Lung Metastasectomy for Colorectal Carcinoma in Patients with a History of Hepatic Metastasis

Abstract

Background: We reviewed resection of pulmonary metastases preformed by the Department of Thoracic Surgery at Kyoto University Hospital to confirm the clinical significance of this surgery in patients with colorectal carcinoma and a history of hepatic metastasis. Methods: From 1992 to 2006, 19 patients with colorectal carcinoma and a history of hepatic metastasis underwent a pulmonary metastasectomy . Surgical outcomes of these patients were investigated in terms of various perioperative variables. Results: Sixteen of 19 patients showed metachronous presentation of hepatic and pulmonary metastases, while 3 patients showed synchronous presentation. Overall survival rate after the pulmonary resection was 93%, at 1 year; 75%, at 3 years and 60% at 5 years. Three years after the pulmonary resection, none of the patients with synchronous hepatic and pulmonary metastases survived, while patients with metachronous metastases had an overall survival rate of more than 80%. Interestingly enough, the overall survival curve of the patients with colorectal carcinoma and a history of hepatic metastasis, who underwent a pulmonary metastasectomy was almost the same as that of patients who did not have the surgery, during the same period. Conclusion: Aggressive resection of pulmonary metastases in a select group of colorectal cancer patients with a history of liver metastases might result in prolonged survival.

Outcome after liver resection in patients presenting with simultaneous hepatopulmonary colorectal metastases

“…arguing that resection is not warranted in patients with simultaneous hepatic and pulmonary metastases (5‐year survival rate 0 per cent versus 44 per cent in patients with sequentially detected pulmonary metastases). Similarly, Chen and colleagues reported that no patients with simultaneous hepatopulmonary CRC metastases were alive at 3 years, and Kawano et al . found a relative risk of 3·73 on multivariable regression analysis for patients presenting with simultaneous hepatopulmonary disease.…”

“…For all studies, the overall survival (OS), and 1-and 5-year survival rates are for the total patient cohort. Survival is presented variably in the literature: from the last pulmonary metastectomy 4,7,10,14,16 ; from the first pulmonary metastectomy 13,15,19,20 ; from the diagnosis of metastatic disease 3 ; from diagnosis of the primary tumour 12,13,18 ; and sometimes not clear if mixed 8,11,17 . *Simultaneous disease defined as metastases presenting less than 3 months apart.…”

Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis

“…We selected 29 papers that met all the selection criteria and divided them into two broad groups: 6 which did not analyse the variable of interest [2], [6], [7], [11], [12], [13], that is, whether patients who underwent surgery had a history of resected liver metastases; and the other 23 which did consider this variable [1], [5], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33]. In this second group of 23 papers, there were 21 patient series, 1 prospective [15] and the others retrospective [5], [14], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30],…”

“…In total, we collected data from 17 studies [2], [5], [12], [13], [14], [16], [17], [18], [20], [21], [25], [26], [27], [28], [30], [32], [33], managing to obtain data on 3501 patients for the meta-analysis of individual data. The authors from three studies [6], [15], [31] replied to the first email, expressing interest in the study, but did not communicate further, and did not provide any information or explain their reasons; one author replied declining to participate in the study [19]; and authors of the other studies [7], [11], [22], [23], [24], [29] did not respond to any of our attempts to contact them.…”

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

“…3,5e15 Simultaneous colorectal liver and lung metastases (SLLM) is the most frequent combination of multiple metastases of colorectal cancer. 5e7,10,12e14, 16,17 Lung metastases constitute one-third of cases of concomitant metastases with CLM, 11 and the prognosis of SLLM treated with chemotherapy is dismal [estimated 3-year overall survival (OS) rate of <15%]. 18 One report suggested that simultaneous rather than sequential detection of liver and lung metastases of colorectal cancer does not warrant resection because of the poor postsurgical outcomes 19 ; however, further subclassification of patients with SLLM might allow for identification of patients who have a more favorable prognosis.…”