Repeat Pulmonary Resection for Isolated Recurrent Lung Metastases Yields Results Comparable to Those after First Pulmonary Resection in Colorectal Cancer

Pulmonary resection for colorectal metastases is well accepted. However, the main cause of death after pulmonary resection is recurrence in the lung. The aim of this study was to clarify whether a repeat pulmonary resection was warranted in patients with recurrent lung metastases. The records of 76 patients undergoing initial pulmonary resection, including 14 patients undergoing a repeat operation for lung metastases, were reviewed for survival, operative morbidity, and mortality. Overall, pulmonary resection was performed 96 times in this group of patients. The operative mortality was 0%, morbidity involved only one case of major postoperative hemorrhage associated with the first operation. The cumulative 5-year survival rate for the 76 patients was 32%. After the second pulmonary operation, recurrence was identified in 79% (11 of 14) of the patients. In 10 patients with isolated lung recurrence after a first pulmonary resection, who showed no extrapulmonary disease before or at the time of first thoracotomy, the 3-year, and 5-year-survival rate after the second pulmonary resection was 67%, and 33%, respectively, comparing favorably with the survival rate in those who underwent primary pulmonary resection. In contrast, all 4 patients with extrapulmonary disease before or at the time of thoracotomy had poor prognosis. Repeat pulmonary operation for isolated recurrent colorectal metastases to the lung yielded results comparable to those after the first pulmonary resection in terms of operative mortality and survival in the absence of hilar/mediastinal lymph node or extrathoracic involvement.     

Microsatellite Instability as a Prognostic Factor in Resected Colorectal Cancer Liver Metastases

Background: Two distinct genetic mutational pathways characterized by either chromosomal instability or high-frequency microsatellite instability (MSI-H) are currently recognized in the pathogenesis of colorectal cancer (CRC). Recently, it has been shown that patients with primary CRC that displays MSI-H have a significant, stage-independent, multivariate survival advantage. Untreated CRC hepatic metastases are incurable and are associated with a median survival of 4 to 12 months. Conversely, surgical resection in selected patients results in a 20% to 50% cure rate. The aim of this study was to investigate the prognostic importance of MSI-H in patients undergoing resection of hepatic CRC metastases.Methods: DNA was extracted from paraffin-embedded, resected metastatic CRC liver lesions and corresponding normal liver parenchyma from 190 patients. MSI-H status was determined by polymerase chain reaction–based evaluation of the noncoding mononucleotide repeats BAT-25 and BAT-26.Results: MSI was detected in tumors from 5 (2.7%) of the 190 CRC patients. All MSI-H tumors were in patients with node-positive CRC primary tumors. The median survival after hepatic resection of MSI-H and non–MSI-H tumors was 67 and 61 months, respectively (P = .9).Conclusions: These data suggest that MSI-H is not a common feature in resected CRC liver metastases and do not suggest a role for MSI in stratifying good versus poor prognosis in these patients.the Annual Meeting of the Society of Surgical Oncology, Los Angeles, California, March 5–9, 2003.     

Survival Analysis of Resection of Lung Metastases From Colorectal Cancer

IntroductionThe publication of the International Registry of Lung Metastases (IRLM) in 1997 was a turning point in favor of surgical resection of lung metastases. Prognostic groups were defined according to resectability, number of metastases, and disease-free interval. The objective of this study was to determine survival in patients who underwent resection of lung metastases from colorectal carcinoma and to evaluate how applicable the prognostic factors established by the IRLM are in this specific patient group.Patients and MethodsPatients with lung metastases from colorectal carcinoma who underwent resection between January 1, 2000, and November 30, 2006, were retrospectively analyzed. Survival was calculated using the Kaplan-Meier method, with log-rank comparisons between groups.ResultsSurvivals at 1, 3, 5, and 6 years was 92%, 75%, 54%, and 43%, respectively. The main finding was that 3-year survival was better in patients who underwent atypical resection of the metastasis (75%) than those who required lobectomy (55%). There were no significant differences in survival in terms of number of lung metastases resected or disease-free interval.ConclusionsSurvival in patients requiring lobectomy for resection of lung metastases from colorectal carcinoma was worse than in those who underwent atypical resection. The number of metastases and disease-free interval may be questionable prognostic factors in the case of lung metastases from colorectal carcinoma.     

Outcome after Resection of Hepatic and Pulmonary Metastases of Colorectal Cancer

Introduction  

Multimodal therapies (especially surgery of metastases and “aggressive” chemotherapy) in patients with metastases of colorectal cancers (CRC) are increasingly performed and may provide long-term survival in selected patients with more than one location of metastases. In the current literature, there are only few studies with relatively low patient numbers reporting on the outcome after resection of both hepatic and pulmonary metastases of CRC. We therefore evaluated survival of patients who underwent sequential resection of hepatic and pulmonary metastases under potentially curative intention.     

Validation of Prognostic Scoring Systems for Patients Undergoing Resection of Colorectal Cancer Liver Metastases

Background  

Several prognostic scoring systems have been established for patients undergoing resection of colorectal cancer (CRC) liver metastases; however, comparative analyses of their prognostic relevance is still lacking in the literature. The aim of the present study was to assess the predictive value of five published scoring systems in an independent patient cohort for the purpose of external validation.     

Extending the Limits of Resection for Colorectal Liver Metastases: Positive Resection Margin and Outcome After Resection of Colorectal Cancer Liver Metastases

Journal of Gastrointestinal Surgery -     

Repeated Resection of Colorectal Cancer Pulmonary Oligometastases: Pooled Analysis and Prognostic Assessment

Background

Repeated resection of colorectal cancer pulmonary metastasis is associated with long-term survival. Nevertheless, very limited data addressing the best candidates for repeated pulmonary resection is available.

Patients and Methods

We searched the PubMed database for retrospective studies evaluating lung metastasectomy for metastatic colorectal cancer (CRC). We included studies with available data about repeated pulmonary metastasectomy. Potential prognostic factors were analyzed for possible impact on survival following the second metastasectomy through univariate and multivariate analysis.

Results

Between 1983 and 2008, 944 lung metastasectomies were carried out on 759 patients. Of those, 148 patients had a second metastasectomy. The 5-year survival rate was 52 % for patients who had 1 metastasectomy and 57.9 % from the second metastasectomy for patients who had repeated resection. More than 2 metastatic pulmonary nodules and maximum diameter of largest pulmonary nodule ≥3 cm were the only independent factors associated with inferior survival following repeated pulmonary resection.

Conclusions

In selected patients with metastatic CRC, repeated pulmonary metastasectomy offers an excellent chance for long-term survival and is associated with a quite low operative mortality. Patients with more than 2 metastatic nodules and a maximum diameter of the largest metastatic lung nodule of ≥3 cm have a significantly inferior survival.     

Intrahepatic Lymphatic Invasion but not Vascular Invasion is a Major Prognostic Factor after Resection of Colorectal Cancer Liver Metastases

Background

Despite advances in diagnosis and surgical strategies, up to 70 % of patients will develop recurrence of the disease after resection of colorectal cancer liver metastases (CRCLM). The purpose of our study was to determine the frequency of four different mechanisms of intrahepatic dissemination, and to evaluate the impact of each mechanism on patient outcomes.

Methods

The medical records of 118 patients who underwent a first resection of CRCLM during the period between 2000 and 2010 were reviewed. Clinicopathologic variables and outcome parameters were examined. Resected specimens were submitted to routine histological evaluation, and immunohistochemical staining with D2-40 (lymphatic vessels), CD34 (blood vessels), CK-7 (biliary epithelium), and CK-20 (CRC cells).

Results

The mean follow-up after resection was 38 months. Tumor recurrence was observed in 76 patients, with a median interval of 13 months after resection. Overall survival and disease-free survival (DFS) rates after hepatectomy were 62 and 56 %, and 26 and 24 % at 3 and 5 years, respectively. Intrahepatic microscopic invasion included portal venous in 49 patients, sinusoidal in 43 patients, biliary in 20 patients, and lymphatic in 33 patients. Intra-hepatic lymphatic invasion was the only mechanism of dissemination independently associated with the risk of hepatic recurrence (odds ratio 2.75) and shorter DFS (p = 0.006).

Conclusion

Intrahepatic lymphatic invasion is a significant prognostic factor. Other mechanisms of invasion, although frequently observed, are not related to recurrence or survival, suggesting that the lymphatic system is the main route for dissemination of CRCLM. Furthermore, immunohistochemical detection of intrahepatic lymphatic invasion might be of value in clinical practice.     

Sarcopenia is a Negative Prognostic Factor After Curative Resection of Colorectal Cancer

Annals of Surgical Oncology - Skeletal muscle depletion (sarcopenia) is closely associated with limited physical ability and high mortality. This study was performed to evaluate the prognostic...     

血清肝细胞生长因子与结直肠癌肝转移的关系

目的研究结直肠癌患者血清中肝细胞生长因子(hepatocyte growth factor,HGF)的表达水平及其与结直肠癌肝转移的关系。方法收集我院2006年9月至2009年1月期间手术治疗并经病理证实为结直肠癌患者35例,应用夹心ELISA法检测血清中HGF表达水平。结果血清中HGF表达在结直肠癌有远处转移者中为(0.37±0.11)ng/ml,明显高于无转移者的(0.20±0.06)ng/ml(P0.05);T3、T4期者为(0.32±0.29)ng/ml,亦明显高于T1、T2期者的(0.20±0.14)ng/ml(P0.05);肝转移者为(0.43±0.10)ng/ml,明显高于其他部位转移者的(0.31±0.09)ng/ml(P0.05)。结论血清HGF水平与结直肠癌发展及肝转移发生有密切关系,血清HGF水平有望作为监测结直肠癌转移的临床指标。     

Synchronous Resection of Colorectal Primary Cancer and Liver Metastases

Background Patients with synchronous colorectal liver metastases are thought to have a less favorable prognosis than those with colorectal cancer alone. Surgical treatment options are controversial, be it synchronous resection or staged resection. This study compared the clinical, perioperative, disease-free survival (DFS), and overall survival (OS) results of patients undergoing synchronous resection versus staged resection. Methods An observational cohort study of 103 patients with synchronous colorectal liver metastases was performed. All data were collected prospectively. Clinical, perioperative, DFS, and OS results of patients undergoing synchronous resection (group I, n = 73) and staged resection (group II, n = 30) were compared. Results More patients in group I had poorly differentiated colorectal cancer, bilobar liver metastases, more than three liver metastases, ≤4 cm liver metastases, and shorter hospital stays than patients in group II. There were no significant statistically differences in DFS and OS between the two groups. The median DFS of groups I and II were 28 and 26 months, respectively (p = 0.585). The median OS of groups I and II were 37 and 36 months, respectively (p = 0.900). Conclusions Synchronous resection achieved DFSs and OSs similar to those seen after staged resection while avoiding a second major operation.     

Clinical Usefulness of Chest Radiography in Detection of Pulmonary Metastases After Curative Resection for Colorectal Cancer

Purpose The purpose of this study was to evaluate the effectiveness of chest radiography (CXR) and abdominal computed tomography (CT) for detecting pulmonary metastases after curative surgery for colorectal cancer. Methods We performed a retrospective analysis of the records of all patients with pulmonary metastasis from colorectal cancer who underwent curative resection between 1994 and 2004 at our institution. Results Pulmonary metastases were detected in 193 patients by either CXR or abdominal CT. They were initially detected by CXR in 87 patients (45.1%) and by abdominal CT in 106 patients (54.9%). In the CXR group, the patterns of pulmonary recurrence were as follows: solitary (n = 38, 43.7%), multiple unilateral (n = 11, 12.6%), and multiple bilateral (n = 38, 43.7%). In the CT group, there were 22 patients (20.8%) with a solitary nodule, 17 patients (16.0%) with multiple unilateral nodules, and 67 (63.2%) with multiple bilateral nodules. The overall survivals of the CXR group and abdominal CT group were 34.6% and 31.7%, respectively (p = 0.312). There was no difference in the median disease-free interval between the CXR group and the abdominal CT group (23.8 vs. 23.2 months, p = 0.428). Conclusions Although this study is limited by its small sample size, it can be speculated that abdominal CT with lower thorax images may replace CXR in surveillance programs.     

Gender Difference as a Prognostic Factor in Patients Undergoing Resection of Non-Small Cell Lung Cancer

Purpose We studied the effects of gender difference on the incidence of lung cancer and its mortality rate, which is a subject of much discussion. Methods We examined gender difference in the clinical features of 491 men and 222 women who underwent resection of primary non-small cell lung cancer (NSCLC) between 1994 and 2004. Results The histological types of cancer were adenocarcinoma in 249 (51%) of the men and 182 (82%) of the women, and squamous cell carcinoma in 182 (37%) of the men and 27 (12%) of the women. The incidence of adenocarcinoma was significantly higher in the women. The proportion of stage IA disease was significantly higher in the women than in the men (45% vs 29%, respectively). The 5-year overall survival rates were 50% in the men and 63% in the women. In a multivariate analysis, gender difference was an independent prognostic factor; however, when death as a result of unrelated disease was excluded, there was no significant difference in prognosis. Conclusion Although the higher incidences of adenocarcinoma and stage IA cancer contributed to the good results of surgery in women, the low incidence of death attributed to diseases other than lung cancer was a major reason for their better prognosis.