scholarly journals Prognostic Factors in the Pulmonary Metastasectomy and Efficacy of the Repeat Pulmonary Metastasectomy from Colorectal Cancer

2020 ◽  
Author(s):  
Masahiro Fukada ◽  
Nobuhisa Matsuhashi ◽  
Takao Takahashi ◽  
Yoshihiro Tanaka ◽  
Naoki Okumura ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Risk Ratio ◽  
Mediastinal Lymph Node ◽  
Pulmonary Metastasectomy ◽  
Mediastinal Lymph Node Metastasis ◽  
Node Metastasis ◽  
Significant Difference

Abstract Background Pulmonary metastasectomy from colorectal cancer (CRC) has improved with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors of response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy.Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Among these 126 patients, 47 cases (37.3%) had pulmonary re-recurrence after initial pulmonary metastasectomy, and 26 cases (20.6%) underwent the second pulmonary metastasectomy. ResultsThe 3- and 5- year survival rates of all 126 patients who underwent complete pulmonary metastasectomy were 84.9% and 60.8%, respectively. Univariate analysis in survival identified seven significant factors: 1) gender (p = 0.04), 2) past history of extra thoracic metastasis (p = 0.04), 3) maximum tumor size (p = 0.002), 4) hilar or mediastinal lymph node metastasis (p = 0.02), 5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), 6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and 7) repeat pulmonary metastasectomy for pulmonary re-recurrence (p < 0.001). On the multivariate analysis, only hilar or mediastinal lymph node metastasis (p = 0.02, risk ratio: 8.206, 95% confidence interval (CI): 1.566-34.962) and repeat pulmonary metastasectomy for pulmonary re-recurrence (p < 0.001, risk ratio: 0.054, 95% CI: 0.010-0.202) were significant. Furthermore, there was no significant difference in clinical and surgical characteristics between the initial and the second pulmonary metastasectomy except for intraoperative blood loss [10 (range 0-1130) mL vs 20 (range 0-220) mL, p = 0.008]. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for re-recurrent cases that meet the indication. However, hilar or mediastinal lymph node metastasis was a significant independent prognostic factor of worse overall survival.

scholarly journals Prognostic factors in the pulmonary metastasectomy and efficacy of the repeat pulmonary metastasectomy from colorectal cancer

2020 ◽  
Author(s):  
Masahiro Fukada ◽  
Nobuhisa Matsuhashi ◽  
Takao Takahashi ◽  
Yoshihiro Tanaka ◽  
Naoki Okumura ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Risk Ratio ◽  
Mediastinal Lymph Node ◽  
Pulmonary Metastasectomy ◽  
Mediastinal Lymph Node Metastasis ◽  
Node Metastasis ◽  
Significant Difference

Abstract Background The rate of pulmonary metastasectomy from colorectal cancer (CRC) has increased with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors for response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy.Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Results The 3- and 5- year survival rates were 84.9% and 60.8%, respectively. Among the 126 patients, 47 (37.3%) had pulmonary recurrence after initial pulmonary metastasectomy, and 26 (20.6%) underwent a second pulmonary metastasectomy. Univariate analysis of survival identified seven significant factors: 1) gender (p = 0.04), 2) past history of extra-thoracic metastasis (p = 0.04), 3) maximum tumor size (p = 0.002), 4) mediastinal lymph node metastasis (p = 0.02), 5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), 6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and 7) repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001). On multivariate analysis, only mediastinal lymph node metastasis (p = 0.02, risk ratio: 8.206, 95% confidence interval (CI): 1.566-34.962) and repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001, risk ratio: 0.054, 95% CI: 0.010-0.202) were significant. Furthermore, there was no significant difference in clinical and surgical characteristics between the initial and the second pulmonary metastasectomy except for intraoperative blood loss. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for recurrent cases that meet the surgical criteria. However, mediastinal lymph node metastasis was a significant independent prognostic factor for worse overall survival.

scholarly journals Prognostic factors in pulmonary metastasectomy and efficacy of repeat pulmonary metastasectomy from colorectal cancer

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Masahiro Fukada ◽  
Nobuhisa Matsuhashi ◽  
Takao Takahashi ◽  
Yoshihiro Tanaka ◽  
Naoki Okumura ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Risk Ratio ◽  
Mediastinal Lymph Node ◽  
Univariate Analysis ◽  
Pulmonary Metastasectomy ◽  
Mediastinal Lymph Node Metastasis ◽  
Node Metastasis

Abstract Background The rate of pulmonary metastasectomy from colorectal cancer (CRC) has increased with recent advances in chemotherapy, diagnostic techniques, and surgical procedures. The purpose of this study was to investigate the prognostic factors for response to pulmonary metastasectomy and the efficacy of repeat pulmonary metastasectomy. Methods This study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital. Results The 3- and 5-year survival rates were 84.9% and 60.8%, respectively. Among the 126 patients, 26 (20.6%) underwent a second pulmonary metastasectomy for pulmonary recurrence after initial pulmonary metastasectomy. Univariate analysis of survival identified seven significant factors: (1) gender (p = 0.04), (2) past history of extra-thoracic metastasis (p = 0.04), (3) maximum tumor size (p = 0.002), (4) mediastinal lymph node metastasis (p = 0.02), (5) preoperative carcinoembryonic antigen (CEA) level (p = 0.01), (6) preoperative carbohydrate antigen 19-9 (CA19-9) level (p = 0.03), and (7) repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001). On multivariate analysis, only mediastinal lymph node metastasis (p = 0.02, risk ratio 8.206, 95% confidence interval (CI) 1.566–34.962) and repeat pulmonary metastasectomy for pulmonary recurrence (p < 0.001, risk ratio 0.054, 95% CI 0.010–0.202) were significant. Furthermore, in the evaluation of surgical outcomes, the safety of second pulmonary metastasectomy was almost the same as that of initial pulmonary metastasectomy. Conclusions Repeat pulmonary metastasectomy is likely to be safe and effective for recurrent cases that meet the surgical criteria. However, mediastinal lymph node metastasis was a significant independent prognostic factor for worse overall survival.

The Pilot Study of Spectral CT for the Diagnosis of Mediastinal Lymph Node Metastasis in Primary Lung Cancer

2019 ◽  
Vol 9 (6) ◽  
pp. 1076-1079
Author(s):  
Xiao-Tong Chi ◽  
Nian-Qiang Bai ◽  
Ming-Ying Li ◽  
Kai Deng ◽  
Guang-Li Wang
Keyword(s):  
Lung Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Spectral Curve ◽  
Mediastinal Lymph Node ◽  
Primary Lung Cancer ◽  
Mediastinal Lymph Node Metastasis ◽  
Spectral Ct ◽  
Node Metastasis ◽  
Significant Difference

Objective: To investigate the application value of spectral CT for the diagnosis of mediastinal lymph node metastasis in primary lung cancer. Materials and Methods: 32 patients who had primary lung cancer with 90 enlarged mediastinal lymph nodes underwent spectral CT by using gemstone spectral imaging (GSI) mode. The spectral curves of regions of interest (ROI) in primary lung cancer and mediastinal lymph nodes were measured with GSI post-processing software. The spectral curve slope between 40 and 140 keV was calculated and compared between them for the diagnosis of mediastinal lymph node metastasis. The data were divided into metastatic group (group A) and non-metastatic group (group B) according to the pathologic findings. SPSS17.0 software with paired sample t test was used for statistical analysis and P < 0.05 was considered statistically significant difference. Results: The spectral curve slopes in primary lung cancer and mediastinal lymph node in group B were 0.96 ± 0.13 and 1.32 ± 0.17. There was significant difference between them (t = –2.68, P < 0.05). While there was no significant difference between them in group A (t = –1.62, P > 0.05) with the values of 1.06 ± 0.09 and 1.09 ± 0.12. The accuracy, sensitivity and specificity of diagnosing mediastinal lymph node metastasis were 84.21%, 86.67% and 82.77%, respectively in line with spectral curve. Conclusions: Spectral CT, as a new and non-invasive method, has valuable effect for the diagnosis of mediastinal lymph node metastasis in pre-operative staging of lung cancer.

Mediastinal lymph node metastasis and recurrence in adenocarcinoma of the esophagogastric junction

Surgery ◽  
2015 ◽  
Vol 157 (3) ◽  
pp. 551-555 ◽  
Author(s):  
Yukinori Kurokawa ◽  
Naoki Hiki ◽  
Takaki Yoshikawa ◽  
Kentaro Kishi ◽  
Yuichi Ito ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Esophagogastric Junction ◽  
Mediastinal Lymph Node ◽  
Mediastinal Lymph Node Metastasis ◽  
Node Metastasis

scholarly journals Colorectal Cancer Presenting as Single Pulmonary Hilar Lymph Node Metastasis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Ahmed M. Habib ◽  
Xenophon Kassianides ◽  
Samuel Chan ◽  
Mahmoud Loubani ◽  
Syed Qadri
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Mediastinal Lymph Node ◽  
Lymph Node Involvement ◽  
Pulmonary Metastasectomy ◽  
Hilar Lymph Node ◽  
Node Metastasis ◽  
Mediastinal Metastasis ◽  
Node Involvement ◽  
Hilar Lymph Node Metastasis

Colorectal carcinoma is the second biggest cancer responsible for mortality. Lung metastasis is the commonest, following the liver. It is not uncommon to perform pulmonary metastasectomy and identify mediastinal metastasis. Previous studies have identified incidental lymph node involvement following routine mediastinal lymph node clearance in 20–50% of cases. However, solitary intrathoracic lymph node metastasis is exceedingly rare. Even when present, it is usually metachronous. In our case, we present an exceedingly rare case whereby the intrathoracic lymph node metastasis is solitary, not accompanying pulmonary disease and with no liver metastasis. We also review the evidence for mediastinal lymphadenectomy in the literature.

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