OUTCOMES AFTER REPEATED LUNG METASTECTOMY OF COLORECTAL CANCER METASTASES

Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer

05.11.09

Category: Scientific News

It remains controversial whether metastasectomy is still feasible in patients with pulmonary recurrence from colorectal cancer, after initial metastasectomy

The role of metastasectomy for treating pulmonary metastasis from colorectal carcinoma is widely accepted. Surgical resection is now indicated for multiple metastases, including metastasis with bilateral involvement, simultaneous hepatic metastasis, and even for advanced diseases in which pulmonary metastasis is found at initial presentation.

However, no consensus has been reached concerning the optimal treatment strategies for patients who have already had pulmonary metastasectomy and are later found to have recurrent pulmonary metastasis, despite efforts (such as systemic chemotherapy) to overcome the disease. Furthermore, no standard has been proposed that enables adequate answers to questions frequently encountered under clinical conditions regarding the benefits actually conferred by repeated resection under the following circumstances: (i) pulmonary recurrence found within a year after initial metastasectomy; (ii) multiple but resectable pulmonary recurrence including bilateral metastasis; or (iii) the feasibility of a third or even fourth resection of pulmonary metastasis.

The aim of the study by the group of clinicians from the Samsung Medical Center, Seoul, South Korea, led by Prof. J Kim, was to evaluate outcomes of repeated metastasectomy in that setting. From 1995 to 2007, 202 patients underwent pulmonary metastasectomy for colorectal cancer at the institution. Over a median follow-up of 28.9 months, 48 patients received a second metastasectomy (29 wedge resections, 5 segmentectomies, 13 lobectomies, and 1 completion pneumonectomy). The median disease-free interval was 9.6 months. Among these 48 patients, 28 showed pulmonary recurrence and of those, 10 patients received a third metastasectomy (two wedge resections, two segmentectomies, four lobectomies, and two completion pneumonectomies).

There was no postoperative mortality. Of the 48 patients who underwent a second metastasectomy, overall and disease-free 5-year survivals were 79% and 49%, respectively, after the second operation. Of the 10 patients who received a third metastasectomy, overall survival was 78% at 5 years after the last operation.

The investigators showed that repeated resection after initial metastasectomy can be done safely. Their findings indicate that close follow-up for early detection of recurrence and parenchyma-saving resection could improve results after repeated resection. The authors published their results in the Advance Access program of Annals of Oncology on 27 October 2009