Thoracic surgical management of colorectal lung metastases: a questionnaire survey of members of the Society for Cardiothoracic Surgery in great Britain and Ireland

Abstract

IntroductionDistant metastases to liver and lung are not uncommon in colorectal cancer. Resection of metastases is accepted widely as the standard of care. However, there is no firm evidence base for this. This questionnaire survey was carried out to assess the current practice preferences of cardiothoracic surgeons in Great Britain and Ireland.MethodsAn online questionnaire survey was emailed to cardiothoracic surgeons in Great Britain and Ireland. The survey was live for 12 weeks. Responses were collated with SurveyMonkey®.ResultsOverall, there were 75 respondents. The majority (83%) indicated thoracic surgery as a specialist interest. Almost all (99%) used thoracic computed tomography (CT) for staging; 70% added liver CT and 51% added pelvic CT. Fluorodeoxyglucose positron emission tomography was used by 86%. The most frequent indication for pulmonary resection (97%) was solitary lung metastasis without extrathoracic disease. Video assisted thoracoscopic surgery (VATS) was used by 85%. In addition, thoracotomy was used by 96%. A third (33%) used radiofrequency ablation. Synchronous liver and lung resection was contraindicated for 83% of respondents. Over three-quarters (77%) thought that scientific equipoise exists presently for lung resection for colorectal lung metastases but only 21% supported a moratorium on this type of surgery until further evidence becomes available.ConclusionsThe results confirm that the majority of respondents use conventional cross-sectional imaging and either VATS or formal thoracotomy for resection. The results emphasise the continuing need for formal randomised trials to provide evidence of any survival benefit from pulmonary metastasectomy for colorectal lung metastases.

Low Accuracy of Computed Tomography and Positron Emission Tomography to Detect Lung and Lymph Node Metastases of Colorectal Cancer

“…Currently, FDG-PET is used as a complementary examination to determine the metabolic activity of suspect lung nodules, define lymph nodal involvement, and detect extrathoracic recurrence. However, its use in the preoperative setting for CRC patient evaluation is an increasing trend in the thoracic surgery community [6,13]. Conversely, the precision of FDG-PET in the evaluation of CRC pulmonary metastases is a rarely investigated topic [20].…”

“…Although still a subject of debate, lung metastasectomy by open thoracotomy is widely accepted by most surgical teams with, for selected populations, reported 5-year overall survival rates of 41% to 68% after radical resection [2,3]. Nevertheless, among alternative metastasisdirected local treatments, minimally invasive surgery (video-assisted thoracic surgery), stereotactic body radiotherapy, and radiofrequency ablation, with or without systemic chemotherapy [4,5], are commonly proposed to CRC metastatic patients in routine clinical practice [6]. Furthermore, a copious amount of literature has indicated that, in CRC patients undergoing lung metastasectomy or local treatment, certain factors, including lymph node involvement (LNI) and number of pulmonary metastases, are consistent predictors of the outcome [3,[7][8][9][10][11].…”

Thoracoscopic resection of pulmonary metastasis: Current practice and results

“…In a recent survey published by the ESTS in 2008, the preferred surgical approach in case of unilateral and bilateral pulmonary lesions was VATS in 28.8% and 20% respectively [29]. More recently, current practice preferences of cardiothoracic surgeons in Great Britain and Ireland have been investigated by an online questionnaire survey reporting that Video assisted thoracoscopic surgery (VATS) was used by 85% of surgeons in case of isolated pulmonary metastatic lesions [30]. Although these data are important to reflect the opinion and practice of thoracic surgeons, there is no hard data on the percentage of procedures performed by VATS in the field of pulmonary metastasectomy.…”

Management of colorectal cancer presenting with synchronous liver metastases

“…Britain and Ireland) revealed evidence of considerable variation in practice. 77 Specifically, although a solitary lung metastasis was the most frequent indication for surgery, 59 (88%) of respondents did not consider lung lesions in the presence of liver metastases as contra-indications to surgery. To address this, PulMiCC a randomised trial of pulmonary metastasectomy in colorectal cancer is undertaking a feasibility study in 11 centres in the United Kingdom with a view to the conduct of a randomised trial.…”