Repeat pulmonary resection satisfactory for metastatic CRC
MedWire News: Repeating pulmonary resection in colorectal cancer (CRC) patients results in no major operative morbidity or mortality and gives satisfactory survival outcomes, report Japanese researchers.
Their study findings also show that the prognostic factors for first and repeat pulmonary resection differ, with prethoracotomy serum carcinoembryonic antigen (CEA) levels and the primary CRC type predicting survival after the first, but not the repeat resection.
"Surgery remains the best treatment for patients with pulmonary metastases from CRC if potentially curative resection is expected," say Ryu Kanzaki, from Osaka Medical Center for Cancer and Cardiovascular Diseases, and colleagues.
"However, the outcomes after repeat pulmonary resection for CRC and the factors associated with the prognosis of these patients remain uncharacterized," they add.
To investigate, the team reviewed data for 156 CRC patients treated with pulmonary resection between 1980 and 2008. Patients were aged a mean of 62 years at first resection, and 25 patients underwent repeat resection.
The median time between the first pulmonary resection and the latest follow-up examination, or death, was 43 months, with no major operative morbidity or mortality observed. A total of 93 patients developed recurrence after the first resection.
Cumulative 3- and 5-year survival rates after the first resection were 71.4% and 56.2%, respectively, report the researchers in the American Journal of Surgery.
Analysis revealed significant relationships between survival after the first resection and the histology of the tumor (well/moderately differentiated vs other/unknown), prethoracotomy serum CEA levels (<5 vs ≥5 ml), maximum tumor size (≤30 vs >30 ml), the type of resection (sublobular vs lobectomy or pneumonectomy), and presence of hilar or mediastinal lymph node metastasis (yes vs no).
Among the repeat pulmonary resection patients, 3- and 5-year survival rates were a respective 54.1% and 42.1%, and the median time to latest follow-up or death was 20 months, report Kanzaki et al.
No major operative morbidity or mortality was noted after the repeated procedure, they note.
"These findings indicated that repeat pulmonary resection for metastatic CRC patients is a safe procedure that provides satisfactory patient outcomes," write the authors.
In contrast to first pulmonary resection, the only significant associations found between repeat resection and survival were the presence of hilar or mediastinal lymph node metastasis.
Based on this result, the researchers suggest that repeat pulmonary resection for metastatic CRC patients with lymph node involvement should be avoided.
"Aggressive repeat resection is justified for carefully selected patients," they conclude.
By Sarah Guy