Background: Up to 35% of patients with colorectal cancer (CRC) present with metastatic disease at diagnosis, and approximately one-third of metastases will be restricted to the liver and lungs. Solitary lung metastases (LM) are relatively uncommon in patients with CRC, with reported overall survival (OS) rates ranging from 35% to 70% after surgical resection. The aim of this study was to compare long-term (5-year) survival outcomes of patients with solitary LM from CRC according to the approach used for surgical resection. Methods: Data were analyzed retrospectively from two prospective protocols enrolling 33 consecutive patients with solitary, surgically resectable, metachronous LM from CRC at first CT-scan evaluation, undergoing pulmonary metastasectomy (PMx). There were 21 (63.6%) men and 12 (36.4%) women, with an overall median age of 64 years (range 31-80 years). The size of the LM ranged from 1 to 3.5 cm. Twelve (36.4%) patients (Group A) underwent video-assisted thoracoscopic surgery (VATS), while 21 (63.6%) patients (Group B) underwent open resection. The age, gender distribution, tumor size and site (right vs. left) did not differ significantly (p=NS) between groups. Kaplan-Meier analyses (to estimates survival curves), the Χ2 test (to compare categorical variables), and the log rank tests (to determine the weight of each prognostic factor (PFs) for survival) were used when required. Results: Overall, multivariate analysis showed that preoperative CEA serum levels, the interval for LM development, and the presence/absence of nodal involvement were independent PFs for survival. The age, gender, and size of LM were not useful PFs. In the entire population the, 1-, 3-, and 5-year OS rates were 87.9%, 66.7%, and 54.5%, respectively. The 5-year OS after PMx was 50.0% and 52.4% (p=0.67) in Groups A and B, respectively, and the log-rank test (p=0.88) was not significant. Conclusions: When technically feasible, VATS should be the technique of choice for PMx to treat patients with solitary LM form CRC. This technique is less aggressive and allows for the same results as open surgery.
Video-assisted thoracoscopic versus open pulmonary metastasectomy in patients with stage IV colorectal cancer and solitary lung metastasis. A preliminary case-control study and factors affecting survival
LUMACHI, FRANCO;
2016
Abstract
Background: Up to 35% of patients with colorectal cancer (CRC) present with metastatic disease at diagnosis, and approximately one-third of metastases will be restricted to the liver and lungs. Solitary lung metastases (LM) are relatively uncommon in patients with CRC, with reported overall survival (OS) rates ranging from 35% to 70% after surgical resection. The aim of this study was to compare long-term (5-year) survival outcomes of patients with solitary LM from CRC according to the approach used for surgical resection. Methods: Data were analyzed retrospectively from two prospective protocols enrolling 33 consecutive patients with solitary, surgically resectable, metachronous LM from CRC at first CT-scan evaluation, undergoing pulmonary metastasectomy (PMx). There were 21 (63.6%) men and 12 (36.4%) women, with an overall median age of 64 years (range 31-80 years). The size of the LM ranged from 1 to 3.5 cm. Twelve (36.4%) patients (Group A) underwent video-assisted thoracoscopic surgery (VATS), while 21 (63.6%) patients (Group B) underwent open resection. The age, gender distribution, tumor size and site (right vs. left) did not differ significantly (p=NS) between groups. Kaplan-Meier analyses (to estimates survival curves), the Χ2 test (to compare categorical variables), and the log rank tests (to determine the weight of each prognostic factor (PFs) for survival) were used when required. Results: Overall, multivariate analysis showed that preoperative CEA serum levels, the interval for LM development, and the presence/absence of nodal involvement were independent PFs for survival. The age, gender, and size of LM were not useful PFs. In the entire population the, 1-, 3-, and 5-year OS rates were 87.9%, 66.7%, and 54.5%, respectively. The 5-year OS after PMx was 50.0% and 52.4% (p=0.67) in Groups A and B, respectively, and the log-rank test (p=0.88) was not significant. Conclusions: When technically feasible, VATS should be the technique of choice for PMx to treat patients with solitary LM form CRC. This technique is less aggressive and allows for the same results as open surgery.
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