Abstract
BackgroundThe 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.MethodsThis study was a retrospective, single-institution study of 126 CRC patients who underwent pulmonary metastasectomy between 2000 and 2019 at the Gifu University Hospital.ResultsThe 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.ConclusionsRepeat 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.
Highlights
Colorectal cancer (CRC) is one of the most common cancers and is known to metastasize frequently to the liver and lungs via the systemic blood flow
All patients who underwent pulmonary metastasectomy met the following criteria based on the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines for the treatment of colorectal cancer (CRC) [9]: (1) the patient was capable of tolerating surgery; (2) the primary colorectal tumor was controlled or could be controlled; (3) the metastatic lung tumor could be completely resected; (4) any extra-thoracic metastases could be controlled; and (5) the function of the remaining lung would be adequate
Since Thomfold et al [14] proposed the principles of surgical treatment for pulmonary metastases, pulmonary metastasectomy has been performed on patients who meet the operative criteria, and the prognosis after treatment is relatively good
Summary
Colorectal cancer (CRC) is one of the most common cancers and is known to metastasize frequently to the liver and lungs via the systemic blood flow. Because of recent advances in chemotherapy, diagnostic techniques, and surgical procedures, pulmonary resection is widely accepted as the optimal treatment for pulmonary metastases [1,2,3,4,5,6,7,8]. It is necessary to continue evaluation of the outcome of pulmonary metastasectomy in CRC patients in order to identify true prognostic factors and determine appropriate surgical criteria. We report the recent clinical outcomes of pulmonary metastasectomy at our institutes. The main purpose of this study was to answer the following questions: (1) What are the potential prognostic factors for patients undergoing pulmonary metastasectomy? 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
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
