Isabelle Moneke1,2,3, Friederike Funcke1,2, Severin Schmid1,2, Thomas Osei-Agyemang1,2, Bernward Passlick1,2,4. 1. Department of Thoracic Surgery, Medical Center - University of Freiburg, Freiburg, Germany. 2. Faculty of Medicine, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany. 3. Division of Cancer Research, Department of Thoracic Surgery, University of Freiburg, Freiburg, Germany. 4. German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
Abstract
BACKGROUND: Pulmonary metastases develop in 10-15% of patients with colorectal cancer. Surgical metastasectomy currently provides the only hope for a cure for these patients. The aim of this study was to analyze the expanding role of pulmonary metastasectomy in the context of laser-assisted surgery (LAS) vs. non-laser-assisted surgery (NLAS). METHODS: We performed a single-center retrospective analysis of 204 patients who underwent curative pulmonary metastasectomy for colorectal cancer between 01/2005 and 12/2016. The main endpoint was survival. The Kaplan-Meier method was applied for statistical analysis and survival rates were compared with the log rank test. RESULTS: Median follow-up was 53 months. A total of 267 metastases were resected in 154 operations in the NLAS group (median: 1) vs. 438 metastases in 122 operations in the LAS group (median: 5; P<0.0001). The interval between treatment of the primary tumor and the first pulmonary metastasectomy was significantly shorter in the LAS group (19 vs. 32 months; P=0.008). Anatomical resections were significantly reduced using LAS, 8% vs. 23% respectively. Despite more negative predictors in the LAS group, there was no statistically significant difference in overall disease-specific 5-year survival (70% LAS vs. 58% NLAS; P=0.18). CONCLUSIONS: Survival after pulmonary metastasectomy has previously been shown to correlate with a low number of metastases and a longer disease-free interval. However, with the tissue-saving LAS technique complete resectability can be achieved in patients with more metastases and long-term survival is possible for selected patients.
BACKGROUND: Pulmonary metastases develop in 10-15% of patients with colorectal cancer. Surgical metastasectomy currently provides the only hope for a cure for these patients. The aim of this study was to analyze the expanding role of pulmonary metastasectomy in the context of laser-assisted surgery (LAS) vs. non-laser-assisted surgery (NLAS). METHODS: We performed a single-center retrospective analysis of 204 patients who underwent curative pulmonary metastasectomy for colorectal cancer between 01/2005 and 12/2016. The main endpoint was survival. The Kaplan-Meier method was applied for statistical analysis and survival rates were compared with the log rank test. RESULTS: Median follow-up was 53 months. A total of 267 metastases were resected in 154 operations in the NLAS group (median: 1) vs. 438 metastases in 122 operations in the LAS group (median: 5; P<0.0001). The interval between treatment of the primary tumor and the first pulmonary metastasectomy was significantly shorter in the LAS group (19 vs. 32 months; P=0.008). Anatomical resections were significantly reduced using LAS, 8% vs. 23% respectively. Despite more negative predictors in the LAS group, there was no statistically significant difference in overall disease-specific 5-year survival (70% LAS vs. 58% NLAS; P=0.18). CONCLUSIONS: Survival after pulmonary metastasectomy has previously been shown to correlate with a low number of metastases and a longer disease-free interval. However, with the tissue-saving LAS technique complete resectability can be achieved in patients with more metastases and long-term survival is possible for selected patients.
Entities:
Keywords:
Pulmonary metastasectomy; colorectal cancer; laser-assisted surgery (LAS); survival
Authors: E L A R Mutsaerts; F A N Zoetmulder; S Meijer; P Baas; A A M Hart; E J Th Rutgers Journal: Eur J Surg Oncol Date: 2002-12 Impact factor: 4.424
Authors: Joachim Pfannschmidt; Joachim Klode; Thomas Muley; Hendrik Dienemann; Hans Hoffmann Journal: Ann Thorac Surg Date: 2006-02 Impact factor: 4.330
Authors: Hannes Neeff; Wolfram Hörth; Frank Makowiec; Eva Fischer; Andreas Imdahl; Ulrich T Hopt; Bernward Passlick Journal: J Gastrointest Surg Date: 2009-07-11 Impact factor: 3.452
Authors: Joachim Pfannschmidt; Gerlinde Egerer; Marc Bischof; Michael Thomas; Hendrik Dienemann Journal: Dtsch Arztebl Int Date: 2012-10-05 Impact factor: 5.594
Authors: Michel Gonzalez; Antoine Poncet; Christophe Combescure; John Robert; Hans Beat Ris; Pascal Gervaz Journal: Ann Surg Oncol Date: 2012-10-28 Impact factor: 5.344