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Vol. 54. Num. 4.April 2018
Pages 175-240
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Vol. 54. Num. 4.April 2018
Pages 175-240
Original Article
DOI: 10.1016/j.arbres.2017.10.003
Combined Hepatic and Pulmonary Metastasectomies From Colorectal Carcinoma. Data From the Prospective Spanish Registry 2008–2010
Metastasectomías hepáticas y pulmonares combinadas de carcinoma colorrectal. Datos del registro prospectivo español 2008-2010
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Jose R. Jaraboa,
Corresponding author
jrjarabo@hotmail.com

Corresponding author.
, Ana M. Gómeza, Joaquín Calatayuda, Carlos A. Frailea, Elena Fernándeza, Nuria Pajuelob, Raul Embúnc, Laureano Molinsd, Juan J. Rivasc, Florentino Hernandoa, on behalf of the Spanish Group of Lung Metastases of Colo-Rectal Cancer of the Spanish Society of Pneumology and Thoracic Surgery (GECMP-CCR-SEPAR)
a Department of Thoracic Surgery, Hospital Clinico San Carlos, Madrid, Spain
b Department of Biostatistics and Data Management, Dynamic Solutions, Barcelona, Spain
c Department of Thoracic Surgery, Hospital Miguel Servet, Zaragoza, Spain
d Department of Thoracic Surgery, Hospital Universitari Sagrat Cor, Barcelona, Spain
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Tables (6)
Table 1. Characteristics of Patients With Combined Resections. Comparison to the Remaining Patients of the Registry.
Table 2. Number of Liver Metastases and Treatment Regarding Pattern of Appearance.
Table 3. Survival analysis of three cohorts: no liver involvement, resected liver metastases and non-resected liver metastases. In pairs comparison between groups using log-rank test.
Table 4. Intervals Between CRC Surgery and First PM.
Table 5. Univariant Analysis of Potential Prognostic Factors.
Table 6. Multivariant Analysis.
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Abstract
Introduction

Resection of both liver and lung metastases from colorectal carcinoma (CRC) is a standard of care in selected patients with oligometastatic disease. We present here the analysis of the subgroup of patients undergoing combined surgery from the Spanish Group of Surgery of Pulmonary Metastases (PM) from Colorectal Carcinoma (GECMP-CCR-SEPAR).

Methods

We analyze characteristics, survival and prognostic factors of patients undergoing combined resection from March-2008 to February-2010 and followed-up during at least 3 years, from the prospective multicenter Spanish Registry.

Results

A total of 138 patients from a whole series of 543 cases from 32 thoracic surgery units underwent both procedures. Seventy-seven (43.8%) resected liver metastases were synchronic with colorectal tumor. Median disease specific survival (DSS) from first pulmonary metastasectomy was 48.9 months, being three and 5-year DSS 65.1% and 41.7%, respectively. From CRC-surgery median DSS was 97.2 months, with 3 and 5-year DSS rates of 96.7% and 77%, respectively. Five-year DSS from pulmonary metastasectomy was 41.7% for patients with combined resection and 52.4% for those without hepatic involvement (P=.04). Differences disappeared when considering DSS from colorectal surgery. Carcinoembrionary antigen (CEA) before lung surgery over 10mg/dl and bilateral PM were independent prognostic factors for survival (hazard ratio 2.4 and 2.5, respectively).

Conclusions

Patients with resection of PM of CRC with history of resected hepatic metastases presented significantly lower disease specific survival rates than those undergoing pulmonary metastasectomy alone. CEA before lung surgery and bilateral PM associated worse prognosis.

Keywords:
Colorectal carcinoma
Lung
Liver
Metastasectomy
Survival
Resumen
Introducción

La resección de metástasis hepáticas y pulmonares del carcinoma colorrectal (CCR) es un tratamiento estándar para determinados pacientes con enfermedad oligometastásica. Presentamos el análisis del subgrupo de pacientes sometidos a cirugía combinada del Grupo Español de Cirugía de Metástasis Pulmonares (MP) de Carcinoma Colorrectal (GECMP-CCR-SEPAR).

Métodos

Analizamos las características, la supervivencia y los factores pronósticos de los pacientes sometidos a resección combinada desde marzo de 2008 a febrero de 2010, con seguimiento durante al menos 3 años en el Registro Español, prospectivo y multicéntrico.

Resultados

Se sometieron a ambos procedimientos 138 pacientes de una serie completa de 543 casos, procedentes de 32 unidades de cirugía torácica. Setenta y siete (43,8%) de las metástasis hepáticas resecadas eran sincrónicas al tumor colorrectal. La mediana de la supervivencia específica para la enfermedad (SEE) desde la primera metastasectomía pulmonar fue de 48,9 meses; las SEE a 3 y 5 años fueron del 65,1 y 41,7%, respectivamente. La mediana de la SEE desde la cirugía del CCR fue de 97,2 meses, con tasas de la SEE a 3 y 5 años del 96,7 y 77%, respectivamente. Las SEE a 5 años de la metastasectomía pulmonar fueron del 41,7% para los pacientes con resección combinada y del 52,4% para aquellos sin afectación hepática (p=0,04). Las diferencias desaparecieron cuando se tenía en cuenta la SEE desde la cirugía colorrectal. Tener un nivel de antígeno carcinoembrionario (ACE) por encima de 10mg/dl antes de la cirugía pulmonar y la presencia bilateral de MP fueron factores pronósticos independientes para la supervivencia (odds ratio: 2,4 y 2,5, respectivamente).

Conclusiones

Los pacientes con resección de MP de CCR con antecedentes de metástasis hepáticas resecadas presentaron tasas de SEE significativamente más bajas que aquellos sometidos a metastasectomía pulmonar sola. El ACE antes de la cirugía pulmonar y la presencia de MP bilaterales se asociaron a peor pronóstico.

Palabras clave:
Carcinoma colorrectal
Pulmón
Hígado
Metastasectomía
Supervivencia

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