Pulmonary resection for metastatic colon and upper rectum cancer

Abstract

The predictive value of the route of venous drainage on prognosis was investigated in a consecutive series of 44 patients who underwent curative resection of pulmonary metastases from colorectal carcinoma. The primary tumor was located in the colon in 14 patients and in the upper third of the rectum in 11 patients, thus indicating blood drainage directed toward the portal vein (Group I). In 10 and 9 cases, respectively, the initial growth was in the middle and lower thirds of the rectum with the venous outflow at least partially directed into the vena cava (Group II). There was no obvious difference between the two groups regarding the initial site of cancer relapse. The liver was involved in 4 of 15 patients failing in Group I as opposed to 4 of 13 patients with hematogenous relapse in Group II. Median survival and tumor-free survival times were significantly longer in patients in Group I (58.4 and 50.2 months) than in patients in Group II (30.9 and 16.8 months), and, even more pronounced, in colon cancer patients (75.4 and 60.2 months) when compared with rectal cancer patients (31.0 and 17.9 months). In contrast, survival curves did not differ significantly if either the two groups with different routes of drainage (5-year survival 53 percent vs. 38 percent, 5-year tumor-free survival 43 percent vs. 37 percent), or tumors of the colon and rectum (5-year survival 67 percent vs. 38 percent, 5-year tumor-free survival 60 percent vs. 32 percent) were compared using the log-rank test. Similar trends were obtained for the subgroup of 34 patients without previous or simultaneous extrapulmonary recurrent disease at the time of lung resection. The primary tumor site does therefore not become a major criterion in selecting patients for surgical resection.

Prognostic Factors in Pulmonary Metastases from Colorectal Cancer

“…While cancer of the [8] 38.6 McAfee et al [ 11 ] 30.5 Marks et al [16] 41.2 Wright et al [21] 30 Morrow et al [22] 13 This study 23 colon metastasizes exclusively via the portal vein, metastases of rectal cancer can spread via the inferior vena cava, although our observations are in agreement with those ofScheel et al [13]: i.e. there are no statistically sig nificant differences between the two locations.…”

Location of rectal cancer as determined using rectal magnetic resonance imaging, and its relationship with pulmonary metastasis

“…Although several reports have described skip metastasis from colon cancer bypassing the liver and spreading to the lungs and/or thyroid gland (1), the precise mechanism for this is unclear, and they are regarded as exceptional cases. In general, venous drainage is thought to be the decisive determinant for distant hematogenous tumor spread (5). There are several references to the anatomy of venous drainage in the rectum.…”

“…In addition, rectal cancer is known to be more strongly associated with the presence of isolated pulmonary metastases than colon cancer (1). It has been suggested that this difference reflects the different routes of venous drainage in the colon and rectum, as venous drainage is thought to be the decisive determinant for distant hematogenous spread (5). Generally, blood from the colon is directed toward the liver via the portal vein, while blood from the rectum drains into the systemic circulation (5).…”

“…It has been suggested that this difference reflects the different routes of venous drainage in the colon and rectum, as venous drainage is thought to be the decisive determinant for distant hematogenous spread (5). Generally, blood from the colon is directed toward the liver via the portal vein, while blood from the rectum drains into the systemic circulation (5). This anatomic feature has been known for more than 50 years, and is thought to be the basis for the different patterns of metastatic spread from these two sites.…”

How Uncommon are Isolated Lung Metastases in Colorectal Cancer? A Review from Database of 754 Patients Over 4 Years

“…3,4 The higher incidence of this isolated lung metastases in rectal compared to colonic carcinoma was attributed to the direct hematogenous spread into the systemic circulation via the inferior and middle rectal veins, bypassing the portal venous system. 3,7 However, colon cancer with isolated metastases not involving the liver is considered very rare with only a few reports mentioning the existence of such an entity. 3,4 Our study aims to review the incidence of isolated lung metastases in all patients with colorectal cancers and to identify clinical factors that could be associated with this phenomenon.…”