Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer
Tóm tắt
Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The aim of this study is to evaluate the overall (OS) and relapse-free survival (RFS) rates of these patients after resection with curative intent. This study is a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent between May 1st, 2002, to December 31st, 2016, at our institution. Colon was the primary tumour site in 2 patients and rectum in 6 patients. The median number of liver and lung metastases was 3 and 2, respectively. Patients received various treatment sequences individualized on tumour disease burden. R0 resection was achieved after all but one procedure. Two severe Clavien-Dindo grade IIIb complications were present. Median hospital stay was 9 (3–24) days per procedure. Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months. Our data suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.
Tài liệu tham khảo
Riihimaki M, Hemminki A, Sundquist J et al (2016) Patterns of metastasis in colon and rectal cancer. Sci Rep 6:29765. https://doi.org/10.1038/srep29765
Nordholm-Carstensen A, Krarup PM, Jorgensen LN, Wille-Jørgensen PA, Harling H, Danish Colorectal Cancer Group (2014) Danish Colorectal Cancer Group. Occurrence and survival of synchronous pulmonary metastases in colorectal cancer: a nationwide cohort study. Eur J Cancer 50:447–456. https://doi.org/10.1016/j.ejca.2013.10.009
Adam R, de Gramont A, Figueras J, Kokudo N, Kunstlinger F, Loyer E, Poston G, Rougier P, Rubbia-Brandt L, Sobrero A, Teh C, Tejpar S, van Cutsem E, Vauthey JN, Påhlman L, of the EGOSLIM (Expert Group on OncoSurgery management of LIver Metastases) group (2015) Managing synchronous liver metastases from colorectal cancer: a multidisciplinary international consensus. Cancer Treat Rev 41:729–741. https://doi.org/10.1016/j.ctrv.2015.06.006
Kumar R, Price TJ, Beeke C, Jain K, Patel G, Padbury R, Young GP, Roder D, Townsend A, Bishnoi S, Karapetis CS (2014) Colorectal cancer survival: an analysis of patients with metastatic disease synchronous and metachronous with the primary tumor. Clin Colorectal Cancer 13:87–93. https://doi.org/10.1016/j.clcc.2013.11.008
Kim HK, Cho JH, Lee HY, Lee J, Kim J (2014) Pulmonary metastasectomy for colorectal cancer: how many nodules, how many times? World J Gastroenterol 20:6133–6145. https://doi.org/10.3748/wjg.v20.i20.6133
Pfannschmidt J, Dienemann H, Hoffmann H (2007) Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg 84:324–338. https://doi.org/10.1016/j.athoracsur.2007.02.093
Rajakannu M, Magdeleinat P, Vibert E, Ciacio O, Pittau G, Innominato P, SaCunha A, Cherqui D, Morère JF, Castaing D, Adam R (2018) Is cure possible after sequential resection of hepatic and pulmonary metastases from colorectal cancer? Clin Colorectal Cancer 17:41–49. https://doi.org/10.1016/j.clcc.2017.06.006
Fong Y, Fortner J, Sun RL, Brennan MF, Blumgart LH (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318; discussion 18-21. https://doi.org/10.1097/00000658-199909000-00004
Sourrouille I, Mordant P, Maggiori L, Dokmak S, Lesèche G, Panis Y, Belghiti J, Castier Y (2013) Long-term survival after hepatic and pulmonary resection of colorectal cancer metastases. J Surg Oncol 108:220–224. https://doi.org/10.1002/jso.23385
Andres A, Mentha G, Adam R, Gerstel E, Skipenko OG, Barroso E, Lopez-Ben S, Hubert C, Majno PE, Toso C (2015) Surgical management of patients with colorectal cancer and simultaneous liver and lung metastases. Br J Surg 102:691–699. https://doi.org/10.1002/bjs.9783
Miller G, Biernacki P, Kemeny NE, Gonen M, Downey R, Jarnagin WR, D’Angelica M, Fong Y, Blumgart LH, DeMatteo RP (2007) Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 205:231–238. https://doi.org/10.1016/j.jamcollsurg.2007.04.039
Barlow AD, Nakas A, Pattenden C, Martin-Ucar AE, Dennison AR, Berry DP, Lloyd DM, Robertson GS, Waller DA (2009) Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases. Eur J Surg Oncol 35:307–312. https://doi.org/10.1016/j.ejso.2008.06.012
Punt CJ, Buyse M, Hohenberger P et al (2007) Endpoints in adjuvant treatment trials: a systematic review of the literature in colon cancer and proposed definitions for future trials. J Natl Cancer Inst 99:998–1003. https://doi.org/10.1093/jnci/djm024
Tsai MS, Su YH, Ho MC, Liang JT, Chen TP, Lai HS, Lee PH (2007) Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis. Ann Surg Oncol 14:786–794. https://doi.org/10.1245/s10434-006-9215-5
Zheng P, Ren L, Feng Q, Zhu D, Chang W, He G, Ji M, Jian M, Lin Q, Yi T, Wei Y, Xu J (2018) Differences in clinical characteristics and mutational pattern between synchronous and metachronous colorectal liver metastases. Cancer Manag Res 10:2871–2881. https://doi.org/10.2147/CMAR.S161392
Manfredi S, Lepage C, Hatem C et al (2006) Epidemiology and management of liver metastases from colorectal cancer. Ann Surg 244:254–259. https://doi.org/10.1097/01.sla.0000217629.94941.cf
Reding D, Pestalozzi BC, Breitenstein S, Stupp R, Clavien PA, Slankamenac K, Samaras P (2017) Treatment strategies and outcome of surgery for synchronous colorectal liver metastases. Swiss Med Wkly 147:w14486. https://doi.org/10.4414/smw.2017.14486
Mise Y, Kopetz S, Mehran RJ, Aloia TA, Conrad C, Brudvik KW, Taggart MW, Vauthey JN (2015) Is complete liver resection without resection of synchronous lung metastases justified? Ann Surg Oncol 22:1585–1592. https://doi.org/10.1245/s10434-014-4207-3
Noren A, Eriksson HG, Olsson LI (2016) Selection for surgery and survival of synchronous colorectal liver metastases; a nationwide study. Eur J Cancer 53:105–114. https://doi.org/10.1016/j.ejca.2015.10.055
Siegel RL, Miller KD, Fedewa SA, Ahnen DJ, Meester RGS, Barzi A, Jemal A (2017) Colorectal cancer statistics, 2017. CA Cancer J Clin 67:7–30. https://doi.org/10.3322/caac.21395
Noone AM, Howlader N, Krapcho M et al. SEER Cancer Statistics Review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018.
Heinemann V, von Weikersthal LF, Decker T, Kiani A, Vehling-Kaiser U, al-Batran SE, Heintges T, Lerchenmüller C, Kahl C, Seipelt G, Kullmann F, Stauch M, Scheithauer W, Hielscher J, Scholz M, Müller S, Link H, Niederle N, Rost A, Höffkes HG, Moehler M, Lindig RU, Modest DP, Rossius L, Kirchner T, Jung A, Stintzing S (2014) FOLFIRI plus cetuximab versus FOLFIRI plus bevacizumab as first-line treatment for patients with metastatic colorectal cancer (FIRE-3): a randomised, open-label, phase 3 trial. Lancet Oncol 15:1065–1075. https://doi.org/10.1016/S1470-2045(14)70330-4
Dexiang Z, Li R, Ye W, Haifu W, Yunshi Z, Qinghai Y, Shenyong Z, Bo X, Li L, Xiangou P, Haohao L, Lechi Y, Tianshu L, Jia F, Xinyu Q, Jianmin X (2012) Outcome of patients with colorectal liver metastasis: analysis of 1,613 consecutive cases. Ann Surg Oncol 19:2860–2868. https://doi.org/10.1245/s10434-012-2356-9
Spelt L, Andersson B, Nilsson J, Andersson R (2012) Prognostic models for outcome following liver resection for colorectal cancer metastases: a systematic review. Eur J Surg Oncol 38:16–24. https://doi.org/10.1016/j.ejso.2011.10.013
Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D, Association Française de Chirurgie (1996) Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie Cancer 77:1254–1262. https://doi.org/10.1002/(SICI)1097-0142(19960401)77:7<1254::AID-CNCR5>3.0.CO;2-I
Adam R, de Haas RJ, Wicherts DA, Vibert E, Salloum C, Azoulay D, Castaing D (2011) Concomitant extrahepatic disease in patients with colorectal liver metastases: when is there a place for surgery? Ann Surg 253:349–359. https://doi.org/10.1097/SLA.0b013e318207bf2c