Colorectal Pulmonary Metastases Research Articles

Metastasectomy for colorectal pulmonary metastases: a survey among members of the European Society of Thoracic Surgeons.

Surgical management of pulmonary metastases in colorectal cancer patients is a debated topic. There is currently no consensus on this matter, which sparks considerable risk for international practice variation. The European Society of Thoracic Surgeons (ESTS) ran a survey to assess current clinical practices and to determine criteria for resection among ESTS members. All ESTS members were invited to complete an online questionnaire of 38 questions on current practice and management of pulmonary metastases in colorectal cancer patients. In total, 308 complete responses were received (response rate: 22%) from 62 countries. Most respondents consider that pulmonary metastasectomy for colorectal pulmonary metastases improves disease control (97%) and improves patients' survival (92%). Invasive mediastinal staging in case of suspicious hilar or mediastinal lymph nodes is indicated (82%). Wedge resection is the preferred type of resection for a peripheral metastasis (87%). Minimally invasive approach is the preferred approach (72%). For a centrally located colorectal pulmonary metastasis, the preferred form of treatment is a minimally invasive anatomical resection (56%). During metastasectomy, 67% of respondents perform mediastinal lymph node sampling or dissection. Routine chemotherapy is rarely or never given following metastasectomy (57% of respondents). This survey among the ESTS members underlines the change in practice of pulmonary metastasectomy with an increasing tendency in favour of minimally invasive metastasectomy and surgical resection is preferred over other types of local treatment. Criteria for resectability vary and controversy remains regarding lymph node assessment and the role of adjuvant treatment.

Commentary: The Reliability of a 2-mm Minimum Margin as an Adequacy Endpoint for Colorectal Pulmonary Metastasis Ablation Success

The investigators Hasegawa et al ( 1 Hasegawa T. Takaki H. Kodama H. et al. Impact of ablative margin on local tumor progression after radiofrequency ablation for lung metastases from colorectal carcinoma: supplementary analysis of a phase II trial (MLCSG-0802). J Vasc Interv Radiol. 2023; 34: 31-37 Abstract Full Text Full Text PDF Google Scholar ) are to be congratulated for identifying the ablation margin as a key technical element for thermal ablation success in tumor control in their article “Impact of Ablative Margin on Local Tumor Progression after Radiofrequency Ablation for Lung Metastases from Colorectal Carcinoma: Supplementary Analysis of a Phase II Trial.” The study evaluated 95 colorectal cancer (CRC) pulmonary metastases treated with radiofrequency (RF) ablation followed by sequential computed tomography (CT) examinations for at least 12 months after RF ablation and aimed to assess the minimum ablation margin (MM) required for better local tumor control ( 1 Hasegawa T. Takaki H. Kodama H. et al. Impact of ablative margin on local tumor progression after radiofrequency ablation for lung metastases from colorectal carcinoma: supplementary analysis of a phase II trial (MLCSG-0802). J Vasc Interv Radiol. 2023; 34: 31-37 Abstract Full Text Full Text PDF Google Scholar ). The MM was estimated as the shortest distance of the outer tumor boundary to the ground-glass opacity representing the ablation zone (AZ) immediately after RF ablation. Impact of the Ablative Margin on Local Tumor Progression after Radiofrequency Ablation for Lung Metastases from Colorectal Carcinoma: Supplementary Analysis of a Phase II Trial (MLCSG-0802)Journal of Vascular and Interventional RadiologyVol. 34Issue 1PreviewPulmonary oligometastatic disease is considered to be an indication for lung radiofrequency (RF) ablation when patients cannot undergo surgical treatment or external radiation therapy because of poor performance status, comorbid disease, or advanced age (1–3). In particular, the treatment outcomes of lung RF ablation for colorectal cancer (CRC) lung metastases have been well investigated, yielding satisfactory results including a 5-year disease-specific survival rate of 47%–69% and overall survival rate of 33%–68% (2–7). Full-Text PDF

Curative-intent treatment of pulmonary metastases from colorectal cancer: A comparison between imaging-guided thermal ablation and surgery.

Pulmonary metastases (PM) are the most frequent extra-abdominal metastases from colorectal cancer.Lung resection and imaging-guided thermal ablation (IGTA) are used as curative-intent treatment. We compared the outcomes of patients with PM, treated with resection or ablation. We retrospectively analyzed data from patients who underwent surgery or IGTA for colorectal PM between April 2011 and November 2020. Surgery was performed for peripheral PM and IGTA for deep-located PM not in contact with major vessels. Patients who had both procedures were excluded. Patients were compared using propensity score matching (PSM) analysis, stratified according to number, size, and unilaterality of PM. One hundred and fourty-six patients were included, 65 (44.5%) underwent surgery and 81 (55.5%) underwent IGTA. After PSM analysis, each group contained 46 patients. IGTA patients had a lower morbidity rate (13.1% vs. 15.2%, p = 0.028) and a shorter length of stay (5.13 vs. 2.63 days, p < 0.001). Oncological outcomes were similar in both groups with 5-year OS of 80% and 5-year progression-free survival(PFS) of 30% (p = 0.657 and p = 0.504, respectively) with similar recurrence patterns. Lung resection and IGTA seem to have similar oncologic outcomes for both OS and PFS. IGTA could be an alternative effective treatment for small PM, whenever technically feasible.

High mutational concordance between primary colorectal tumors and associated pulmonary metastases.

Precision medicine has altered the management of colorectal cancer (CRC). However, the concordance of mutational findings between primary CRC tumors and associated pulmonary metastases (PM) is not well-described. This study aims to determine the concordance of genomic profiles between primary CRC and PM. Patients treated for colorectal PM at a single institution from 2000 to 2017 were identified. Mutational concordance was defined as either both wild-type or both mutant alleles in lung and colorectal lesion; genes with opposing mutational profiles were reported as discordant. Thirty-eight patients met inclusion criteria, among whom KRAS, BRAF, NRAS, MET, RET, and PIK3CA were examined for concordance. High concordance was demonstrated among all evaluated genes, ranging from 86% (KRAS) to 100% concordance (NRAS, RET, and MET). De novo KRAS mutations were detected in the PM of 4 from 35 (11%) patients, 3 of whom had previously received anti-epidermal growth factor receptor (EGFR) therapy. Evaluation of Cohen's κ statistic demonstrated moderate to perfect correlation among evaluated genes. Because high intertumoral genomic homogeneity exists, it may be reasonable to use primary CRC mutational profiles to guide prognostication and targeted therapy for PM. However, the possibility of de novo KRAS-mutant PM should be considered, particularly among patients previously treated with anti-EGFR therapy.

Molecular profiling of colorectal pulmonary metastases and primary tumours: implications for targeted treatment.

This study aimed to molecularly characterise colorectal pulmonary metastases (PM) and investigate whether their molecular profiles were concordant with those of the primary tumour. Clinical data and archival formalin fixed paraffin embedded tissue samples were retrospectively collected from patients who underwent ≥ 1 pulmonary metastasectomies for colorectal cancer between 1997–2012. Primary tumour and metastatic samples were analysed using a targeted capture sequencing panel of 46 cancer-associated genes. The 5-year progression-free and overall survival rates for the 81 patients in this study were 32% (95% CI 22–42%) and 77% (95% CI 66–85%) respectively. Fifty-four patients had samples available from ≥ 1 PM, and sequencing data were successfully obtained from 33 PM from 24 patients. The most frequently mutated genes were APC (71%), KRAS (58%) and TP53 (46%). Seventy-three percent of the 15 patients with matched primary and PM samples and 6 of the 7 patients (86%) with data from ≥ 2 PM had concordant molecular profiles. The concordance for KRAS and NRAS was 100%. At our institutions, patients with resectable colorectal PM had a favourable prognosis. RAS mutations were commonly detected in PM and the molecular profiles of colorectal PM were highly concordant with the primary tumour.

Surgical Management of Metastatic Colorectal Cancer: A Single-Centre Experience on Oncological Outcomes of Pulmonary Resection vs Cytoreductive Surgery and HIPEC.

Metastasectomy is accepted as standard of care for selected patients with colorectal pulmonary metastases (CLM); however, the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastases (CPM) is not universally accepted. We aim to compare oncological outcomes of patients with CLM and CPM after pulmonary resection and CRS-HIPEC, respectively, by comparing overall survival (OS) and disease-free survival (DFS). A retrospective review of 49 CLM patients who underwent pulmonary resection, and 52 CPM patients who underwent CRS-HIPEC in a single institution from January 2003 to March 2015, was performed. The 5-year OS for CLM patients and CPM patients were 59.6 and 40.5%, respectively (p=0.100), while the 5-year DFS were 24.0 and 14.2%, respectively (p=0.173). CPM patients had longer median operative time (8.38 vs. 1.75h, p<0.001), median hospital stay (13 vs. 5days, p<0.001), a higher rate of intensive care unit (ICU) admissions (67.3 vs. 8.2%, p<0.001), and a higher rate of high-grade complications (17.3 vs. 4.1%, p<0.001). Multivariate analysis demonstrated that recurrent lung metastasis after metastasectomy was an independent prognostic factor for OS of CLM patients (OR=0.045, 95%, CL 0.003-0.622, p=0.021). There were no independent prognostic factors for OS in CPM patients by multivariate analysis. There were no independent prognostic factors for DFS in CLM patients by multivariate analysis, but peritoneal cancer index score, bladder involvement, and higher nodal stage at presentation of the initial malignancy were independent prognostic factors for DFS in CPM patients. OS and DFS for CPM patients after CRS and HIPEC are comparable to CLM patients after lung resection, although morbidity appears higher. The prognostic factors affecting survival after surgery are different between CPM and CLM patients and must be considered when selecting patients for metastasectomy.

Abstract 390: Colorectal cancer pulmonary metastasis treatment with lung-selective delivery of PAN-class I PI3K inhibitors

Abstract Colorectal cancer (CRC) is the second leading cause of cancer death in the US, and its frequency is increasing worldwide. Phosphatidylinositol 3-kinase (PI3K) signaling is an important therapeutic target that is currently being evaluated in multiple clinical trials. The purpose of this study was to: i) determine expression of pAkt (Ser473), Akt1 and Akt2 in primary and metastatic CRCs, and ii) evaluate lung-selective delivery of PI3K inhibitors as a novel therapeutic approach against CRC lung metastasis. METHODS. i) To determine the expression of PI3K/Akt pathway components, we obtained primary CRCs (n = 12) and CRC lung metastases (n = 10). Akt1, Akt2 and pAkt (S473) expression was analyzed by immunohistochemistry (IHC) and blindly scored by a pathologist. ii) To confirm lung-selective nanoparticle accumulation, we used two methods. First, polymeric nanoparticles were constructed and loaded with fluorescent dye (Alexa547). IVIS Spectrum imaging and confocal imaging of frozen tissue sections was used to determine distribution of fluorescently-labeled nanoparticles after intravenous administration (50 μg/g; 300 μl). Second, polymeric nanoparticles were loaded with either wortmannin, PX866, BEZ235, PIK-90, ZSTK474 or GDC-094 and administered intravenously. Western blot analysis of protein extracts from lung, liver, spleen and kidney for pAkt (Ser473) expression was used to determine PI3K pathway inhibition. iii) The anti-metastatic potential of PI3K drug-loaded lung-selective nanoparticles was evaluated in a preclinical model of CRC lung metastasis. RESULTS. i) We found strong Akt2 and pAkt (S473) expression in all primary and metastatic lung CRC patient samples. ii) We confirmed lung-selective accumulation of fluorescent nanoparticles and absence of fluorescent nanoparticle accumulation in liver, spleen and kidney. Lung-selective drug delivery was confirmed by western blot analysis of PI3K pathway inhibition in protein extracts from lung, liver, spleen and kidney after a single (10 μg/g; 300 μl) intravenous administration of drug-loaded nanoparticles. PI3K pathway inhibition was observed only in lung tissue samples. iii) Mice with established lung metastases were treated with PI3K drug-loaded nanoparticles daily (10 μg/g; 300 μl). Treatment in vivo with wortmannin and PX866 showed marked suppression of CRC lung metastatic growth. BEZ235, PIK-90, ZSTK474 or GDC-0941 had no significant effect on growth in metastatic CRC to the lung when delivered by nanoparticles. CONCLUSIONS. We developed a safe and efficient lung selective drug nanocarrier and evaluated lung selective PI3K inhibition as a viable treatment strategy. Treatment of CRC lung metastasis with pan-PI3K-loaded nanoparticles demonstrated a marked suppression of metastatic lung growth, and suggests that lung selective PI3K inhibition is a viable treatment strategy for CRC lung metastasis. Citation Format: Piotr Rychahou, Younsoo Bae, Yekaterina Zaytseva, Eun Y. Lee, Heidi L. Weiss, B. Mark Evers. Colorectal cancer pulmonary metastasis treatment with lung-selective delivery of PAN-class I PI3K inhibitors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 390.

Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors.

We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.

PTH-307 Percutaneous management of pulmonary metastases arising from colorectal cancer; a systematic review

<h3>Introduction</h3> Radiofrequency ablation (RFA) has been successfully utilised in the management of colorectal hepatic metastases and has also been used in the context of colorectal pulmonary metastases (CRPM). The aim was to systematically review the evidence and to assess the safety and efficacy of ablative techniques in the management of CRPM. <h3>Method</h3> A literature search was performed using PubMed, Embase, Cochrane Library, CINAHL and Google scholar databases to identify studies, which analysed ablative techniques and its efficacy in the management of CRPM. The primary outcomes of interest were overall survival and progression free survival. The secondary outcome measure was complication rates. <h3>Results</h3> 7 studies were included in the review with a total of 553 patients and all of which used RFA for ablation. Mortality from ablation was &lt;1% with overall survival ranging from 31–67 months. 1, 2 and 3 year survival ranges of 79–91%, 56–72% and 35–65% respectively. Local progression following ablation ranged from 9–22%. Major complication rates were noted in 1–8% of patients with minor complications ranging between 7–33%. 25% of patients required chest drain insertion post procedure. <h3>Conclusion</h3> This is the first paper to systematically review the use of RFA specifically for CRPM. This review provides evidence that RFA is a safe and effective technique for the management of CRPM. However in the absence of large randomised controlled trials it is unclear where RFA should sit in the treatment algorithm for patients with pulmonary metastases from colorectal primaries. <h3>Disclosure of interest</h3> None Declared.

Adjuvant systemic chemotherapy with or without bevacizumab in patients with resected pulmonary metastases from colorectal cancer.

e14533 Background: To determine impact of modern chemotherapy regimens after pulmonary metastasectomy from colorectal cancer (CRC). Methods: A total of 122 consecutive patients who curatively resected for pulmonary metastases of CRC in eleven oncology centers were retrospectively analysed between January 2000 and April 2012. Results: Of 122 patients, 108 who received chemotherapy with fluoropyrimidine-based (n = 12), irinotecan-based (n = 56) and oxaliplatin-based (n = 40) combinations were analyzed. Among these, 52 patients received bevacizumab (BEV) while 56 did not (NoBEV). With a median follow-up of 14 months after metastasectomy, median recurrence-free survival (RFS) was 17 months, overall survival (OS) was not reached. Three and 5-years OS rates were 66% and 53%, respectively. There was no significant difference among cytotoxic regimens in respect to RFS and OS. Similarly, no significant difference was seen between BEV and NoBEV arms in respect to OS and RFS. In univariate analysis prior liver metastasectomy (p = 0.045), positive pulmonary margin (p = 0.028), disease-free interval &lt; 12 months (p = 0.013), and KRAS mutation (0.009) were negative significant prognostic for RFS. Thoracic pathological lymphatic involvement (p = 0.006) and higher prethoracotomy carcinoembryonic antigen (p = 0.038) were negative significant prognostic for OS. In multivariate analysis, positive pulmonary margin was the only negative independent prognostic for RFS, while thoracic lymphatic involvement was the only negative independent prognostic for OS. Conclusions: Chemotherapy type and addition of bevacizumab have no impact on both RFS and OS in the adjuvant setting following complete resection of colorectal pulmonary metastases.

Outcomes After Hepatic and Pulmonary Metastasectomies Compared With Pulmonary Metastasectomy Alone in Patients With Colorectal Cancer Metastasis to Liver and Lungs

Surgical resection is the most effective treatment for colorectal cancer that has metastasized to the liver. Similarly, surgical resection improves survival for selected patients with pulmonary colorectal metastases. However, the indication for pulmonary metastasectomy is not clear in patients with both hepatic and pulmonary colorectal metastases. Therefore, we evaluated outcomes after pulmonary resection of colorectal metastases in patients with or without a history of curative hepatic metastasectomy. We retrospectively analyzed 96 patients who underwent pulmonary metastasectomy from March 1999 to November 2009. Patients were grouped according to treatment: resection of pulmonary metastases alone (lung metastasectomy group) or resection of both hepatic and pulmonary metastases (liver and lung metastasectomy group). Overall survival (OS) and disease-free survival (DFS) were evaluated by Kaplan-Meier analysis. Survival curves were compared using the log-rank test. The 5-year OS for all patients was 61.3 %, and the 5-year DFS was 26.7 %. Group comparisons showed that the 5-year OS of the lung metastasectomy group was significantly better than that of the liver and lung metastasectomy group (69 vs. 43 %; p = 0.030). However, the 5-year DFS rates of the lung metastasectomy group (25.8 %) and liver and lung metastasectomy group (28.0 %) did not differ significantly. Recurrence was higher after resection of both hepatic and pulmonary metastases than after pulmonary metastases alone (79 vs. 45 %; p = 0.025). Resection of pulmonary colorectal metastases may increase survival. However, the combination of liver and lung metastasectomies had a worse prognosis than pulmonary metastasectomy alone. In selected patients, combined liver and lung metastasectomy can be beneficial and result in acceptable DFS.

Biology of colorectal pulmonary metastasis: implications for surgical resection†

In colorectal cancer, little high grade evidence for cure, life extension, disease modification or palliation achieved by pulmonary metastasectomy exists. This has prompted the pulmonary metastasectomy in colorectal cancer (PulMiCC) trial. Reappraisal of the biological facts on colorectal metastasis may, however, shed light on an alternative avenue of clinical management. Early onset of metastasis, short doubling time and a short disease-free interval are all associated with poor clinical outcomes. Selecting who will be cured (i.e. no occult metastasis) remains the holy grail for pulmonary metastasectomy surgery. Serial CT scans can be utilized to calculate the tumour doubling time by volumetric analysis. Knowing the doubling time and size of the largest metastasis, which by definition is the first cell that has successfully spread from the primary site, the time of initial metastasis can be predicted. More importantly, using the doubling time, calculating the time interval from the primary surgery to the point at which all pulmonary metastases are visible should be possible. Perhaps watchful waiting, with interval CT scanning, followed by pulmonary metastasectomy should be utilized, rather than clinical opinion or randomization in a trial based upon first presentation.

CT-guided radiofrequency ablation in the management of pulmonary colorectal metastases.

e17526 Background: Radiofrequency ablation (RFA) has emerged as an effective treatment of unresectable lung metastases that preserves pulmonary function. Methods: Forty-eight patients with unresect...

Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases

We read with interest the article by Chua et al and would like to share the belief that the combination of chemotherapy and radiofrequency ablation (RFA) offers the potential for disease control in patients with colorectal pulmonary metastases. In fact, in our institution, 74 (94.9%) of 78 consecutive patients with colorectal cancer who received RFA for the treatment of pulmonary metastases received systemic chemotherapy after RFA. The 1year and 3-year overall survival rates were 83.9% (95% confidence interval [95% CI], 92.7%-75.2%) and 56.1% (95% CI, 70.5%-41.7%), respectively, and the median survival time was 38.0 months in all patients. In the article by Chua et al, the survival curve was plotted only between patients treated with and without adjunctive systemic chemotherapy (the median survival times were 59 months and 21 months, respectively, as shown in Figure 5 in their article), although the presence of extrapulmonary metastases at the time of RFA treatment, identified as a negative predictive factor for patient survival in both studies, was found to be significantly dominant (P 1⁄4 .019 using the chi-square test) in our study cohort compared with that of Chua et al (24 of 78 patients and 16 of 100 patients, respectively). This finding might also support the benefit of systemic chemotherapy as an adjunct to RFA in patients with pulmonary metastases from colorectal cancer in multimodality therapy. With regard to a prospective randomized trial to compare metastasectomy and RFA, which Chua et al mentioned as a valid trial in the last part of their discussion, we launched a multicenter randomized controlled trial of surgical metastasectomy versus RFA in patients with resectable colorectal lung metastases in October 2008 in Japan. However, the recruitment of candidates was troublesome because most of the patients preferred RFA to surgical treatment and refused to join in this phase 3 trial. Therefore, we changed it to a 1-arm phase 2 clinical trial for RFA in patients with resectable colorectal lung metastases in October 2009 (NCT00776399). We are expecting a favorable survival outcome in this ongoing trial compared with previous studies of multimodality therapy including pulmonary resection because patients with extrapulmonary metastases at the time of RFA or lymph node swelling are excluded from enrollment.

Reply to Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases

Reply to Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases

Efficacy of Surgical Resection of Both Pulmonary and Liver Metastases from Colorectal Cancer

Purpose: Resection is effective for some patients with isolated hepatic or pulmonary metastases of colorectal cancer (CRC). But the role of surgery in the management of patients who have both liver and lung metastases is not well defined. The aim of this study was to evaluate the validity of surgical therapy for isolated hepatic and pulmonary colorectal metastases. Methods: Between 1992 and 2006, 256 patients underwent hepatic resection for the first treatment of CRC metastases. Among these patients, 31 patients underwent both lung and liver resections for metastatic CRC. Demographic, perioperative, survival and variables were evaluated by retrospective chart review. Results: Twenty-nine patients (93.5%) underwent sequential pulmonary resection after hepatectomy because of recurrent disease. Two patients (6.5%) underwent staged liver and lung metastasectomy from synchronously identified metastases. Median interval between heaptic resection and pulmonary resection was 17.7±10.4 month. The features of the first liver metastases: The median number of tumors was 1.59 (range 1 to 20 tumors) and 14 patients had bilateral disease. The median size of the largest tumor was 3.0 cm (range 0.3 to 8 cm). In 11 (35.5%) patients, a hemihepatectomy or more was required to remove all gross disease. The features of the first pulmonary metastases: The median number of nodules was 2.7 (range 1 to 10) and 13 patients (41.9%) had their metastatic disease confined to bilateral lung. The median tumor size was 1.9 cm (range 0.4 to 6 cm). A large majority of patients (83.9%) had a wedge resection; lobectomy was required in only 5 (16.1%) patients. Median survival from resection of the first liver metastasis was 86.5 month, with the 5-, and 10-year over all survival rates of 77.5% and 39.5%, respectively. Median survival from resection of the first pulmonary metastasis was 55.2 month, with the 5-, and 10-year over all survival rates of 44.7% and 38.2%, respectively. By multivariate analysis, number of pulmonary metastases more than 3 (risk ratio= 4.417, 95% confidence interval CI=1.376-14.175, p=0.013) was an independent unfavorable prognostic factor of long-term survival. The overall cumulative survival results in patients with more than 3 pulmonary metastases (5,10-year 16.6 median survival 23.4 months) was markedly worse than in patients less than 3 pulmonary metastases (5-year 60.2%, 10-year 45.1% median survival 97.1 months) (p<0.0071). Conclusion: Surgical resection of both hepatic and pulmonary colorectal metastases is safe and results in excellent long term survival in selected patients. Poor results were obtained in patients who had more than 3 pulmonary metastases.

Imaging Characteristics of a Mucinous Colorectal Pulmonary Metastasis

Imaging Characteristics of a Mucinous Colorectal Pulmonary Metastasis

Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases

Aims Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy. Methods Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data. Results Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2–10) days for the pulmonary and 7 (1–23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8–87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%. Conclusion We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.

Long-term survival following resection of colorectal pulmonary metastases

Long-term survival following resection of colorectal pulmonary metastases

Outcomes after Resection of Synchronous or Metachronous Hepatic and Pulmonary Colorectal Metastases

Outcomes after Resection of Synchronous or Metachronous Hepatic and Pulmonary Colorectal Metastases