Pulmonary Metastasectomy in Colorectal Cancer: A Population-Based Retrospective Cohort Study Using the Korean National Health Insurance Database

Abstract

Purpose The study aimed to investigate the current status and prognostic factors for overall survival in patients who had undergone pulmonary metastasectomy for colorectal cancer.Materials and Methods The data of 2,573 patients who had undergone pulmonary metastasectomy after surgery for colorectal cancer between January 2009 and December 2014 were extracted from the Korean National Health Insurance Service claims database. Patient-, colorectal cancer–, pulmonary metastasis–, and hospital-related factors were analyzed using the Kaplan-Meier method, log-rank test, and Cox proportional hazards analysis to identify prognostic factors for overall survival after pulmonary metastasectomy.Results The mean age of the patients was 60.9±10.5 years; 66.2% and 79.1% of the participants were male and had distally located colorectal cancer, respectively. Wedge resection (71.7%) was the most frequent extent of pulmonary resection; 21.8% of the patients underwent repeated pulmonary metastasectomies; 73% of pulmonary metastasectomy cases were performed in tertiary hospitals; 53.9% of patients were treated in Seoul area; 82% of patients received chemotherapy in conjunction with pulmonary metastasectomy. The median survival duration was 51.8 months. The 3- and 5-year overall survival rates were 67.7% and 39.4%, respectively. In multivariate analysis, female sex, distally located colorectal cancer, pulmonary metastasectomy-only treatment, and high hospital volume (> 10 pulmonary metastasectomy cases/yr) were positive prognostic factors for survival.Conclusion Pulmonary metastasectomy seemed to provide long-term survival of patients with colorectal cancer. The female sex, presence of distally located colorectal cancer, and performance of pulmonary metastasectomy in high-volume centers were positive prognostic factors for survival.

Prognostic Factors in Stage IV Colorectal Cancer Patients With Resection of Liver and/or Pulmonary Metastases: A Population-Based Cohort Study

“…A retrospective study by Corsini et al aiming to study the effect of primary colorectal cancer tumor location on survival after pulmonary metastasectomy showed that left-sided colon and rectal cancer was associated with prolonged survival in patients after resection of PM (14). Yu et al (15), using the Korean National Health Insurance database to study the prognostic factors of patients with colorectal cancer after PM resection, reported that the presence of distally located colon and rectal cancer is a positive factor for survival and prognosis. Yi, Chenghao (11) and Engstrand ( 16) also found that compared with the proximal colon, the distal colon and rectum were associated with better long-term survival after resection of metastatic tumors.…”

“…Yu et al. ( 15 ), using the Korean National Health Insurance database to study the prognostic factors of patients with colorectal cancer after PM resection, reported that the presence of distally located colon and rectal cancer is a positive factor for survival and prognosis. Yi, Chenghao ( 11 ) and Engstrand ( 16 ) also found that compared with the proximal colon, the distal colon and rectum were associated with better long-term survival after resection of metastatic tumors.…”

Laparoscopic Resection of Synchronous Liver Metastasis Involving the Left Hepatic Vein and the Common Trunk Bifurcation: A Strategy of Parenchyma-Sparing Resection with Left Sectionectomy and 4a Subsegmentectomy by Arantius Approach

“…Many different approaches to improving respectability have been taken, such as the liver-first approach [ 16 ], two-stage hepatectomy [ 6 ], the Alpps procedure [ 7 ], and enhanced ultrasound-guided liver resection [ 8 ]. Aggressive surgery with resection has also been extended to pulmonary metastases, with three- and five-year survival rates of 67.7% and 39.4%, respectively [ 17 ], suggesting that surgery and chemotherapy together constitute a synergic approach to the disease. Multidisciplinary team discussion is becoming essential for achieving high rates of resection, which have reached 41% [ 15 ], even in the case of recurrent disease [ 18 ].…”

The Pulmonary Metastasectomy in Colorectal Cancer cohort study: Analysis of case selection, risk factors and survival in a prospective observational study of 512 patients

“…The big data study in the English NHS already referred to showed that lung metastasectomy is highly selective, being used on only 2.3% of patients with resected CRC in 2013 [ 10 ]. A study in the Korean National Health Insurance Database of 2573 CRC lung metastasectomy patients found a similar rate of 2.5% [ 24 ]. The lung metastasectomy operations referred to as ‘a pillar of modern thoracic surgery’ were performed at a rate of about one a month in the two series cited in support [ 5 ]—more a flying buttress than a pillar.…”