Preoperative evaluation and indications for pulmonary metastasectomy

Kanzaki, Ryu; Fukui, Emiko; Kanou, Takashi; Ose, Naoko; Funaki, Soichiro; Minami, Masato; Shintani, Yasushi; Okumura, Meinoshin

doi:10.21037/jtd-19-3791

Cited by 14 publications

(10 citation statements)

References 120 publications

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“…Additionally, several prognostic factors associated with poor survival in patients with metastatic CRC have been described. These include short DFI, multiple pulmonary metastases, involvement of hilar or mediastinal lymph nodes, elevated CEA before metastasectomy, tumor size, patients older than 70 years, extrapulmonary metastatic lesions treated before pulmonary metastasectomy, synchronous presentation, advanced primary tumor stage and rectum localization ( 3 , 5 , 6 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…General indications for pulmonary metastasectomy also apply for metastasectomy in CRC. These include adequate cardiopulmonary reserve that allows resection, controlled primary tumor, completely resectable lung metastases, no other effective treatment other than resection, and no extrapulmonary metastatic disease, or if present, controllable by surgery or other local therapy ( 3 ). Pulmonary metastasectomy has been generally accepted as a potentially curative option in the management of metastatic CRC.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Adenoidzystische Karzinome haben dabei eine bessere Prognose im Vergleich zu Plattenepithelkarzinomen [ 16 ]. Ein hohes Patient:innenalter und Lokalrezidive vor Auftreten von Lungenmetastasen sind Faktoren, die mit einer schlechteren Prognose und einem schlechteren Gesamtüberleben einhergehen [ 17 , 18 ].…”

Section: Chirurgische Therapieunclassified

Lungenmetastasen – Onkologische Bedeutung und Therapie

Krämer¹,

Bläker²,

Denecke³

et al. 2023

Onkologie

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Hintergrund Die Lunge ist ein häufiger Ort der Metastasierung bei einer Vielzahl unterschiedlicher Tumorerkrankungen. Fragestellung Darstellung der Inzidenz, Diagnostik, Therapie und Prognose von Lungenmetastasen. Material und Methode Sichtung der relevanten Literatur über öffentlich zugängliche Datenbanken (u. a. PubMed, Embase) und Bewertung im multidisziplinären Expertenkreis Ergebnisse Die Lungenmetastasierung bedarf einer differenzierten und spezialisierten radiologischen und histopathologischen Bewertung. Es stehen zahlreiche wirksame lokal-ablative und systemische Behandlungsverfahren zur Verfügung. Schlussfolgerung Der Beitrag gibt eine multidisziplinäre ausgerichtete Übersicht über Diagnose- und Therapieoptionen bei Lungenmetastasen

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“…Adenoid cystic carcinomas have been associated with a better prognosis compared to head and neck squamous cell carcinoma (50). Furthermore, old age and the occurrence of local recurrence before lung metastases have been reported as factors associated to a worse prognosis and poor overall survival (51).…”

Section: Surgery According To the Histological Typementioning

confidence: 99%

Lung Metastases: Current Surgical Indications and New Perspectives

et al. 2022

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Pulmonary metastasectomy is an established treatment that can provide improved long- term survival for patients with metastatic tumor(s) in the lung. In this mini-review, we discuss the state of the art of thoracic surgery in surgical management of lung metastases which actually occurs for a large part of surgical activity in thoracic surgery department. We describe the principles of surgical therapy that have been defined across the time, and that should remain the milestones of lung metastases treatment: a radical surgery and an adequate lymphadenectomy. We then focus on current surgical indications and report the oncological results according to the surgical approach (open vs. mini-invasive), the histological type and number of lung metastases, and in case of re-metastasectomy. Finally, we conclude with a brief overview about the future perspectives in thoracic surgery in treatment of lung metastases.

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Preoperative evaluation and indications for pulmonary metastasectomy

Cited by 14 publications

References 120 publications

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

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

Lungenmetastasen – Onkologische Bedeutung und Therapie

Lung Metastases: Current Surgical Indications and New Perspectives

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