Skip to main content

Advertisement

SpringerLink
Log in

Pulmonary metastasectomy in elderly colorectal cancer patients: a retrospective single center study

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Colorectal cancer (CRC) is one of the most common malignancies worldwide and the lung is one of the most frequent sites for CRC metastasis. The geriatric population is increasing, but clinical decision making is often influenced by the effect of aging. For this reason, the elderly population does not often receive potentially curative cancer treatments as offered to younger ones. From January 2000 to March 2016, 21 elderly patients (older than 75 years) underwent pulmonary resections for colorectal cancer pulmonary metastases. A postoperative morbidity rate of 23.8 % and a 30-day mortality rate of 4.8 % were reported. A cumulative overall survival of 34.19 ± 23.51 months (95 % CI 23.71–50.28) and a disease-free interval of 24.62 ± 23.79 months (95 % CI 6.44–39.56) were observed. By considering only R0 surgically resected patients, the 1-, 3- and 5-year OS were 94.1, 59.5 and 21.2 % with a mean overall survival and disease-free interval of 51.10 ± 7.82 and 42.75 ± 9.35, respectively. Concerning risk factors, an important correlation between the number of pulmonary metastases, surgical radicality and overall survival was reported (p = 0.030 and p = 0.005, respectively). In summary, according to our series, pulmonary metastasectomy in selected elderly CRC oligometastatic patients seems to be safe and effective.

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
Fig. 6

Similar content being viewed by others

Abbreviations

OS:

Overall survival

DFI:

Disease-free interval

CRC:

Colorectal cancer

References

  1. Siegel R, Naishadham D, Jemal A (2013) Cancer statistics, 2013. CA Cancer J Clin 63(1):11–30. doi:10.3322/caac.21166

    Article  PubMed  Google Scholar 

  2. Jemal A, Center MM, DeSantis C, Ward EM (2010) Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 19:1893–1907

    Article  PubMed  Google Scholar 

  3. Yancik R, Ries LA (2004) Cancer in older persons: an international issue in an aging world. Semin Oncol 31:128–136

    Article  PubMed  Google Scholar 

  4. Treasure T, Milošević M, Fiorentino F, Macbeth F (2014) Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax 69:946–949

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gonzalez M, Poncet A, Combescure C, Robert J, Ris HB, Gervaz P (2013) Risk factors for survival after lung metastasectomy in colorectal cancer patients: a systematic review and meta-analysis. Ann Surg Oncol 20:572–579

    Article  PubMed  Google Scholar 

  6. National Cancer Institute. Surveillance, Epidemiology and End Results program (SEER). Cancer Statistics Review (CSR) 1975–2013. http://seer.cancer.gov/csr/1975_2013/

  7. Yancik RM, Ries L (1997) Cancer and age: magnitude of the problem. In: Balducci L, Lyman GH, Ershler WB (eds) Comprehensive geriatric oncology. Harwood Academic Publishers, London, pp 95–103

    Google Scholar 

  8. Tan KK, Lopes Gde L Jr, Sim R (2009) How uncommon are isolated lung metastases in colorectal cancer? A review from database of 754 patients over 4 years. J Gastrointest Surg 13(4):642–648. doi:10.1007/s11605-008-0757-7

    Article  PubMed  Google Scholar 

  9. Pfannschmidt J, Muley T, Hoffmann H, Dienemann H (2003) Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. J Thorac Cardiovasc Surg 126:732–739

    Article  PubMed  Google Scholar 

  10. Riquet M, Foucault C, Cazes A, Mitry E, Dujon A, Le Pimpec Barthes F, Médioni J, Rougier P (2010) Pulmonary resection for metastases of colorectal adenocarcinoma. Ann Thorac Surg 89:375–380

    Article  PubMed  Google Scholar 

  11. Embún R, Fiorentino F, Treasure T, Rivas JJ, Molins L; Grupo Español de Cirugía Metástasis Pulmonares de Carcinoma Colo-Rectal (GECMP-CCR) de la Sociedad Española de Neumoloña y Cirurña Torácica (SEPAR) (see appendix for membership of GECMP-CCR-SE. Pulmonary metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal metastasectomy registry (GECMP-CCR). BMJ Open 3(5). doi:10.1136/bmjopen-2013-002787

  12. Hachimaru A, Maeda R, Suda T, Takagi Y (2016) Repeat pulmonary resection for recurrent lung metastases from colorectal cancer: an analysis of prognostic factors. Interact Cardiovasc Thorac Surg

  13. 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

    Article  PubMed  Google Scholar 

  14. Pastorino U, Buyse M, Friedel G et al (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 113:37–49

    Article  CAS  PubMed  Google Scholar 

  15. Kurniali PC, Hrinczenko B, Al-Janadi A (2014) Management of locally advanced and metastatic colon cancer in elderly patients. World J Gastroenterol 20(8):1910–1922. doi:10.3748/wjg.v20.i8.1910

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Hunt SL, McKay A, Kelly LM, Kirk AJ (2015) A case series of pulmonary resection for metastatic colorectal cancer in a UK regional thoracic center. Future Oncol 11(2 Suppl):35–36. doi:10.2217/fon.14.299

    Article  CAS  PubMed  Google Scholar 

  17. Borasio P, Gisabella M, Billé A, Righi L, Longo M, Tampellini M, Ardissone F (2011) Role of surgical resection in colorectal lung metastases: analysis of 137 patients. Int J Colorectal Dis 26:183–190. doi:10.1007/s00384-010-1075-6

    Article  PubMed  Google Scholar 

  18. Hwang MR, Park JW, Kim DY, Chang HJ, Kim SY, Choi HS, Kim MS, Zo JI, Oh JH (2010) Early intrapulmonary recurrence after pulmonary metastasectomy related to colorectal cancer. Ann Thorac Surg 90:398–404. doi:10.1016/j.athoracsur.2010.04.058

    Article  PubMed  Google Scholar 

  19. Embún R, Fiorentino F, Treasure T et al (2013) Oncologic outcomes following metastasectomy in colorectal cancer patients developing distant metastases after initial treatment. BMJ Open 3:e002787. doi:10.1136/bmjopen-2013-002787

    Article  PubMed  PubMed Central  Google Scholar 

  20. Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251

    Article  CAS  PubMed  Google Scholar 

  21. Melloni G, Doglioni C, Bandiera A, Carretta A, Ciriaco P, Arrigoni G et al (2006) Prognostic factors and analysis of microsatellite instability in resected pulmonary metastases from colorectal carcinoma. Ann Thorac Surg 81:2008e13

    Article  Google Scholar 

  22. Onaitis MW, Petersen RP, Haney JC, Saltz L, Park B, Flores R et al (2009) Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases. Ann Thorac Surg 87:1684–1688

    Article  PubMed  Google Scholar 

  23. Rama N, Monteiro A, Bernardo JE, Eugénio L, Antunes MJ (2009) Lung metastases from colorectal cancer: surgical resection and prognostic factors. Eur J Cardiothorac Surg 35:444–449

    Article  PubMed  Google Scholar 

  24. Iizasa T, Suzuki M, Yoshida S, Motohashi S, Yasufuku K, Iyoda A et al (2006) Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer. Ann Thorac Surg 82:254–260

    Article  PubMed  Google Scholar 

  25. Bains MS, Ginsberg RJ, Jones WG II et al (1994) The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor. Ann Thorac Surg. 58(1):30–32 (discussion 33)

    Article  CAS  PubMed  Google Scholar 

  26. van der Veen AH, van Geel AN, Hop WC, Wiggers T (1998) Median sternotomy: the preferred incision for resection of lung metastases. Eur J Surg 164(7):507–512

    Article  CAS  PubMed  Google Scholar 

  27. Cerfolio R, Bryant AS (2008) Is palpation of the nonresected pulmonary lobe(s) required for patients with non-small cell lung cancer? A prospective study. J Thorac Cardiovasc Surg 131:261–268

    Article  Google Scholar 

  28. Meng D, Fu L, Wang L, Dai Y, Lv W, Zhang J, Hu J (2016) Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies. Interact CardioVasc Thorac Surg 22(2):200–206. doi:10.1093/icvts/ivv309

    Article  PubMed  Google Scholar 

  29. Cattaneo SM, Park BJ, Wilton AS et al (2008) Use of video-assisted thoracic surgery for lobectomy in the elderly results in fewer complications. Ann Thorac Surg 85:231–236

    Article  PubMed  Google Scholar 

  30. Scott WJ, Allen MS, Darling G, Meyers B, Decker PA, Putnam JB, McKenna RW, Landrenau RJ, Jones DR, Inculet RI, Malthaner RA (2010) Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 139(4):976–981. doi:10.1016/j.jtcvs.2009.11.059 (discussion 981–983)

    Article  PubMed  Google Scholar 

  31. Jung J, Song SY, Kim JH, Yu CS, Kim JC, Kim TW, Jeong SY, Kim SS, Choi EK (2015) Clinical efficacy of stereotactic ablative radiotherapy for lung metastases arising from colorectal cancer. Radiat Oncol 21(10):238. doi:10.1186/s13014-015-0546-x

    Article  Google Scholar 

  32. Carrafiello G, Mangini M, Fontana F, Di Massa A, Ierardi AM, Cotta E, Piacentino F, NocchiCardim L, Pellegrino C, Fugazzola C (2012) Complications of microwave and radiofrequency lung ablation: personal experience and review of the literature. Radiol Med 117(2):201–213. doi:10.1007/s11547-011-0741-2

    Article  CAS  PubMed  Google Scholar 

  33. Ridge CA, Solomon SB (2015) Percutaneous ablation of colorectal lung metastases. J Gastrointest Oncol 6(6):685–692. doi:10.3978/j.issn.2078-6891.2015.095

    PubMed  PubMed Central  Google Scholar 

  34. Cassidy J, Saltz LB, Giantonio BJ, Kabbinavar FF, Hurwitz HI, Rohr UP (2010) Effect of bevacizumab in older patients with metastatic colorectal cancer: pooled analysis of four randomized studies. J Cancer Res Clin Oncol 136(5):737–743. doi:10.1007/s00432-009-0712-3

    Article  CAS  PubMed  Google Scholar 

  35. VanCutsem E, Rivera F, Berry S, Kretzschmar A, Michael M, DiBartolomeo M, Mazier MA, Canon JL, Georgoulias V, Peeters M, Bridgewater J, Cunningham D, First BEAT investigators (2009) Safety and efficacy of first-line bevacizumab with FOLFOX, XELOX, FOLFIRI and fluoropyrimidines in metastatic colorectal cancer: the BEAT study. Ann Oncol 20(11):1842–1847. doi:10.1093/annonc/mdp233

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Thoracic Surgery, University Hospital of Chieti, via dei Vestini n.1, 66100, Chieti, Italy

    Mirko Barone, Marco Prioletta, Decio Di Nuzzo, Giuseppe Cipollone, Pierpaolo Camplese & Felice Mucilli

Authors
  1. Mirko Barone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marco Prioletta
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Decio Di Nuzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giuseppe Cipollone
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pierpaolo Camplese
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Felice Mucilli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mirko Barone.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The article is in accordance with ethical standards.

Research involving human participants and or animals

The article does not contain any research with human participants performed by the authors.

Informed consent

For this type of study, no formal consent is required. It is an anonymous one.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Barone, M., Prioletta, M., Di Nuzzo, D. et al. Pulmonary metastasectomy in elderly colorectal cancer patients: a retrospective single center study. Updates Surg 68, 357–367 (2016). https://doi.org/10.1007/s13304-016-0399-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-016-0399-3

Keywords

Search

Navigation