Skip to main content
SpringerLink
Log in

Patterns and Treatment of Recurrence Following Pulmonary Resection for Colorectal Metastases

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Pulmonary resection is the best therapeutic option for lung metastases from colorectal cancer (CRC) today. However, recurrences are frequent following pulmonary resection. We aimed to evaluate the recurrence pattern and treatment of initial pulmonary resection for metastases from CRC.

Methods

Data from 76 patients with recurrence after curative resection of primary CRC and lung metastases were reviewed. The primary outcome measure was overall survival (OS), defined as the interval between the date of recurrence after pulmonary resection and the date of death or last follow-up. Cox regression analyses were performed to identify the factors associated with OS.

Results

Recurrence sites after initial pulmonary resection were lung (n = 37), liver (n = 12), others (n = 11), and multiple (n = 16). Treatments for recurrence included surgery (n = 35), chemotherapy (n = 37), and palliative care (n = 4). Of 35 patients who underwent surgery, 22 had pulmonary resection, and 11 had hepatic resection, and 2 had other resection. The 3-year OS was 84.1 % for surgery, 38.9 % for chemotherapy, and 0 % for palliative care, respectively (p < 0.001). In the surgery group, there was no difference in survival between surgical treatments for pulmonary and hepatic recurrences (p = 0.503). Cox regression analyses identified three factors: disease-free interval (DFI) (HR 1.99, 95 % CI 1.03–3.83), surgery (HR 0.30, 95 % CI 0.12–0.72), and recurrence site (lung: HR 0.10, 95 % CI 0.04–0.28, liver: HR 0.08, 95 % CI 0.02–0.31).

Conclusions

The most common recurrence site after resection of lung metastases was the lung. Although the relapse rate is high, surgery for isolated recurrences is a promising strategy, especially for patients with long DFI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90

    Article  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics. CA Cancer J Clin 62(1):10–29

    Article  PubMed  Google Scholar 

  3. Andreoni B, Chiappa A, Bertani E et al (2007) Surgical outcomes for colon and rectal cancer over a decade: results from a consecutive monocentric experience in 902 unselected patients. World J Surg Oncol 5:73

    Article  PubMed Central  PubMed  Google Scholar 

  4. Tsikitis VL, Malireddy K, Green EA et al (2009) Postoperative surveillance recommendations for early stage colon cancer based on results from the clinical outcomes of surgical therapy trial. J Clin Oncol 27(22):3671–3676

    Article  PubMed Central  PubMed  Google Scholar 

  5. Yedibela S, Klein P, Feuchter K et al (2006) Surgical management of pulmonary metastases from colorectal cancer in 153 patients. Ann Surg Oncol 13(11):1538–1544

    Article  PubMed  Google Scholar 

  6. Welter S, Jacobs J, Krbek T et al (2007) Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg 31(2):167–172

    Article  PubMed  Google Scholar 

  7. Watanabe K, Nagai K, Kobayashi A et al (2009) Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer. Br J Surg 96(9):1058–1065

    Article  CAS  PubMed  Google Scholar 

  8. Riquet M, Foucault C, Cazes A et al (2010) Pulmonary resection for metastases of colorectal adenocarcinoma. Ann Thorac Surg 89(2):375–380

    Article  PubMed  Google Scholar 

  9. Park JS, Kim HK, Choi YS et al (2010) Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer. Ann Oncol 21(6):1285–1289

    Article  CAS  PubMed  Google Scholar 

  10. Borasio P, Gisabella M, Bille A et al (2011) Role of surgical resection in colorectal lung metastases: analysis of 137 patients. Int J Colorectal Dis 26(2):183–190

    Article  PubMed  Google Scholar 

  11. Lin BR, Chang TC, Lee YC et al (2009) Pulmonary resection for colorectal cancer metastases: duration between cancer onset and lung metastasis as an important prognostic factor. Ann Surg Oncol 16(4):1026–1032

    Article  PubMed  Google Scholar 

  12. Chen F, Sakai H, Miyahara R et al (2010) Repeat resection of pulmonary metastasis is beneficial for patients with colorectal carcinoma. World J Surg 34(10):2373–2378. doi:10.1007/s00268-010-0695-x

    Article  PubMed  Google Scholar 

  13. Blackmon SH, Stephens EH, Correa AM et al (2012) Predictors of recurrent pulmonary metastases and survival after pulmonary metastasectomy for colorectal cancer. Ann Thorac Surg 94(6):1802–1809

    Article  PubMed  Google Scholar 

  14. de Jong MC, Pulitano C, Ribero D et al (2009) Rates and patterns of recurrence following curative intent surgery for colorectal liver metastasis: an international multi-institutional analysis of 1669 patients. Ann Surg 250(3):440–448

    PubMed  Google Scholar 

  15. Petrowsky H, Gonen M, Jarnagin W et al (2002) Second liver resections are safe and effective treatment for recurrent hepatic metastases from colorectal cancer: a bi-institutional analysis. Ann Surg 235(6):863–871

    Article  PubMed Central  PubMed  Google Scholar 

  16. Sa Cunha A, Laurent C, Rault A et al (2007) A second liver resection due to recurrent colorectal liver metastases. Arch Surg 142(12):1144–1149 discussion 1150

    Article  PubMed  Google Scholar 

  17. Thelen A, Jonas S, Benckert C et al (2007) Repeat liver resection for recurrent liver metastases from colorectal cancer. Eur J Surg Oncol 33(3):324–328

    Article  CAS  PubMed  Google Scholar 

  18. Simmonds PC, Primrose JN, Colquitt JL et al (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94(7):982–999

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Gonzalez M, Robert JH, Halkic N et al (2012) Survival after lung metastasectomy in colorectal cancer patients with previously resected liver metastases. World J Surg 36(2):386–391. doi:10.1007/s00268-011-1381-3

    Article  PubMed  Google Scholar 

  20. Saito Y, Omiya H, Kohno K et al (2002) Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg 124(5):1007–1013

    Article  PubMed  Google Scholar 

  21. Ogata Y, Matono K, Hayashi A et al (2005) Repeat pulmonary resection for isolated recurrent lung metastases yields results comparable to those after first pulmonary resection in colorectal cancer. World J Surg 29(3):363–368. doi:10.1007/s00268-004-7537-7

    Article  PubMed  Google Scholar 

  22. Welter S, Jacobs J, Krbek T et al (2007) Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg 84(1):203–210

    Article  PubMed  Google Scholar 

  23. Gonzalez M, Poncet A, Combescure C et al (2013) Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 20(2):572–579

    Article  PubMed  Google Scholar 

  24. Koga R, Yamamoto J, Saiura A et al (2006) Surgical resection of pulmonary metastases from colorectal cancer: four favourable prognostic factors. Jpn J Clin Oncol 36(10):643–648

    Article  PubMed  Google Scholar 

  25. Rama N, Monteiro A, Bernardo JE et al (2009) Lung metastases from colorectal cancer: surgical resection and prognostic factors. Eur J Cardiothorac Surg 35(3):444–449

    Article  PubMed  Google Scholar 

  26. Iida T, Nomori H, Shiba M et al (2013) Prognostic factors after pulmonary metastasectomy for colorectal cancer and rationale for determining surgical indications: a retrospective analysis. Ann Surg 257(6):1059–1064

    Article  PubMed  Google Scholar 

  27. Landes U, Robert J, Perneger T et al (2010) Predicting survival after pulmonary metastasectomy for colorectal cancer: previous liver metastases matter. BMC Surg 10:17

    Article  PubMed Central  PubMed  Google Scholar 

  28. Zabaleta J, Aguinagalde B, Fuentes MG et al (2011) Survival after lung metastasectomy for colorectal cancer: importance of previous liver metastasis as a prognostic factor. Eur J Surg Oncol 37(9):786–790

    Article  CAS  PubMed  Google Scholar 

  29. Salah S, Watanabe K, Park JS et al (2013) Repeated resection of colorectal cancer pulmonary oligometastases: pooled analysis and prognostic assessment. Ann Surg Oncol 20(6):1955–1961

    Article  PubMed  Google Scholar 

  30. Portier G, Elias D, Bouche O et al (2006) Multicenter randomized trial of adjuvant fluorouracil and folinic acid compared with surgery alone after resection of colorectal liver metastases: FFCD ACHBTH AURC 9002 trial. J Clin Oncol 24(31):4976–4982

    Article  CAS  PubMed  Google Scholar 

  31. Mitry E, Fields AL, Bleiberg H et al (2008) Adjuvant chemotherapy after potentially curative resection of metastases from colorectal cancer: a pooled analysis of two randomized trials. J Clin Oncol 26(30):4906–4911

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

Grant support for this study was provided by a National Cancer Center (NCC) Research and Development Fund (23-A-14).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Mitsuru Yokota, Akihiro Kobayashi, Yuji Nishizawa, Masaaki Ito & Norio Saito

  2. Clinical Trial Section, Research Center for Innovative Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Shogo Nomura

  3. Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Kanji Nagai

Authors
  1. Mitsuru Yokota
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihiro Kobayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shogo Nomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuji Nishizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Masaaki Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kanji Nagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Norio Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Norio Saito.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yokota, M., Kobayashi, A., Nomura, S. et al. Patterns and Treatment of Recurrence Following Pulmonary Resection for Colorectal Metastases. World J Surg 39, 1758–1766 (2015). https://doi.org/10.1007/s00268-015-3006-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-015-3006-8

Keywords

Search

Navigation