Top

Published in:

01-03-2022 | Metastasis | Original Article

Clinical outcomes following colorectal resection of colorectal cancer with simultaneous hepatic and pulmonary metastases at the time of diagnosis

Authors: Yusuke Tanaka, Yusuke Yamaoka, Akio Shiomi, Hiroyasu Kagawa, Hitoshi Hino, Shoichi Manabe, Kai Chen, Kenji Nanishi, Akifumi Notsu

Published in: Langenbeck's Archives of Surgery | Issue 2/2022

Abstract

Purpose

There are no established treatment strategies for patients with hepatic and pulmonary metastases at the time of primary colorectal cancer (CRC) diagnosis. This study assessed patients undergoing complete resection of primary CRC and hepatic and pulmonary metastases, to evaluate long-term outcomes and clarify clinicopathological factors associated with failure of complete resection.

Methods

This retrospective analysis enrolled patients at Shizuoka Cancer Center between 2002 and 2018 who underwent colorectal resection with curative intent for primary CRC with hepatic and pulmonary metastases. The curative resection (CR) group comprised patients who underwent complete resection of the primary tumor and metastatic lesions, and the non-curative resection (Non-CR) group consisted of those in whom resection of the metastatic lesions was not performed. Univariate and multivariate analyses were conducted to determine clinicopathological factors associated with non-curative resection.

Results

Of 26 total patients, the CR and Non-CR groups consisted of 14 (54%) and 12 patients (46%), respectively. In the CR group, the 3-year overall and relapse-free survival rates were 92.9% and 28.6%, respectively. Multivariate analysis showed that pathological stage T4 (odds ratio 8.58, 95% confidence interval 1.13–65.20, p = 0.04) was independently associated with non-curative resection.

Conclusion

The percentage of patients undergoing complete resection of primary CRC and metastatic lesions was 56%, and the 3-year OS rate was 92.9%. Resection of primary CRC and metastatic lesions was considered to be appropriate in this population, and pathological stage T4 tumor was associated with incomplete resection of metastatic tumors.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Bray JA, F, (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492CrossRef

Riihimaki M, Hemminki A, Sundquist J, Hemminki K (2016) Patterns of metastasis in colon and rectal cancer. Sci Rep 6:29765. https://doi.org/10.1038/srep29765CrossRefPubMedPubMedCentral

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 simultaneous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg 205:231–238. https://doi.org/10.1016/j.jamcollsurg.2007.04.039CrossRefPubMed

Jeong S, Heo JS, Park JY, Choi DW, Choi SH (2017) Surgical resection of simultaneous and metachronous pulmonary and hepatic metastases of colorectal cancers. Ann Surg Treat Res 92:82. https://doi.org/10.4174/astr.2017.92.2.82CrossRefPubMedPubMedCentral

Zizzo M, Galeone C, Braglia L, Ugoletti L, Siciliani A, Nachira D, Margaritora S, Pedrazzoli C, Paci M, Lococo F (2020) Long-term outcomes after surgical resection for simultaneous or metachronous hepatic and pulmonary colorectal cancer metastases. Digestion 101:144–155. https://doi.org/10.1159/000497223CrossRefPubMed

Benson AB, Venook AP, Al-Hawary MM, Cederquist L, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Engstrom PF, Garrido-Laguna I, Grem JL, Grothey A, Hochster HS, Hoffe S, Hunt S, Kamel A, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Murphy JD, Nurkin S, Saltz L, Sharma S, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Wuthrick E, Gregory KM, Freedman-Cass DA (2018) NCCN guidelines insights: colon cancer, version 2.2018. J Natl Compr Cancer Netw 16:359–369. https://doi.org/10.6004/jnccn.2018.0021CrossRef

Benson AB, Venook AP, Arain A-H, MA, Chen YJ, Ciombor KK, Cohen S, Cooper HS, Deming D, Garrido-Laguna I, Grem JL, Gunn A, Hoffe S, Hubbard J, Hunt S, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Nurkin S, Overman MJ, Parikh A, Patel H, Pedersen K, Saltz L, Schneider C, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Johnson-Chilla A, Gurski LA, (2020) NCCN guidelines insights: rectal cancer, version 6.2020. J Natl Compr Cancer Netw 18:806–815. https://doi.org/10.6004/jnccn.2020.0032CrossRef

Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguch S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K (2020) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42. https://doi.org/10.1007/s10147-019-01485-zCrossRefPubMed

Robinson BJ, Rice TW, Strong SA, Rybicki LA, Blackstone EH, Allen MS, Kaiser LS, Odell JA (1999) Is resection of pulmonary and hepatic metastases warranted in patients with colorectal cancer? J Thorac Cardiovasc Surg 117:66–76. https://doi.org/10.1016/S0022-5223(99)70470-8CrossRefPubMed

10.

Kobayashi K, Kawamura M, Ishihara T (1999) Surgical treatment for both pulmonary and hepatic metastases from colorectal cancer. J Thorac Cardiovasc Surg 118:1090–1096. https://doi.org/10.1016/S0022-5223(99)70106-6CrossRefPubMed

11.

Headrick JR, Miller DL, Nagorney DM, Allen MS, Deschamps C, Trastek VF, Pairolero PC (2001) Surgical treatment of hepatic and pulmonary metastases from colon cancer. Ann Thorac Surg 71:975–980. https://doi.org/10.1016/S0003-4975(00)02522-4CrossRefPubMed

12.

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.2008.06.012CrossRefPubMed

13.

Brouquet A, Vauthey JN, Contreras CM, Walsh GL, Vaporciyan AA, Swisher SG, Curley SA, Mehran RJ, Acdalla EK (2011) Improved survival after resection of hepatic and pulmonary colorectal metastases compared with hepatic-only metastases: a study of 112 patients with limited pulmonary metastatic disease. J Am Coll Surg 213:62–69. https://doi.org/10.1016/j.jamcollsurg.2010.02.039CrossRefPubMed

14.

Marín C, Robles R, López Conesa A, Torres J, Flores DP, Parrilla P (2013) Outcome of strict patient selection for surgical treatment of hepatic and pulmonary metastases from colorectal cancer. Dis Colon Rectum 56:43–50. https://doi.org/10.1097/DCR.0b013e3182739f5eCrossRefPubMed

15.

Schüle S, Dittmar Y, Knösel T, Krieg P, Albrecht R, Settmacher U, Altendor HA (2013) Long-term results and prognostic factors after resection of hepatic and pulmonary metastases of colorectal cancer. Int J Colorectal Dis 28:537–545. https://doi.org/10.1007/s00384-012-1553-0CrossRefPubMed

16.

Tsukamoto S, Kinugasa Y, Yamaguchi T, Shiomi A (2014) Survival after resection of hepatic and pulmonary colorectal metastases in the era of modern multidisciplinary therapy. Int J Colorectal Dis 29:81–87. https://doi.org/10.1007/s00384-013-1752-3CrossRefPubMed

17.

Bellier J, De Wolf J, Hebbar M, El AM, Desauw C, Leteurtre E, Pruvot FR, Porte H, Truant S (2018) Repeated resections of hepatic and pulmonary metastases from colorectal cancer provide long-term survival. World J Surg 42:1171–1179. https://doi.org/10.1007/s00384-013-1752-3CrossRefPubMed

18.

Brierly JD, Gopodarowicz MK, CW, Wittekind C, (2017) TNM classification of malignant tumours, 8th edn. Wiley-Blackwell, Oxford

19.

Limmer S, Oevermann E, Killaitis C, Kujath P, Hoffmann M, Bruch HP (2010) Sequential surgical resection of hepatic and pulmonary metastases from colorectal cancer. Langenbeck’s Arch Surg 395:1129–1138. https://doi.org/10.1007/s00423-010-0595-4CrossRef

20.

Andres A, Mentha G, Adam R, Gerstel E, Skipenko OG, Barroso E, Lopez BS, Hubert C, Majno PE, Tosos C (2015) Surgical management of patients with colorectal cancer and simultaneous hepatic and pulmonary metastases. Br J Surg 102:691–699. https://doi.org/10.1002/bjs.9783CrossRefPubMed

21.

Kanemitsu Y, Shitara K, Mizusawa J, Hamaguchi T, Shida D, Komori K, Ikeda S, Ojima H, Ike H, Shiomi A, Watanabe J, Takii Y, Yamaguchi T, Katsumata K, Ito M, Okuda J, Hyakudomi R, Shimada Y, Katayama H, Fukuda H (2021) Primary tumor resection plus chemotherapy versus chemotherapy alone for colorectal cancer patients with asymptomatic, simultaneous unresectable metastases (JCOG1007; iPACS): a randomized clinical trial. J Clin Oncol 39:1098–1107. https://doi.org/10.1200/JCO.20.02447CrossRefPubMed

22.

Van Cutsem E, Cervantes A, Adam R, Sobrero A, Van Krieken JH, Aderka D, Aranda Aguilar E, Bardelli A, Benson A, Bodoky G, Ciardiello F, D’Hoore A, Diaz-Rubio E, Douillard JY, Ducreux M, Falcone A, Grothey A, Gruenberger T, Haustermans K, Heinemann V, Hoff P, Köhne CH, Labianca R, Laurent-Puig P, Ma B, Maughan T, Muro K, Normanno N, Österlund P, Oyen WJG, Papamichael D, Pentheroudakis G, Pfeiffer P, Price TJ, Punt C, Ricke J, Roth A, Salazar R, Scheithauer W, Schmoll HJ, Tabernero J, Taïeb J, Tejpar S, Wasan H, Yoshino T, Zaanan A, Arnold D (2016) ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 27:1386–1422. https://doi.org/10.1093/annonc/mdw235CrossRefPubMed

23.

Reissfelder C, Brand K, Sobiegalla J, Rahbari NN, Bork U, Schirmacher P, Büchler MW, Weitz J, Koch M (2014) Chemotherapy-associated liver injury and its influence on outcome after resection of colorectal liver metastases. Surgery 155:245–254. https://doi.org/10.1016/j.surg.2013.07.022CrossRefPubMed

24.

Seymour MT, Morton D (2019) FOxTROT: an international randomised controlled trial in 1052 patients (pts) evaluating neoadjuvant chemotherapy (NAC) for colon cancer. J Clin Oncol 37:3504–3504. https://doi.org/10.1200/jco.2019.37.15_suppl.3504CrossRef

25.

Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW, van de Velde CJ (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646. https://doi.org/10.1056/nejmoa010580CrossRefPubMed

26.

Cedermark B, Dahlberg M, Glimelius B, Påhlman L, Rutqvist LE, Wilking N (1997) Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med 336:980–987. https://doi.org/10.1056/nejm199704033361402CrossRefPubMed

27.

Slesser AAP, Simillis C, Goldin R, Brown G, Mudan S, Tekkis PP (2013) A meta-analysis comparing simultaneous versus delayed resections in patients with synchronous colorectal liver metastases. Surg Oncol 22:36–47. https://doi.org/10.1016/j.suronc.2012.11.002CrossRefPubMed

28.

Treasure T, Farewell V, Macbeth F, Monson K, Williams NR, Brew-Graves C, Lees B, Grigg O (2019) Fallowfield L (2019) Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): a multicentre randomised clinical trial. Trials 20:1–13. https://doi.org/10.1186/s13063-019-3837-yCrossRef

29.

Filippi AR, Guerrera F, Badellino S, Ceccarelli M, Castiglione A, Guarneri A, Spadi R, Racca P, Ciccone G, Ricardi U, Ruffini E (2016) Exploratory analysis on overall survival after either surgery or stereotactic radiotherapy for lung oligometastases from colorectal cancer. Clin Oncol 28:505–512. https://doi.org/10.1016/j.clon.2016.02.001CrossRef

30.

Muhi A, Ichikawa T, Motosugi U, Sou H, Nakajima H, Sano K, Sano M, Kato S, Kitamura T, Fatima Z, Fukushima K, Iino H, Mori Y, Fujii H, Araki T (2011) Diagnosis of colorectal hepatic metastases: comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. J Magn Reson Imaging 34:326–335. https://doi.org/10.1002/jmri.22613CrossRefPubMed

Title: Clinical outcomes following colorectal resection of colorectal cancer with simultaneous hepatic and pulmonary metastases at the time of diagnosis
Authors: Yusuke Tanaka
Yusuke Yamaoka
Akio Shiomi
Hiroyasu Kagawa
Hitoshi Hino
Shoichi Manabe
Kai Chen
Kenji Nanishi
Akifumi Notsu
Publication date: 01-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Pneumonectomy
Colorectal Cancer
Colorectal Cancer
Cytostatic Therapy
Published in: Langenbeck's Archives of Surgery / Issue 2/2022
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02385-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Clinical outcomes following colorectal resection of colorectal cancer with simultaneous hepatic and pulmonary metastases at the time of diagnosis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2022

A propensity score matching study between conventional and soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy for treatment of cholelithiasis

Preference between medical outcomes and travel times: an analysis of liver transplantation

Nab-paclitaxel plus S-1 with or without PD-1 inhibitor in pancreatic ductal adenocarcinoma with only hepatic metastases: a retrospective cohort study

Near-infrared autofluorescence-based parathyroid glands identification in the thyroidectomy or parathyroidectomy: a systematic review and meta-analysis

Fluorescence angiography vs. direct palpation for bowel viability evaluation with strangulated bowel obstruction

Short- and long-term follow-up of patients with non-neoplastic esophageal perforation