Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer

Shiono, Satoshi; Okumura, Takehiro; Boku, Narikazu; Hishida, Tomoyuki; Ohde, Yasuhisa; Sakao, Yukinori; Yoshiya, Katsuo; Hyodo, Ichinosuke; Mori, Keita; Kondo, Haruhiko

doi:10.1093/ejcts/ezw322

Cited by 42 publications

(67 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, in cases involving pulmonary malignancies, a sufficient surgical margin from the tumor is essential (23)(24)(25). The resected segment inflation method is reported to yield a sufficient surgical margin from the tumor by inflation of the affected segment (15).…”

Section: Discussionmentioning

confidence: 99%

Determination of the intersegmental plane using the slip-knot method

Endoh¹,

Oizumi²,

Kato³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

Background: Visualization of intersegmental planes in the lung is desirable for precise anatomical lung segmentectomy. We developed the slip-knot method for creating inflation-deflation lines. This study aimed to assess relevant data for thoracoscopic segmentectomy performed using this method. Methods: In the slip-knot method, the objective segmental bronchus is looped with a monofilament thread.One end of the thread is then pulled during temporary bilateral ventilation, causing the knot to slip toward the bronchus. Thereafter, bronchial ligation is tightened to block the outflow of segmental air, ensuring that the segment remains expanded while the other reserved segments collapse on resumption of unilateral ventilation. Data from 221 patients who underwent thoracoscopic pulmonary segmentectomy between 2010 and 2016 were analyzed. Results: A total of 147 patients (67%) were indicated for the slip-knot method, and 74 cases (33%) were non-adaptive cases. Ninety six percent of 147 cases were well adapted to the slip-knot method, which allowed us to obtain good inflation-deflation line images to determine the intersegmental plane. The mean operative time was 171±51 min (range, 71-367 min). The mean duration of chest tube insertion was 1.5±1.2 days (range, 1-7 days). Three cases (2.0%) had prolonged air-leakage and one (0.7%) case had readmission for late air-leakage. Conclusions: Our method enables determination of anatomical intersegmental planes using only one monofilament thread, thus facilitating thoracoscopic pulmonary anatomical segmentectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Determination of the intersegmental plane using the slip-knot method

Endoh¹,

Oizumi²,

Kato³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Metastases to the lung are typically well‐circumscribed nodules and in two‐thirds of cases are found in the peripheral third of the lung . Thus, they can often be removed easily with a wedge resection, and this is the most common type of resection performed for PM . The only concern with performing a wedge resection is the risk of local recurrence at the margin.…”

Section: Operative Techniquementioning

confidence: 99%

“…Anatomic lung resections are less commonly used for PM than wedge resections, but are indicated in cases where lesions cannot be removed completely via a wedge, or when lesions are central and/or not amenable to wedge resection . Segmentectomy should be the initial choice of anatomic resection as it preserves normal lung tissue compared with formal lobectomy, and minimizing the extent of resection likely improves perioperative outcomes .…”

Section: Operative Techniquementioning

confidence: 99%

“…Segmentectomy should be the initial choice of anatomic resection as it preserves normal lung tissue compared with formal lobectomy, and minimizing the extent of resection likely improves perioperative outcomes . Historically, segmentectomies have been used in less than 20% of PM resections for CRC, but the use of this technique appears to be increasing over time, likely reflecting improved understanding of the importance of pulmonary parenchymal preservation and the potential need for repeat resections . In addition, a recent study by Shiono et al comparing wedge resection (n = 455) with segmentectomy (n = 98) demonstrated an improved overall 5‐year survival, 5‐year recurrence‐free survival, and decreased risk of local recurrence in the segmentectomy group.…”

Section: Operative Techniquementioning

confidence: 99%

“…Historically, segmentectomies have been used in less than 20% of PM resections for CRC, but the use of this technique appears to be increasing over time, likely reflecting improved understanding of the importance of pulmonary parenchymal preservation and the potential need for repeat resections . In addition, a recent study by Shiono et al comparing wedge resection (n = 455) with segmentectomy (n = 98) demonstrated an improved overall 5‐year survival, 5‐year recurrence‐free survival, and decreased risk of local recurrence in the segmentectomy group. Also, Renaud et al found kirsten rat sarcoma viral oncogene ( KRAS) patients who had a segmentectomy for PM for CRC metastases had longer time to pulmonary recurrence (50 vs 15 months; P = 0.01) and a lower risk of resection‐margin recurrence (4.8% vs 54.4%; P = 0.001) in the segmentectomy group compared with wedge resection.…”

Section: Operative Techniquementioning

confidence: 99%

See 2 more Smart Citations

Surgical management of colorectal lung metastases

Phillips

Hasson

2019

Journal of Surgical Oncology

View full text Add to dashboard Cite

Pulmonary metastasectomy for colorectal cancer is an established means of treatment for select patients. This article will highlight the recent evidence published in the literature related to current practices for the surgical management of colorectal lung metastases and propose a diagnostic algorithm for use in clinical practice. It will also discuss controversies related to pulmonary metastasectomy, including the optimal timing of surgery, the extent of lymph node sampling/dissection, and the extent of surgical resection.

show abstract

The potential role of circulating tumor DNA (ctDNA) in the further investigation of colorectal cancer patients with nonspecific findings on standard investigations

Wong

Tie

Lee

et al. 2019

Intl Journal of Cancer

View full text Add to dashboard Cite

Early detection of metastatic colorectal cancer, at initial diagnosis or during routine surveillance, can improve survival outcomes. Current routine investigations, including CEA and CT, have limited sensitivity and specificity. Recent studies of colorectal cancer cohorts under post surgery surveillance indicate circulating tumor DNA (ctDNA) evidence of recurrence can occur many months before clinical detection. Another possible role for ctDNA is in the further assessment of indeterminate findings on standard CEA or CT investigations. To further explore this potential, we undertook a prospective study. Further investigation, including FDG‐PET imaging, was at clinician discretion, blinded to ctDNA analysis. Forty‐nine patients were enrolled. Analyzed here are the 45 patients with an evaluable blood sample of whom 6 had an isolated elevated CEA, 30 had indeterminate CT findings, and 9 had both. FDG‐PET scans were performed in 30 patients. Fourteen of 45 patients (31%) had detectable ctDNA. At completion of the planned 2 year follow‐up, recurrence has occurred in 21 (47%) patients. Detectable ctDNA at study entry was associated with inferior relapse free survival (HR 4.85, p < 0.0001). Where FDG‐PET scan was normal/equivocal (n = 15, 50%) 1 of 1 with detectable ctDNA versus 3 of 14 with undetectable ctDNA ultimately had recurrence confirmed. In summary, for colorectal cancer patients with indeterminate findings on routine investigations, ctDNA detection increases the probability that the findings indicate metastatic disease, including in a nonpredefined subset that also underwent FDG‐PET imaging. Further studies of the value of ctDNA analysis during patient surveillance are warranted.

show abstract

Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer

Abstract: Segmentectomy demonstrated a good efficacy with less resection-margin recurrence in patients with resectable pulmonary-limited metastasis from colorectal cancer.

Cited by 42 publications

References 23 publications

Determination of the intersegmental plane using the slip-knot method

Determination of the intersegmental plane using the slip-knot method

Surgical management of colorectal lung metastases

The potential role of circulating tumor DNA (ctDNA) in the further investigation of colorectal cancer patients with nonspecific findings on standard investigations

Contact Info

Product

Resources

About