Size of metastatic deposits affects prognosis in patients undergoing pulmonary metastectomy for colorectal cancer

INTRODUCTION Pulmonary metastectomy for colorectal cancer (CRC) is a well accepted procedure although data regarding indications and prognostic outcomes are inconsistent. This study aimed to analyse our experience with resection of pulmonary CRC metastases to evaluate clinically relevant prognostic factors affecting survival. METHODS A retrospective analysis was undertaken of the records of all patients with pulmonary metastases from CRC who underwent a thoracotomy between 2004 and 2010 at a single surgical centre. RESULTS Sixty-six patients with pulmonary metastases from the colon (n=34) and the rectum (n=32) were identified. The 30-day hospital mortality rate was 0%, with 63 patients undergoing a R0 resection and 3 having a R1 resection. The median survival was 45 months and the cumulative 3-year survival rate was 61%. Size of pulmonary metastasis and ASA (American Society of Anesthesiologists) grade were statistically significant prognostic factors (p=0.047 and p=0.009 respectively) with lesions over 20mm associated with a worse prognosis. Sex, age, site, disease free interval (cut-off 36 months), primary tumour stage, hepatic metastases, number of metastases (solitary vs multiple), type of operation (wedge vs lobe resection), hilar lymph node involvement and administration of adjuvant chemotherapy were not found to be statistically significant prognostic factors. CONCLUSIONS Pulmonary metastectomy has a potential survival benefit for patients with metastatic CRC. Improved survival even in the presence of hepatic metastases or multiple pulmonary lesions justifies aggressive surgical management in carefully selected patients. In our cohort, size of metastatic deposit was a statistically significant poor prognostic factor.

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Role of Thermal Ablation in Colorectal Cancer Lung Metastases

Cancers ◽

10.3390/cancers13040908 ◽

2021 ◽

Vol 13 (4) ◽

pp. 908

Author(s):

Alexandre Delpla ◽

Thierry de Baere ◽

Eloi Varin ◽

Frederic Deschamps ◽

Charles Roux ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Thermal Ablation ◽

Medical Oncology ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Stereotactic Ablative Radiotherapy ◽

Chest Drainage ◽

Results Of Surgery

Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.

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Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer

Indian Journal of Surgery ◽

10.1007/s12262-021-02848-5 ◽

2021 ◽

Author(s):

Franz Xaver Singhartinger ◽

Martin Varga ◽

Tarkan Jäger ◽

Adam Dinnewitzer ◽

Oliver Koch ◽

...

Keyword(s):

Colorectal Cancer ◽

Lung Metastases ◽

Primary Tumour ◽

Median Number ◽

R0 Resection ◽

Curative Intent ◽

Median Hospital Stay ◽

Free Survival ◽

Colorectal Cancer Patients ◽

Primary Tumour Site

Abstract Background Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. Methods This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Results Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Conclusion Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

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Hypofractionated radiotherapy for pulmonary metastases from hepatocellular carcinoma: Treatment response and prognostic factors affecting survival

Annals of Oncology ◽

10.1093/annonc/mdz422.039 ◽

2019 ◽

Vol 30 ◽

pp. ix56

Author(s):

I.Y. Jo ◽

M.-S. Kim ◽

J.S. Seong ◽

J.W. Kim ◽

H.C. Park ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Treatment Response ◽

Pulmonary Metastases ◽

Hypofractionated Radiotherapy ◽

Factors Affecting

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Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study

Surgery Today ◽

10.1007/s00595-012-0373-8 ◽

2012 ◽

Vol 43 (5) ◽

pp. 494-499 ◽

Cited By ~ 29

Author(s):

Tomoichiro Hirosawa ◽

◽

Michio Itabashi ◽

Takamasa Ohnuki ◽

Naohito Yamaguchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Prognostic Factors ◽

Pulmonary Metastases ◽

Complete Resection ◽

Follow Up Study

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Evaluation of Clinical Prognostic Factors and Further Delineation of the Effect of Mesenteric Fibrosis on Survival in Advanced Midgut Neuroendocrine Tumours

Neuroendocrinology ◽

10.1159/000493317 ◽

2018 ◽

Vol 107 (3) ◽

pp. 292-304 ◽

Cited By ~ 15

Author(s):

Faidon-Marios Laskaratos ◽

Martin Walker ◽

Dominic Wilkins ◽

Alexander Tuck ◽

Shashank Ramakrishnan ◽

...

Keyword(s):

Prognostic Factors ◽

Large Scale ◽

Neuroendocrine Tumours ◽

Primary Tumour ◽

Stage Iv ◽

Epidemiological Data ◽

Tumour Resection ◽

Carcinoid Heart Disease ◽

Factors Affecting ◽

Stage Iv Disease

Background: Small intestinal neuroendocrine tumours (SI NETs) represent 30–50% of small bowel neoplasms and often present at an advanced stage. To date, there is relatively limited literature regarding prognostic factors affecting overall survival (OS) in stage IV disease. In addition, the prevalence of mesenteric fibrosis (MF) in SI NETs and its effect on OS have not been sufficiently explored in the literature. Aim: The primary aim of this study was to perform a large-scale survival analysis in an institutional cohort of 387 patients with metastatic (stage IV) SI NETs. The secondary aim was to provide epidemiological information regarding the prevalence of MF and to evaluate its effect on OS. Results: The median OS was 101 months (95% CI 84, 118). Age > 65 years, mesenteric metastases with and without desmoplasia, liver metastases, carcinoid heart disease (CHD) and bone metastases were associated with a significantly shorter OS, while primary tumour resection was predictive of a longer OS. The benefit of surgical resection was limited to symptomatic patients. MF was present in approximately 50% of patients with mesenteric lymphadenopathy. Elevated urinary 5-HIAA levels correlated strongly with the presence of CHD (p < 0.001) and to a lesser extent (p = 0.02) with MF. MF and CHD did not usually co-exist, suggesting that different mechanisms are likely to be involved in the development of these fibrotic complications. Conclusions: This study has identified specific prognostic factors in a large cohort of 387 patients with advanced SI NETs and has provided useful epidemiological data regarding carcinoid-related fibrotic complications.

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Weekly Irinotecan in Patients with Metastatic Colorectal Cancer Failing 5-Fluorouracil-Based Chemotherapy: Efficacy and Prognostic Factors

Tumori Journal ◽

10.1177/030089160308900207 ◽

2003 ◽

Vol 89 (2) ◽

pp. 141-145 ◽

Cited By ~ 3

Author(s):

Aziz Karaoğrlu ◽

Suayib Yalcin ◽

Gülten Tekuzman ◽

Ayse Kars ◽

Ismail Çelik ◽

...

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Objective Response ◽

Response Duration ◽

Response To Treatment ◽

Time To Progression ◽

Median Response ◽

Poor Prognostic Factor ◽

Histologic Subtype

Aims and background We evaluated the efficacy and tolerability of weekly irinotecan as a second-line treatment in patients with colorectal cancer failing 5-fluorouracil-based chemotherapy and searched for predictive and prognostic factors. Methods A total of 36 patients were included. Median age was 53 years (range, 33-72). One treatment cycle consisted of irinotecan, 100 mg/m2 weekly, for 4 weeks followed by a 2-week rest. Gender, age, primary site, number of metastatic sites, histologic subtype, differentiation, pretreatment CEA, CA 19-9 and lactate dehydrogenase levels and marker response to treatment were investigated as predictive factors for response to treatment and as prognostic factors in the overall survival and time to progression of the patients. Results A total of 120 cycles (median, 3 cycles) was delivered. An overall 14% objective response rate (1 complete and 4 partial responses) was achieved. The median response duration was 4 months (range, 2-7). Another 36% of the patients had stable disease for a median duration of 4 months (range, 2-8). Median time-to-disease progression was 4 months and overall median survival was 12 months (95% confidence interval, 9-15). Pretreatment serum CA 19-9 level and marker response to two courses of treatment were found to be clinically significant in time to progression and overall survival. Younger age (≤45 years) was a poor prognostic factor associated with a shorter time to progression. The major toxicity was grade 3-4 diarrhea, which occurred in 28% of the patients, and treatment was discontinued in 3 (8%) patients due to toxicity. Other hematological and non-hematological toxicities were mild and manageable. Conclusions We concluded that weekly irinotecan at the dose of 100 mg/m2 is an effective and tolerable treatment option, with a 50% disease control rate, for patients with colorectal cancer failing previous 5-fluorouracil-based chemotherapy.

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The Presence of Mutations in the K-RAS Gene Does Not Affect Survival after Resection of Pulmonary Metastases from Colorectal Cancer

ISRN Surgery ◽

10.1155/2014/157586 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Jon Zabaleta ◽

Borja Aguinagalde ◽

José M. Izquierdo ◽

Nerea Bazterargui ◽

Stephany M. Laguna ◽

...

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Pulmonary Metastases ◽

Direct Sequencing ◽

Lymph Node Involvement ◽

Ras Gene ◽

Surgical Interventions ◽

Cox Regression Analysis ◽

Ras Mutations ◽

Time To Recurrence

Introduction. Our objective was to identify mutations in the K-RAS gene in cases of pulmonary metastases from colorectal cancer (CRC) and determine whether their presence was a prognostic factor for survival. Methods. We included all patients with pulmonary metastases from CRC operated on between 1998 and 2010. K-RAS mutations were investigated by direct sequencing of DNA. Differences in survival were explored with the Kaplan-Meier method log-rank tests and multivariate Cox regression analysis. Results. 110 surgical interventions were performed on 90 patients. Factors significantly associated with survival were disease-free interval (P=0.002), age (P=0.007), number of metastases (P=0.001), lymph node involvement (P=0.007), size of the metastases (P=0.013), and previous liver metastasis (P=0.003). Searching in 79 patients, K-RAS mutations were found in 30 cases. We did not find statistically significant differences in survival (P=0.913) comparing native and mutated K-RAS. We found a higher rate of lung recurrence (P=0.040) and shorter time to recurrence (P=0.015) in patients with K-RAS mutations. Gly12Asp mutation was associated with higher recurrence (P=0.022) and lower survival (P=0.389). Conclusions. The presence of K-RAS mutations in pulmonary metastases does not affect overall survival but is associated with higher rates of pulmonary recurrence.

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