Pulmonary metastectomy of colorectal cancer origin: evaluating process and outcome

By: Dr. Praveen Kammar
Authors: Naveena A.N. Kumar, Kamlesh Verma, Rajesh S. Shinde, Rohit Dusane, Ashwin Desouza, Vikas Ostwal, Prachi Patil, Reena Engineer, George Karimundackal, C. S. Pramesh, Avanish Saklani
Journal: Journal of Surgical Oncology Techniques
Category: Colorectal Surgeries
Start: October 17, 2018
Source: https://onlinelibrary.wiley.com/doi/10.1002/jso.25273
DOI:10.1002/jso.25273

ABSTRACT

Background

This study was undertaken to evaluate the effect of change in policy of computed tomography (CT) scan of the thorax in staging and follow‐up of colorectal cancer (CRC). Another objective was to review the outcomes following pulmonary metastasectomies (Pmets) and to determine the prognostic factors affecting outcomes.

Methods

This is a retrospective analysis from a prospective cohort database of patients, who underwent Pmet for CRC origin from August 2004 to February 2016. The outcome measures were number of Pmets per year, overall survival (OS), disease‐free survival (DFS), and prognostic factors affecting survival.

Results

Of 71 patients, 38% (n = 27) underwent Pmet before 2013 and 62% ( n = 44) had surgery after 2013. The 2‐year DFS after Pmet was 49.3% and estimated 5‐year OS was 51.4% at a median follow‐up of 28 months.

There was a significant increase in number of Pmets/year ( P = 0.0015), increased detection of synchronous pulmonary metastasis (PM) ( P = 0.005), increased diagnosis of extra‐pulmonary metastases (EPM) ( P = 0.005), and improved OS ( P = 0.026) after introduction of CT scan as staging tool.

Site of primary tumor (colon) ( P = 0.045), primary nodal stage ( P = 0.009), and the presence of EPM ( P = 0.01) were independent important prognostic factors affecting survival.

Conclusion

The CT scan of thorax as a baseline tool for staging and follow‐up in CRC increases referral for pulmonary metastasectomy. Surgery achieves excellent prognosis and long‐term survival outcomes in CRC with isolated PM and carefully selected patients with solitary liver metastasis.