[Surgical therapy of pulmonary metastases of colorectal cancer—ten-year results]

J Vodicka, V Spidlen, V Simánek, J Safránek, V Treska, T Skalický, A Sutnar, J Fichtl, P Mukensnabl
Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti 2012, 91 (2): 81-6

INTRODUCTION: Nowadays, surgical therapy of pulmonary metastases of colorectal cancer is a generally accepted therapeutic approach that has been proven to extend long term patient survival with acceptable perioperative morbidity and mortality rates. The aim of the study is to retrospectively analyse a group of patients who underwent surgery for pulmonary metastases of colorectal cancer over a period of ten years.

MATERIALS AND METHODS: From 2000 to 2009, 39 patients with pulmonary metastases of colorectal cancer underwent surgical therapy at the site of the authors, out of whom 21 were males (53.8%), with a mean age of 60.4 years. Out of the total, 24 patients (61.5%) presented with solitary metastases, multiple metastases were found in the remaining patients. 8 patients (20.5%) bileral affection was detected. 34 patients (87.2%) underwent adjuvant oncological therapy of a radically surgically curable primary tumor before metastasectomy and 6 patients (15.4%) underwent surgery for liver metastases. Five patients in the group (12.8%) had both pulmonary and secondary liver affections at the same time. The median disease-free period after the primary tumor surgery was 27 months in the whole group.

RESULTS: In total, we performed 31 unilateral (79.5%) and 8 bilateral (20.5%) one- or two- step surgeries. The most common type of surgery included anatomical pulmonary resections (18 procedures), laser excisions (13 procedures) and wedge resections (9 procedures). In total, we performed 73 radical resections of metastases and 5 metastases were treated by radiofrequency ablation (RFA). Metastatic affection of hilar lymph nodes was found in three patients (7.7%). Perioperative morbidity reached 12.8%, mortality was zero, and two re-operations were required because of complications (5.1%). 53.8% of patients with metastasectomy are still alive, the median survival time is 38 months. The three-year survival rate is 52% and the five-year survival rate is 41% five years. Pre-operatively increased value of tissue polypeptid specific antigen (TPS) was the only statistically significant factor that had a negative impact on the overall survival. 30.7% of patients with metastasectomy show no disease progression, the median disease- free interval is 14 months. There is a statistically significant correlation between DFI (Disease Free Interval) following metastasectomy and the type of surgery and the lowest value of DFI was achieved with radiofrequency ablation. The risk of disease progression is 3.4-times higher in patients with two and more metastases of colorectal cancer up to 3.9-times higher in subjects with three and more metastases.

CONCLUSION: The positive effect of pulmonary metastasectomy on the long-term survival is evident. However, careful selection of patients with individual evaluation of each single case is required. In particular, indication for metastasectomy should be carefuly considered in cases of multiple affection, which are associated with higher risk of disease progression. The essential requirement is to achieve complete resection of the pathological focus, with a maximum effort aimed at sparing healthy pulmonary tissue, which allows for potential necessary reoperations in case of the disease recurrence. Systematic mediastinal lymphadenectomy (SMLA) should be an integral part of any pulmonary metastasectomy.


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