Prognostic factors after pulmonary metastasectomy of colorectal cancers: a single-center experience

Fournel, Ludovic; Maria, Stefania; Séminel, Marie; Nesci, Jessica; Lupo, Audrey; Guinet, C.; Magdeleinat, Pierre; Bobbio, Antonio; Régnard, Jean-François; Alifano, Marco

doi:10.21037/jtd.2017.04.44

Cited by 13 publications

(7 citation statements)

References 17 publications

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“…Previous studies had mostly focused on the patients undergoing resection of the lung metastases and patients who did not receive lung metastasectomy were excluded. Although the clinical factors analyzed in each study were different, the roles of some predictors had been confirmed in many studies [9][10][11][12], including: the distribution and size of lung metastases, the status of pulmonary lymph nodes, the CEA level of lung lesions before surgery, and the existence of liver metastases, etc. [10,11,[13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 97%

Local treatment combined with chemotherapy improves survival of patients with pulmonary metastases of colorectal cancer—a real-world retrospective study

Cai

Wang

Yang

et al. 2020

Preprint

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Background The effect of local treatments for pulmonary metastases from colorectal cancer (CRC-PM) remains controversial. This study aims to figure out whether local treatments combined with chemotherapy could improve patients’ survival by comparing the outcomes of CRC-PM patients who submitted to local interventions combined with chemotherapy or just chemotherapy.Patients and Methods From January 2009 to July 2019, a total of 119 patients with CRC-PM from two surgical centers were reviewed. Patients were divided into two groups according to treatments for the lung metastases: Local intervention combined with chemotherapy (Group-LI) and Chemotherapy alone (Group-Chem). Overall survival (OS) and progression-free survival (PFS) were assessed with the Kaplan-Meier method. Clinical characteristics associated with prognosis were analyzed by using a Cox proportional hazards regression model. Propensity score matching analyses were used to overcome the possible biases in some baseline characteristics.Result Multivariable analysis revealed that the level of carcinoembryonic antigen (CEA) and treatment for CRC-PM are independent predictors of both OS and PFS. The median OS in Group-LI (n = 39) and Group-Chem (n = 80) were 34.5 months and 13.8 months, respectively(P < 0.001). The 3-year progression-free survival rate in Group-LI and Group-Chem were 75.2% and 45.1% (P < 0.001). After propensity score matching, patients in Group-LI had better OS (HR = 3.304, P = 0.022) and PFS (HR = 4.029, P < 0.001) than Group-Chem.Conclusion. CRC-PM patients with lower lever of CEA or local treatment of lung metastases are more likely to be those with favorable prognosis. Selected CRC-PM patients could benefit from local treatment of pulmonary metastases.

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Section: Discussionmentioning

confidence: 97%

Local treatment combined with chemotherapy improves survival of patients with pulmonary metastases of colorectal cancer—a real-world retrospective study

Cai

Wang

Yang

et al. 2020

Preprint

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“…As we reported in previous paragraphs, multidisciplinary evaluation is fundamental, especially in the case of multi-organ involvement. In particular, patients with a history of extra-thoracic metastases[ 61 , 68 - 70 ] had a worse prognosis similar to patients with synchronous or bilateral lung involvement[ 71 ].…”

Section: Discussionmentioning

confidence: 99%

“…With regard to long-term outcome, 5-year OS after single metastasis resection ranged between 32% and 62%[ 61 , 71 , 77 ], but it is interesting to note that the best survival rates (around 60% at 5 years) were reported in recent studies[ 61 , 71 ] suggesting a progressive improvement in terms of therapeutic strategies, but also regarding more accurate patient selection. The presence of a single metastases was one of the most important prognostic factors in surgically treated patients (Table 1 ), which was also confirmed in a meta-analysis by Gonzalez et al [ 78 ], who demonstrated a favorable prognostic role for the number of resected metastases, which was a significant favorable factor associated with CEA levels, DFI, and presence of lymph node involvement.…”

Section: Discussionmentioning

confidence: 99%

Management of single pulmonary metastases from colorectal cancer: State of the art

Chiappetta¹,

Salvatore²,

Congedo³

et al. 2022

WJGO

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Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.

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“…Pulmonary metastasectomy is considered part of the treatment in these patients and has become recommended in many types of tumors. Thus, it has been shown that there is an increase in overall survival and disease-free survival times [ 2 ]. On the other hand, presence of mediastinal or hilar lymph node metastasis is also important in terms of prognosis especially in tumors of epithelial origin [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Is video-assisted thoracoscopic surgery sufficient for lymph node dissection in pulmonary metastasectomy?

Kermenli

2020

kitp

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Aim: We evaluated the results of patients undergoing pulmonary metastasectomy with video-assisted thoracoscopic surgery (VATS) and aimed to investigate postoperative lymph node positivity after lymph node dissection (PM-LND). Material and methods: Patients who underwent pulmonary metastasectomy and mediastinal lymph node dissection with VATS between March 2015 and March 2020 in our clinic were included in the study. Results: The mean age of 58 patients who underwent pulmonary metastasectomy and mediastinal lymph node dissection with VATS was 56.5. Thirty-four of the patients were female and 24 were male. A total of 61 surgical procedures, 3 of which were bilateral, were performed in 58 patients. The mean number of resected pulmonary metastases was 1.72. The total number of dissected lymph nodes was 191, with an average of 3.1 per surgical procedure. Colon carcinoma (20 patients) and breast carcinoma (16 patients) were the most common primary tumor origin. Others were thyroid, sarcoma, renal cell carcinoma and melanoma. Unexpected lymph node positivity was present in 9 of 58 patients. Conclusions: Video-assisted thoracoscopic surgery is a technique that can be applied in pulmonary metastasectomy with its advantages such as a low complication rate and rapid recovery. In these patients, lymph node dissection, which is one of the determining factors of prognosis, can be performed effectively with VATS. Mediastinal and hilar lymph node dissection combined with pulmonary metastasectomy is effective in detecting unexpected lymph node positivity.

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Prognostic factors after pulmonary metastasectomy of colorectal cancers: a single-center experience

Abstract: Bilateralism and primary tumor local extension influence the prognosis of patients surgically treated for pulmonary colorectal metastases. Specifically designed randomized trials are necessary.

Cited by 13 publications

References 17 publications

Local treatment combined with chemotherapy improves survival of patients with pulmonary metastases of colorectal cancer—a real-world retrospective study

Local treatment combined with chemotherapy improves survival of patients with pulmonary metastases of colorectal cancer—a real-world retrospective study

Management of single pulmonary metastases from colorectal cancer: State of the art

Is video-assisted thoracoscopic surgery sufficient for lymph node dissection in pulmonary metastasectomy?

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