Simultaneous Detection of Colorectal Carcinoma Liver and Lung Metastases Does Not Warrant Resection

Nagakura, Shigenori; Shirai, Yoshio; Yamato, Yasushi; Yokoyama, Naoyuki; Suda, Takeyasu; Hatakeyama, Katsuyoshi

doi:10.1016/s1072-7515(01)00970-x

Cited by 82 publications

(52 citation statements)

References 24 publications

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“…This could be understood when it might be considered that majority of the patients were metachronous liver and lung metastasis in this study since the spread of malignant cells through the two drainages at the same time, that is, simultaneous metastasis was considered an adverse prognostic factor. 20) Although there was no significant differences in the OS between the patients with metachronous liver and pulmonary metastases and those with synchronous metastases in our study (P = 0.23, Fig. 2), but this would probably be due to the small number of cases in the group of synchronous metastases.…”

Section: Discussioncontrasting

confidence: 57%

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

Chen¹,

Tanaka²,

Sakai³

et al. 2011

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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.

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Section: Discussioncontrasting

confidence: 57%

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

Chen¹,

Tanaka²,

Sakai³

et al. 2011

ATCS

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“…Resultados diferentes foram relatados por JAECK et al (22) , CADY et al (8) e AMBIRU et al (3) , que não consideraram o intervalo de tempo entre a ressecção do tumor primário e o surgimento da metástase hepática como fatores prognósticos independentes. Apesar dos resultados discordantes a respeito da importância desse fator, há consenso na literatura (3,12,23,26,28,29,36,39,41,45) de que o intervalo entre a ressecção do tumor primário e o surgimento da metástase no fígado não contra-indica a ressecção hepática.…”

Section: Discussionunclassified

“…Embora a presença de doença tumoral extra-hepática reduza a sobrevida em 5 anos, a níveis não superiores a 20% (20) , a invasão direta por tumor a estruturas adjacentes, implantes localizados e metástases pulmonares não constitui contra-indicação para a ressecção hepática, desde que também possam ser ressecadas inteiramente e com margens livres (28,36) .…”

Section: Discussionunclassified

Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal

Chedid

Villwock

Chedid

et al. 2003

Arq. Gastroenterol.

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RESUMO -Objetivo -Determinar o impacto de fatores prognósticos na sobrevida de pacientes com metástases hepáticas ressecadas e originadas de câncer colorretal. Casuística e Métodos -Foram analisados os prontuários de 28 pacientes submetidos a ressecção hepática de metástases de câncer colorretal de abril de 1992 a setembro de 2001. Foram realizadas 38 ressecções (8 pacientes com mais de uma ressecção no mesmo tempo cirúrgico e 2 pacientes submetidos a re-ressecções). Todos haviam sido submetidos previamente a ressecção do tumor primário. Utilizou-se protocolo de rastreamento de metástases hepáticas que incluiu revisões clínicas trimestrais, ecografia abdominal e dosagem de CEA até se completarem 5 anos de seguimento e após, semestralmente. Os fatores prognósticos estudados foram: estágio do tumor primário, tamanho das metástases > 5cm, intervalo entre ressecção do tumor primário e surgimento da metástase < 1 ano, CEA >100 ng/mL, margens cirúrgicas < 1cm e doença metastática extra-hepática. O estudo foi retrospectivo e a análise estatística foi feita pela curva de Kaplan-Meier, log-rank e regressão de Cox. Resultados -A morbidade foi 39,3% e a mortalidade operatória foi 3,6%. A sobrevida em 5 anos foi de 35%. Os fatores prognósticos independentes adversos foram: intervalo < 1 ano entre ressecção do tumor primário e surgimento da metástase, e doença metastática extra-hepática. Conclusões -A ressecção hepática de metástases de câncer colorretal é um procedimento seguro com sobrevida em 5 anos acima dos 30%. Foram fatores prognósticos independentes adversos: doença metastática extra-hepática e intervalo < 1 ano entre ressecção do tumor primário e surgimento da metástase.DESCRITORES -Neoplasias colorretais. Neoplasias hepáticas. Metástase neoplásica. Prognóstico. INTRODUÇÃOAproximadamente 150.000 novos casos de câncer colorretal são tratados anualmente nos Estados Unidos e cerca da metade desses pacientes terão metástases hepáticas no curso de sua doença (39) . No Brasil, segundo dados do Instituto Nacional do Câncer (6) , a incidência aproximada para o ano 2001 era de 20.000 casos. A sobrevida de pacientes com metástases hepáticas de câncer colorretal não-ressecadas é em torno de 9 meses (29) . As metástases hepáticas de câncer colorretal se desenvolvem em geral nos 2 anos subseqüentes à ressecção do tumor primário, são mais freqüentes nos pacientes com estágio Dukes C (32) e são sincrônicas com o tumor primário em torno de 25% das vezes (4) . Em 1963, WOODINTON e WAUGH (44) relataram sobrevida de 20% em 5 anos em pacientes submetidos a ressecção hepática de metástases de câncer colorretal.Em 1976, WILSON e ADSON (43) relataram sobrevida de 28% em 5 anos e recomendaram tratamento agressivo para lesões aparentemente solitárias. Em 1977, FOSTER e BERMANN (15) , analisando criticamente o estágio da cirurgia hepática, fortaleceram a utilização da abordagem cirúrgica para tumores sólidos do fígado.Atualmente, com uma seleção adequada dos pacientes, a ressecção hepática é o tratamento de escolha para metástases de cânce...

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“…Extrahepatic disease has traditionally been considered a contraindication to resection of hepatic colorectal cancer metastasis [9,14,15,45]. However, improvements in morbidity and mortality rates following hepatectomy, as well as the advent of more effective systemic chemotherapy agents, have prompted several investigators [95][96][97][98] to attempt surgery for some of these patients. Local extension to adjacent structures, intraluminal biliary tumor thrombus, and locoregional recurrence should not be considered true extrahepatic disease, and none of these should be considered a contraindication to surgery when an R0 resection is feasible.…”

Section: Extrahepatic Diseasementioning

confidence: 99%

Expanding Criteria for Resectability of Colorectal Liver Metastases

2008

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After completing this course, the reader will be able to:1. Identify the criteria for hepatic resection of colorectal metastases.2. Describe strategies for expanding the number of patients who may potentially benefit from hepatic resection.3. List the factors associated with poor prognosis following hepatic resection.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTSurgical resection is the treatment of choice in patients with colorectal liver metastases, with 5-year survival rates reported in the range of 40%-58%. Over the past 10 years, there has been an impetus to expand the criteria for defining resectability for patients with colorectal metastases. In the past, such features as the number of metastases (three to four), the size of the tumor lesion, and a mandatory 1-cm margin of resection dictated who was "resectable." More recently, the criteria for resectability have been expanded to include any patient in whom all disease can be removed with a negative margin and who has adequate hepatic volume/reserve. Specifically, instead of resectability being defined by what is removed, decisions concerning resectability now center around what will remain after resection. Under this new paradigm, the number of patients with resectable disease can be expanded by increasing/preserving hepatic reserve (e.g., portal vein embolization, two-stage hepatectomy), combining resection with ablation, and decreasing tumor size (preoperative chemotherapy). The criteria for resectability have also expanded to include patients with extrahepatic disease. Rather than being an absolute contraindication to surgery, patients with both intra-and extrahepatic disease should potentially be considered for resection based on strict selection criteria. The expansion of criteria for resectability of colorectal liver metastases requires a much more nuanced and sophisticated approach to the patient with advanced disease. A therapeutic approach that includes all aspects of multidisciplinary and multimodality care is required to select and treat this complex group of patients. The Oncologist 2008;13:51-64

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Simultaneous Detection of Colorectal Carcinoma Liver and Lung Metastases Does Not Warrant Resection

Cited by 82 publications

References 24 publications

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

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

Fatores prognósticos na ressecção de metástases hepáticas de câncer colorretal

Expanding Criteria for Resectability of Colorectal Liver Metastases

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