Predictors and outcome of complete removal of colorectal cancer with synchronous lung metastases

Abstract

Abstract. The prognosis-improving effect of radical surgery has been demonstrated in patients with colorectal cancer (CRC) with liver metastases. However, few studies have examined the effectiveness of treatments for CRC with metastases in organs other than the liver. The aim of the present study was to evaluate the outcome of surgical treatment for CRC with lung metastases. The study retrospectively examined 57 primary CRC patients (28 men, median age of 65 years) with synchronous lung metastases who underwent surgery between 2003 and 2012. Data such as clinicopathological parameters, metastasized organs, and the details of surgery, recurrence and survival periods were extracted and analyzed. Curative resection was performed in 10 patients ('curative group'). Primary tumors were resected without metastasectomy in 37 patients ('non-curative group'), whereas 10 underwent stoma surgery ('stoma group'). All the metastasized lesions were confined to the lung and liver in the curative group. By contrast, 43% of the non-curative/stoma groups had metastases in organs other than the lung and liver. Multivariate analyses indicated the absence of extrahepatic metastases as the only predictor of curative resection in CRC patients with lung metastases. The 3-year overall survival rates for the curative, non-curative and stoma groups were estimated as 74, 20 and 17%, respectively (P=0.0007). In conclusion, curative resection was possible in CRC patients with lung metastases if other disseminated lesions were limited to the liver and this treatment resulted in a longer survival time. Furthermore, palliative resection may contribute to a better prognosis compared to stoma surgery alone in selected cases.

Oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases

“…22 Lung metastasectomy was indicated only for patients in whom all lung metastases (generally up to five metastases) could be removed with adequate surgical margins and future respiratory function based on mutual consent among members of a multidisciplinary team conference. 1,6,23 The basic procedure of lung resection was wedge resection, while lobectomy was performed if lung metastases were located in the deep parenchyma. 6 Regardless of the tumor number, size, and distribution, surgical resection was indicated for patients who met the above-mentioned criteria.…”

Preoperative evaluation and indications for pulmonary metastasectomy

“…Shimizu et al (80) recently analyzed the outcomes of PM in patients with a history of liver metastases and showed that a high preoperative CEA level was an independent prognostic factor for the overall survival. Although there have been only a few reports on PM for patients with both pulmonary and hepatic metastases detected simultaneously with the primary tumor, PM for such patients was still shown to provide favorable long-term outcomes (81,82). However, a history of distant metastases other than to the liver is believed to be a poor prognostic factor (72,79).…”

The Primary Tumor Surgery Prolongs the Medium Cancer Specific Survival in Metastatic Colorectal Cancer Patients with Initial Isolated Unresectable Lung Metastasis: A SEER-based Retrospective Study

“…[3,4] Some studies observe that primary tumor resection (PTR) without metastasectomy has no superiority to palliative stoma surgery. [5,6] Another SEER-based study shows a trend toward fewer PTS from 1988 to 2010 with better survival. [7] However, there are still other studies a rming the effectiveness of PTR, especially which present with related symptoms.…”