Prediction of Prognosis and Surgical Indications for Pulmonary Metastasectomy From Colorectal Cancer

Iwamoto, Toshihiko; Suzuki, Makoto; Yoshida, Shigetoshi; Motohashi, Shinichiro; Yasufuku, Kazuhiro; Iyoda, Akira; Shibuya, Kiyoshi; Hiroshima, Kenzo; Nakatani, Yukio; Fujisawa, Takehiko

doi:10.1016/j.athoracsur.2006.02.027

Cited by 178 publications

(157 citation statements)

References 25 publications

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“…These factors are in agreement with previous studies. 15,[21][22][23] The pre-thoracotomy CEA level was the most prognostic factor for survival in a multivariate analysis, and has been reviewed in other reports. 34,35) It has been reported that 70% of patients with recurrent or metastatic colorectal carcinoma are CEA-positive.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Osoegawa

Kometani

Fukuyama

et al. 2016

ATCS

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IntroductionRecent advances in systemic chemotherapy have prolonged the survival in patients with metastatic colorectal carcinoma. [1][2][3] The combination of oxaliplatin, fluoropyrimidine and CPT-11, along with other newly developed molecular targeting agents like bevacizumab, cetuximab/ panitumumab and regorafenib has led to the median overall survival reaching approximately 2.5 years. [4][5][6][7][8][9][10][11][12] Nearly half of the patients with colorectal carcinoma experience distant metastases, mainly in the liver and lungs. 13) From the pathological view with regard to the cascade hypothesis, these two metastatic sites develop in discrete steps, which supports the idea that these hematogenous metastases are limited diseases. 14) Several retrospective studies have shown that patients with isolated pulmonary metastases from colorectal carcinoma benefit from resection. The published five-year survival rates after pulmonary Purpose: As chemotherapy has improved, the survival of patients with metastatic colorectal carcinoma has reached up to 2.5 years. Many of these patients experience pulmonary metastases; however, the prognosis after pulmonary metastasectomy is not satisfying. In this study, we analyzed the prognostic factors for survival in patients who underwent pulmonary metastasectomy. Methods: Eighty-seven patients with colorectal carcinoma received pulmonary metastasectomy. The pathological status of the primary tumor, outcome of the pulmonary metastasectomy, disease-free interval, perioperative carcinoembryonic antigen (CEA) level and history of liver metastases were assessed. Results: The five-year survival was 42.5% after pulmonary metastasectomy. A univariate analyses revealed that the CEA level (p = 0.043) and the number of pulmonary metastases (p = 0.047) were prognostic factors for survival. The CEA level was an independent prognostic factor in a multivariate analysis (relative risk = 2.01, p = 0.037). Among cases with elevated preoperative CEA levels, those whose CEA level normalized after metastasectomy had a better prognosis compared with those whose CEA level decreased but was still high, or whose level increased after metastasectomy (median survival time of 41.8 months compared with 28.1 or 15.7 months, respectively p = 0.021). Conclusion: The CEA level can be a predictive marker for the prognosis in patients with pulmonary metastases from colorectal carcinoma.

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Section: Discussionmentioning

confidence: 99%

“…metastasectomy range from 30.5% to 61.4%, [15][16][17][18][19][20][21][22][23] including the study from our institution reported in 1993. 24) In this study, we evaluated the survival after resection for patients with pulmonary metastases from colorectal origin, and assessed the prognostic factors for survival among these patients.…”

mentioning

confidence: 99%

Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Osoegawa

Kometani

Fukuyama

et al. 2016

ATCS

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“…However, nowadays resectable pulmonary metastases are no longer the contraindication for surgical treatment [6,[21][22][23]. The follow-up period in our case continues, still after two years after last surgery no metastases were detected neither in the liver, nor in the lungs; CEA also says in reference range.…”

Section: Discussionmentioning

confidence: 60%

Case report: High-volumetric atypical hemihepatectomy in patient with colorectal cancer with extensive metastatic disease

Sjomina¹,

Pavlova²,

Gashenko³

et al. 2017

Liver Pancreat Sci

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Hepatic metastasectomy in colorectal cancer is becoming a routine procedure, however the presence of extrahepatic metastatic disease worsens the life expectancy. A high-volumetric hepatic resection in case of multiple liver metastases might be performed after iatrogenic liver hypertrophy aimed to enlarge functional liver volume. Ligation or embolization of portal vein can be done. The outcome of the procedure is significantly improved using newest chemotherapy regimens and biological medications. We report a case with successful combined therapy of a 49-year-old male with colorectal cancer and bilateral extended metastatic process in liver and lungs.

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“…In a literature review of reports of more than 40 patients from 1995 up to 2006, an overall 5-year survival ranging between 38.3% and 63.7% was found (59). Positive hilar or mediastinal lymph nodes or elevated carcinoembryonic antigen negatively influence survival (59)(60)(61)(62)(63). It is suggested that obtaining R0 resection is important to achieve long-term survival and that patients with only one lung nodule tend to have a better survival than patients with more metastases (59).…”

Section: Colorectal Cancermentioning

confidence: 99%

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

Hengst¹,

Hendriks²,

Schil³

2012

Toraks Cer Bult

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Currently, surgical resection remains the gold standard for resectable lung metastases. Prognostic factors are histology, complete resection, number of metastases and disease-free interval. However, there is a high rate of recurrent disease in the thorax, even if systemic chemotherapy is applied. Because the latter is limited in dose due to systemic toxicity, new treatment options are being developed to selectively deliver high-dose chemotherapy into the lung, reducing systemic toxicity. Isolated lung perfusion (ILuP), similar to isolated limb perfusion, is an experimental surgical technique to deliver highdose chemotherapy into the lung without systemic exposure. Biological response modifiers like tumour necrosis factor can also be administered. ILuP results in significantly higher concentration of chemotherapy in the target organ compared to systemic chemotherapy, together with a survival benefit in experimental models of pulmonary metastases. Several phase I studies have shown that ILuP is technically feasible with low morbidity and low impact on the patient's pulmonary function. However, the utility of this technique is limited because it is an invasive technique. Other techniques to selectively deliver high-dose locoregional chemotherapy are embolic trapping (chemo-embolization), selective pulmonary artery perfusion (SPAP) without control of the venous effluent and the minimally invasive lung suffusion technique. This review will discuss surgical resection of lung metastases and address several techniques developed to deliver high doses of chemotherapy into the lung, as well as the current progress in experimental and clinical studies.

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Prediction of Prognosis and Surgical Indications for Pulmonary Metastasectomy From Colorectal Cancer

Cited by 178 publications

References 25 publications

Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Prognostic Factors for Survival after Resection of Pulmonary Metastases from Colorectal Carcinoma

Case report: High-volumetric atypical hemihepatectomy in patient with colorectal cancer with extensive metastatic disease

Lung Metastatic Disease: Surgical Resection and Locoregional Chemotherapy

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