Metachronous Resection Research Articles

Is resection of pulmonary and hepatic metastases warranted in patients with colorectal cancer?

Background: Conventional management of stage IV colorectal carcinoma is palliative. The value of resecting both liver and lung colorectal metastases that occur in isolation of other sites of metastasis is undetermined. Objectives: Our objectives were to (1) assess the efficacy of resecting both hepatic and pulmonary metastases, (2) investigate the influence of the sequence and timing of metastases, and (3) identify the profile of patients likely to benefit from both hepatic and pulmonary metastasectomy. Patients and methods: Of 48 patients identified with resection of colorectal cancer and, at some point in time, both liver and lung metastases, 25 patients underwent metastasectomy (resection group). The remaining 23 patients comprised the nonresection group. Risk factors for death were identified by multivariable analyses. Results: Median survival was longer after the last metastatic appearance in the resection group (16 months) than in the nonresection group (6 months; P < .001). The pattern of risk also differed; it peaked at 2 years and then declined in the resection group but was constant in the nonresection group. In the resection group, patients with metachronous resections survived longer after colorectal resection (median, 70 months) than patients with synchronous (median, 22 months) or mixed resections (median, 31 months; P < .001). Risk factors for death included older age, multiple liver metastases, and a short disease-free interval. Conclusions: Younger patients with solitary metachronous metastases to the liver, then the lung, and long disease-free intervals are more likely to benefit from resection of both liver and lung metastases. Patients with risk factors also had better survival with resection than without resection. (J Thorac Cardiovasc Surg 1999;117:66-76)

Surgical treatment of metastatic melanoma

The survival of patients with metastatic melanoma is poor. The response rates for chemotherapy and immunotherapy have been low, with no real improvement in survival. We reviewed the results of surgical resection. We performed a retrospective review of the medical records of all patients who underwent resection of metastases from melanoma from 1979 to 1994. There were 77 patients (44 men, 33 women, mean age 51 years). Metastases were resected from soft tissue (n = 28), abdominal viscera (n = 22), lung (n = 15), and brain (n = 12). Forty-four patients had complete resections, and 33 had incomplete resections. Sixty-five patients had solitary lesions and 12 had multiple lesions resected. The overall 5-year survival rate was 10%. Patients with solitary lesions had a 5-year survival rate of 12%, compared with 0% for patients with multiple lesions (P = 0.01). Patients with complete resection had a 5-year survival rate of 15%, compared with 4% for patients with incomplete resection (P < 0.001). Patients with complete resection of solitary lesions had a 5-year survival of 18%. There was no difference in survival between synchronous and metachronous resection. Gender, primary site, disease-free interval, and metastatic site had no impact on survival rates. We conclude that patients with metastatic melanoma should be resected for (1) relief of symptoms such as obstruction and bleeding, (2) solitary lesions that can be completely resected, (3) serial lesions that can be completely resected, and (4) selected cases that can be rendered macroscopically free of disease. Surgical resection is superior to any other available therapy for metastatic melanoma.

A RESECTED CASE OF PANCREATIC METASTASIS FROM RENAL CELL CARCINOMA PRESENTING WITH ACUTE DUODENAL BLEEDING

This paper describes a rare case of renal cell carcinoma metastasizing to the pancreas head. A 63-year-old woman was admitted to the hospital because of hematemesis and melena. There was a previous history of undergoing left-sided nephrectomy 19 years earlier. She presented a remarkable anemia in the clinical examination. CT, ultrasonography and angiography showed a solid and hypervascular tumor 6cm in diameter in the head of the pancreas. Active bleeding from this tumor into the duodenal canal was diagnosed and successfully treated with emergency pancreaticoduodenectomy. The histological examination confirmed a solitary pancreatic metastasis of renal cell carcinoma. In a review of the literature, 31 cases of resected pancreatic metastasis from renal cell carcinoma were seen and several clinical characteristics were drawn out from these case reports. The mean interval between the pancreatic metachronous resection and the initial tumor resection was as long as 9.5 years. There was a relatively high incidence of solitary pancreatic head metastasis without other organ metastasis. All cases had hypervascular lesion on abdominal angiography, and histologically most metastatic tumors were of clear cell subtype. Since the surgical approach should be indicated to such late metastasis, prolonged follow-up of the patients and exact diagnosis of the metastatic lesion are important.

根治切除しえた直腸・肝異時性重複癌の１例

根治切除しえた直腸・肝異時性重複癌の１例