, 95% CI, 1.01–3.86, p = 0.045] and DFI ≤ 12 months (HR: 3.08, 95% CI, 1.26–7.53, p = 0.014) were independent factors for worst OS.ConclusionsThe OS found falls within the wide range described in the world literature but interestingly it falls at the bottom end of this range. The factors associated with worst survival were identified as bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and DFI ≤12 months.Contribution to the fieldPulmonary metastasectomy is the standard of care in patients with metastatic CRC. However, the literature supporting this conduct is based on retrospective studies and the only randomized controlled trial conducted to date was stopped due to poor recruitment. Limited information is available in South America about survival and factors associated with prognosis in patients with metastatic CRC. While this study is another series that adds to the many studies across the world that describe the use of pulmonary metastasectomy in CRC, it presents critical data as it is one of the few studies carried out in South America. As described in a wide range of world literature, OS found falls in patients that underwent lung metastasectomy due to CRC however; interestingly, in the South American population analyzed here it falls at the bottom end of this range. This may be explained by a large number of patients included with a history of extrapulmonary metastasis as well as may reflect inadequate patient access to reference cancer centers in Colombia. Factors associated with worst survival in our population were bilateral, more than one pulmonary metastasis, abnormal postmetastasectomy CEA, history of liver metastasis, and interval from diagnosis to development of pulmonary metastasis ≤12 months.

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“…Their results support the use of SBRT in this cohort of patients as it was associated with a delay in progression to polymetastatic disease. Further prospective studies are necessary to obtain a better understanding of the long-term effect of lung metastasectomy in metastatic colorectal cancer [ 83 ].…”

Section: Contemporary Management Strategiesmentioning

confidence: 99%

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Collaborative¹

2022

Cancers

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Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments.

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Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review

Cited by 5 publications

References 18 publications

Stage IV and recurrent colorectal cancer cured following multimodal therapy: A case series

Stage IV and recurrent colorectal cancer cured following multimodal therapy: A case series

Lung Metastasectomy from Colorectal Cancer, 10-year Experience in a South American Cancer Center

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

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