Pulmonary Metastasectomy in Patients with Colorectal Cancer 


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The largest-to-date and only prospective Spanish series of 549 patients who underwent surgical resection of lung metastases from colorectal carcinoma demonstrated a good postoperative recovery from the procedure. A further analysis on morbidity, the correlation between imaging studies and pathologic findings, and survival after 3 years is underway. The initial findings from this study were presented by Laureano Molins, MD, PhD, of the Department of Thoracic Surgery, Sagrat Cor University Hospital and Hospital Clinic, Barcelona, Spain, at the recent European Multidisciplinary Conference in Thoracic Oncology.1

Pulmonary metastasectomy is a commonly performed surgical treatment in patients with lung metastases from colorectal cancer, despite the lack of evidence from any controlled study of survival benefit. Claims for a survival benefit derive from case series.

Prospective Cohort Study

Dr. Molins headed a team of investigators at cancer centers throughout Spain in conducting a prospective cohort study using data from the Registry of the Spanish Group for Surgery of Lung Metastases from Colorectal Carcinoma. The study objective was to analyze the main clinical factors involved in the prognosis of patients undergoing surgery for lung metastases from colorectal carcinoma.

From March 2008 to March 2010, a total of 549 patients underwent at least one episode of radical lung metastasectomy and were enrolled in this study. The mean number of nodules detected by computed tomography (CT) was 1.88 (range, 1–12); 314 (59%) patients presented with a single node, 96 (18%) had multiple unilateral nodules, and 120 (23%) had multiple bilateral nodules in lung. Synchronous lung metastases and colorectal carcinoma were detected in 78 (15%) patients. Patients with metachronous lesions showed a mean disease-free interval of 24 months.

Key Data

A video-assisted thoracoscopic approach was decided on for 75 (17%) of the 446 patients who had unilateral clinical involvement. Wedge resection was performed in 80% of patients. Occult metastases were detected by CT in 23% of patients showing bilateral pathologic involvement, compared to 7% of patients without bilateral involvement (P < .001). Staging was done by positron-emission tomography (PET) or PET-CT in 75% of patients, with the following diagnostic values: sensitivity 84%, specificity 78%, positive predictive value 98%, and negative predictive value 26%.

Patients who underwent pulmonary metastasectomy experienced few complications in this series; postoperative morbidity was observed in 81 (15%) patients. Postoperative mortality was exceptionally low, with two deaths (0.4%) occurring after resection of lung metastasis from colorectal cancer.

Thoracotomy and wedge resection were the most frequently performed surgical techniques in this setting. The authors commented that the imaging tests used—CT and PET or PET-CT— had clear limitations in preoperative evaluation of patients as candidates for lung metastasectomy.

They pointed out that this is the only prospective data collection regarding pulmonary metastasectomy in Spain, with a larger database than previously seen in the literature. Resection of lung metastases from colorectal carcinoma is a procedure with low morbidity and mortality. Their analyses are ongoing, and 3-year follow-up data on morbidity, the correlation between imaging studies and pathologic findings, and survival will be reported as data become mature. ■

Disclosure: The study authors reported no potential conflicts of interest.

Reference

1. Molins L, Fibla JJ, Embun R, et al: Surgical treatment of 549 patients with lung metastases from colorectal carcinoma. Initial results of a prospective Spanish study. European Multidisciplinary Conference in Thoracic Oncology. Abstract 950. Presented May 11, 2013.



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