Incidence of Ipsilateral Side Recurrence After Open or Video-Assisted Thoracic Surgery Resection of Colorectal Lung Metastases.

BACKGROUND: There is still controversy whether full lung palpation is required for patients undergoing pulmonary metastasectomy. We aimed to compare pulmonary ipsilateral recurrence (IR) after video-assisted thoracic surgery (VATS) or open surgery. METHODS: A retrospective study of all patients who underwent surgery for colorectal cancer lung metastases between 2003 and 2012 was performed. IR rate was compared between the 2 groups after adjusting for a propensity score matching based on age, sex, disease-free interval, number of metastases, type of resection, presence of a cardiovascular risk factor, presence of a respiratory risk factor, as well as the interaction between the number of metastases and the disease-free interval. The propensity score was used for matched and weighted comparisons of VATS and open patients. RESULTS: A total of 211 patients underwent surgery for colorectal cancer lung metastases. Of these, 75 (35.5%) were performed via VATS and 136 (64.5%) via open surgery. Before matching, 118 (55.9%) were male and the median age at the time of metastases diagnosis was 61 (range, 49.8-72.2) years. Median disease free-interval was 20 (19.7 ± 28.3) months; 22 (21.6 ± 28.5) months in VATS and 19 (19.0 ± 28.3) months in open surgery. In total, 19 (25.3%) developed IR in VATS, and 39 (28.7%) in open surgery. Five-year overall survival was 53.1% (61.9% VATS; 49.2% open). In the matched sample, IR was 23.6% in VATS vs 26.2% in open surgery (95% confidence interval for risk reduction with VATS: -22.6% to 17.5%; P = .80). CONCLUSIONS: No significant difference was observed in IR rates between VATS and open surgery in the treatment of colorectal cancer lung metastases.

Factores pronóstico de las metástasis pulmonares de cáncer colorrectal / Prognostic factors of colorectal cancer lung metastases

lntroducción carcinoma colorrectal es la tercera neoplasia más frecuente y la segunda causa de muerte por cáncer en los países desarrollados. Aproximadamente el 10% de los pacientes con este diagnóstico desarrollan metástasis pulmonares, Si bien solo el 2-4% de ellos tienen metástasis pulmonares como única localización de recidiva. Objetivo Estudio de los factores pronóstico de las metástasis pulmonares de carcinoma colorrectal. Pacientes y métodos Estudio observacional retrospectivo de 30 pacientes afectos de metástasis pulmonares de carcinoma colorrectal intervenidos quirúrgicamente en nuestro centro desde enero de 2003 hasta diciembre de 2007.ResultadosSe intervinieron un total de 30 pacientes, 19 varones (63%) y 11 mujeres (37%) con una edad media de 63,37 años (intervalo 35-82 años). La supervivencia global media fue de 36,64 meses (intervalo 18,58-54,70 meses).Para el análisis estadístico se consideraron 13 parámetros, tanto preoperatorios como intra- y postoperatorios. En el análisis univariante, el número de metástasis superior a 3 (p=0,051), la bilateralidad (p=0,001) y la bilobularidad (p<0,001) fueron factores de mal pronóstico estadísticamente significativos. En el análisis multivariante, solo la bilobularidad demostró ser un factor de mal pronóstico estadísticamente significativo (p=0,005). Conclusiones En nuestra serie de pacientes afectos de metástasis pulmonares de carcinoma colorrectal, el número de metástasis superior a tres, la bilobularidad y la bilateralidad resultaron factores de mal pronóstico. Dichos factores deben tenerse en cuenta en el seguimiento de estos pacientes, aunque se necesitan estudios prospectivos con mayor número de casos para confirmar dichos hallazgos (AU)

Introduction Colorectal cancer is the third most common neoplasia and the second cause of death due to cancer in developed countries. Approximately 10% of patients with this diagnosis develop lung metastases, although only 2-4% of them have lung metastases as the only extension location. Objective To study the prognostic factors of colorectal cancer lung metastases. Patients and methods A retrospective observational study was conducted on 30 patients with colorectal cancer lung metastases who were operated on in our hospital between January 2003 and December 2007.ResultsOf the 30 patients who received surgery, 19 were males (63%) and 11 were female (37%), with a mean age of 63.37 years (range 35-82 years). The mean overall survival was 36.64 months (range 18.58-54.70 months).A total of 13 pre-, intra-, and postoperative parameters were used in the statistical analysis. In the univariate analysis, the number of metastases greater than 3 (P=.051), whether they were bilateral (P=.001), or bilobar (P<.001), were statistically significant factors of a poor prognosis. In the multivariate analysis, only being bilobar was shown to be a statistically significant factor of a poor prognosis (P=.005).Conclusions In our patient series affected by colorectal carcinoma lung metastases, the number of metastases greater than three, whether they are bilobar and bilateral, are factors of a poor prognosis. These factors should be taken into account in the follow-up of these patients, although prospective studies with a larger number of patients are required to confirm these findings (AU)

[Prognostic factors of colorectal cancer lung metastases]. / Factores pronóstico de las metástasis pulmonares de cáncer colorrectal.

INTRODUCTION: Colorectal cancer is the third most common neoplasia and the second cause of death due to cancer in developed countries. Approximately 10% of patients with this diagnosis develop lung metastases, although only 2-4% of them have lung metastases as the only extension location. OBJECTIVE: To study the prognostic factors of colorectal cancer lung metastases. PATIENTS AND METHODS: A retrospective observational study was conducted on 30 patients with colorectal cancer lung metastases who were operated on in our hospital between January 2003 and December 2007. RESULTS: Of the 30 patients who received surgery, 19 were males (63%) and 11 were female (37%), with a mean age of 63.37 years (range 35-82 years). The mean overall survival was 36.64 months (range 18.58-54.70 months). A total of 13 pre-, intra-, and postoperative parameters were used in the statistical analysis. In the univariate analysis, the number of metastases greater than 3 (P=.051), whether they were bilateral (P=.001), or bilobar (P<.001), were statistically significant factors of a poor prognosis. In the multivariate analysis, only being bilobar was shown to be a statistically significant factor of a poor prognosis (P=.005). CONCLUSIONS: In our patient series affected by colorectal carcinoma lung metastases, the number of metastases greater than three, whether they are bilobar and bilateral, are factors of a poor prognosis. These factors should be taken into account in the follow-up of these patients, although prospective studies with a larger number of patients are required to confirm these findings.

[Surgery of lung metastases]. / Cirugía de las metástasis pulmonares.

The aim of surgical treatment of lung metastases is to eliminate all known tumoral disease. After a clinical diagnosis of lung metastases, the criteria for selecting patients who are candidates for surgical treatment, the route of access to the thoracic cavity and the technique for metastases resection are not universally defined. Moreover, half of all patients will show recurrence and the advisability of further surgery will have to be reconsidered. The present article discusses aspects related to the oncological and functional limits of surgical resection of lung metastases, preoperative workup, postoperative follow-up, and the surgical approaches and resection techniques.

Cirugía de las metástasis pulmonares / Surgery of lung metastases

El tratamiento quirúrgico de las metástasis pulmonares tiene como objetivo la eliminación de toda la enfermedadtumoral conocida. Una vez establecido el diagnóstico clínico de metástasis pulmonar, los criterios deselección de los pacientes candidatos a tratamiento quirúrgico, la vía de acceso a la cavidad torácica y la técnicade resección de las metástasis no están universalmente definidos. Además, la mitad de los enfermospresentará una recidiva y de nuevo se planteará la idoneidad de un nuevo tratamiento quirúrgico. En el presenteartículo se discuten aspectos relacionados con los límites oncológicos y funcionales de la cirugía de resecciónde las metástasis pulmonares, el estudio preoperatorio, el seguimiento postoperatorio de los pacientes,las vías de abordaje quirúrgico y las técnicas de resección(AU)

The aim of surgical treatment of lung metastases is to eliminate all known tumoral disease. After a clinicaldiagnosis of lung metastases, the criteria for selecting patients who are candidates for surgical treatment, theroute of access to the thoracic cavity and the technique for metastases resection are not universally defined.Moreover, half of all patients will show recurrence and the advisability of further surgery will have to bereconsidered. The present article discusses aspects related to the oncological and functional limits of surgicalresection of lung metastases, preoperative workup, postoperative follow-up, and the surgical approaches andresection techniques(AU)