Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer

Park, J. S.; Kim, Hyeong-Ki; Choi, Young Don; Kim, K.; Shim, Young Mog; Jo, Jung Ki; Lee, W.-Y.; Chun, Ho-Kyung; Park, Y. S.; Kang, Won Ki; Kim, J.

doi:10.1093/annonc/mdp475

Cited by 68 publications

(50 citation statements)

References 20 publications

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“…Thirty-one patients (35.6 %) live without progression of the disease after resection of metastases, and the median DFI is 15 months (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In total, 34 % and 28 % of patients survived without any signs of relapse or progression of the disease for three years and 5 years, respectively (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…This type of laser enables an ideal excision of a metastasis together with the necessary resection edge also in cases where it is more deeply located in the pulmonary parenchyma, and furthermore it enables resection of metastases without the need for anatomical pulmonary resection or bilateral surgeries (20). The saving of maximum pulmonary parenchyma does not limit the possibly recommended re-operations in case of recurrence of the disease (21,22). The number of removed lesions is not primarily limited.…”

Section: Discussionmentioning

confidence: 99%

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Surgical therapy of pulmonary metastases – 10-year results

Vodička¹,

Spidlen²,

Šimánek³

et al. 2013

BLL

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Introduction:The surgical therapy of selected secondary pulmonary tumors, including both solitary and multiple or bilateral tumours, is currently a generally accepted therapeutic procedure demonstrably extending the long term survival of these patients. Purpose: The purpose of the present study is a ten-year retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors. Methods: In 2000-2009, 87 patients (of which 44 were male with a median age of 64 years) with secondary pulmonary tumors underwent surgery at the departments of the authors of this study. Solitary metastases were found in 60 patients, multiple metastases in the remaining patients, while 13 patients had bilateral metastases. The median disease-free period from surgery of the primary tumor was 31 months. Results: In total, 74 unilateral and 13 bilateral surgeries were performed in one or two periods. The most common type of surgery included anatomical pulmonary resections (32 procedures), wedge resections (29 procedures) and laser excisions (24 procedures). In total, the radical resection was performed in 156 metastases. Post-operative morbidity was 17.2 % with zero mortality. A proportion of 50.6 % of operated patients survived after resection of metastases with median survival of 39 months. The overall three-year and fi ve-year survivals in the group were 57 % and 38 %, respectively. A proportion of 35.6 % of patients live after resection of metastases without disease progression, and the median is 15 months. Conclusion:The achieved results confi rm the positive role of pulmonary metastasectomy in the therapy of disseminated cancer disease (Tab. 1, Fig. 5, Ref. 34 Hematogeneous pulmonary metastases are generally considered as a sign of advanced generalization of malignant disease. Up to one third of malignant tumors have pulmonary metastases, and in most of them the lungs are even the fi rst site of dissemination. Nevertheless, in a signifi cant number of patients, the pulmonary affl iction is stopped or eliminated during the dissemination of metastases, and these patients may benefi t from radical resection of metastases (1, 2). Surgical therapy of the selected secondary pulmonary tumors, not only solitary but also multiple or bilateral, is today generally the accepted therapeutic procedure which demonstrably extends long term survival of these patients with acceptable peri-operative morbidity and mortality. The purpose of the following study is a retrospective analysis of a group of patients who underwent surgery due to pulmonary metastases of various primary tumors over a period of ten years. Material and methodsIn 2000-2009 we performed surgery on 87 patients with secondary pulmonary tumors. Only patients who had undergone a radical resection of the primary tumor, were free from other extrapulmonary metastases, their pulmonary metastases appeared to be radically removable according to the pre-operative examinations as for the number and location, and the benefi t of surgery...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical therapy of pulmonary metastases – 10-year results

Vodička¹,

Spidlen²,

Šimánek³

et al. 2013

BLL

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“…KRAS mutations for example are associated with increased lung metastasis, whereas loss of Smad4 expression seems to predict liver metastasis (17,37,38). This is an important information since repeated pulmonary and hepatic metastasectomy can be offered to the patients with good results and low morbidity (39). We therefore determined the site-specific pattern of metastatic recurrence in our patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy

et al. 2017

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Background: Pulmonary metastasectomy (PM) is a standard procedure in the treatment of stage IV colorectal cancer (CRC). In most centers the indication for PM is solely based on clinical factors without taking the tumor biology into account. This results in diverse outcomes ranging from long-term remission to early recurrence. Inflammation is considered a hallmark of cancer development and progression. On the other hand the accessibility of CRC cells to the immune system reflects the grade of tumor aggressiveness.We sought to investigate the impact of cyclooxygenase-2 (COX-2) and prostaglandin-E2 (PGE2) expression in pulmonary metastases on different outcome parameters following PM. Results: COX-2 and PGE2 were detected in nearly every pulmonary CRC metastasis. Staining intensities of pulmonary metastases correlated only weakly with intensities found in primary tumors. When dividing metastases in high expressing and low expressing tumors, a trend towards longer recurrence free survival and improved survival was found in tumors with strong COX-2 and PGE2 staining. Conclusions:In conclusion, this pilot study shows that COX-2 and PGE2 are uniformly overexpressed in pulmonary metastases from CRC. High expression of COX-2 and PGE2 seems to reflect a beneficial tumor biology with late tumor recurrence and prolonged overall survival after PM.

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“…However, recent trends of aggressive metastasectomy, particularly of lung metastases of colorectal origin (6,7), could shed a light on this problem. Surgical resection of metastatic tumors is usually performed when, i) recurrence is not detected in the primary site, ii) complete surgical removal of the metastases is feasible, iii) there is no evidence of metastasis in other organs other than the lung, and iv) the patient can tolerate the surgery (6).…”

Section: Introductionmentioning

confidence: 99%

“…Surgical resection of metastatic tumors is usually performed when, i) recurrence is not detected in the primary site, ii) complete surgical removal of the metastases is feasible, iii) there is no evidence of metastasis in other organs other than the lung, and iv) the patient can tolerate the surgery (6). The tumors removed thereby, are chronologically separated during the latent periods, and genetic differences (5,8) reflect the changes in their ability to colonize the lung.…”

Section: Introductionmentioning

confidence: 99%

Differential gene expression during colon-to-lung metastasis

Kim

Choi²,

Cho³

et al. 2011

Oncol Rep

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Abstract. Primary tumors in certain metastatic cases have potential dissemination mechanisms. However, they often lack the potential to colonize distant microenvironments, and consequently the disseminated cancer cells enter into a state of latency which can last for years. In order to investigate the metastatic colonization potential at the gene expression level, we compared such primary tumors with their matching, actively proliferating metastatic tumors. Six pairs of colonto-lung metachronous tumor samples were examined for the expression levels of 84 well-known metastatic genes using the quantitative RT-PCR-based PCR Array technology. The unsupervised hierarchical clustering of all 12 samples together, resulted in the formation of one closely related cluster by the primary tumors, but highly diversified ones by the metastatic tumors. A pair-wise comparison of the matching primarymetastatic tumors showed that different groups of genes were activated in the lung metastases. Therefore we charted specific genes involved in the genetic diversification processes. A number of these genes showed similar differential expression (ΔCt) patterns in all the patients. These were the cancer cell-, the microenvironment-and the stem cell-specific gene groups. In conclusion, the results suggest that the primary colorectal cancer cells are diversified as regards colonization of the lung, which could explain why the effective therapies for primary colorectal cancers are often not appropriate for controling the growth of pulmonary metastases. IntroductionMetastasis can be viewed as two consecutive cellular processes: Dissemination of the cancer cells from the primary tumor to distant sites, and colonization of the disseminated cancer cells of microscopic size into full-blown metastatic malignancies (1,2). When disseminated to a distant microenvironment, most cancer cells can no longer grow in the alien microenvironment, and thus enter into a state of latency which can last for months or years until they discover new growth mechanisms (3-5). Understanding how the micrometastases come out of their latent state to colonize the distant organ is of prime interest, as it could lead us to a therapeutic means of controling the process. However, such studies are generally not practically feasible, as metastasectomies are rarely performed, and even in those rare cases, the invasiveness of the matching primary tumors often decreases during the latent years.However, recent trends of aggressive metastasectomy, particularly of lung metastases of colorectal origin (6,7), could shed a light on this problem. Surgical resection of metastatic tumors is usually performed when, i) recurrence is not detected in the primary site, ii) complete surgical removal of the metastases is feasible, iii) there is no evidence of metastasis in other organs other than the lung, and iv) the patient can tolerate the surgery (6). The tumors removed thereby, are chronologically separated during the latent periods, and genetic differences (5,8) reflect the changes in t...

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Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer

Cited by 68 publications

References 20 publications

Surgical therapy of pulmonary metastases – 10-year results

Surgical therapy of pulmonary metastases – 10-year results

Impact of cyclooxygenase-2 and prostaglandin-E2 expression on clinical outcome after pulmonary metastasectomy

Differential gene expression during colon-to-lung metastasis

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