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Exérèse chirurgicale des métastases pulmonaires de cancer colorectal : quelle stratégie en 2014 ?

Surgical removal of colorectal cancer pulmonary metastases: what is the strategy in 2014?

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Oncologie

Résumé

La résection pulmonaire en cas de cancer colorectal métastatique est possible si la maladie est stable et sous contrôle. Les patients sont admissibles après une évaluation stricte et une longue période de rémission. Nous avons effectué une revue de la littérature récente portant sur la résection pulmonaire en cas de cancer colorectal métastatique en comparant particulièrement le rôle de la chirurgie conventionnelle face à la thoracotomie et à la vidéothoracoscopie. La survie à cinq ans de ces patients varie entre 35 et 61,4 % selon les séries. La chirurgie vidéothoracoscopique permet une résection complète de la maladie (R0), mais seule la chirurgie conventionnelle semble offrir un bon curage ganglionnaire. Il est établi que la vidéothoracoscopie peut être une alternative pour les patients fragiles et difficilement opérables. La chirurgie ouverte reste aujourd’hui la référence ; cependant, et à notre connaissance, elle est controversée, car il n’existe pas d’études randomisées solides pour démontrer son efficacité. La chirurgie est plus susceptible de détecter une petite tumeur via palpation bidigitale du reste du poumon. Elle reste aujourd’hui la meilleure stratégie possible pour les patients atteints de cancers métastatiques dont la fonction pulmonaire permet une résection du poumon. Dans ce contexte, la médiastinoscopie garde clairement une place prépondérante dans la stratégie thérapeutique, car elle définit le staging ganglionnaire. L’ablation par radiofréquence (RF) et la radiothérapie stéréotaxique ablative sont aussi des alternatives appropriées pour le contrôle local. Pour les patients fragiles, elles représentent une thérapeutique acceptable.

Abstract

Pulmonary resection of metastatic colorectal cancer is reasonable if the disease is stable and hallmark. Patients are eligible after highly selected assessment and long disease-free interval. We reviewed the recent literature about pulmonary resection of metastatic colorectal cancer, especially comparing the role of conventional surgery through thoracotomy with videothoracoscopy. The survival (5 years) rate of these patients ranges from 35 to 61.4% depending on the series. Videothoracic surgery allows a complete resection of the disease (R0); however, only conventional surgery seems to provide good lymphatic nodes removal. It is well known that videothoracoscopy may be an alternative in fragile and poor condition patients. Open surgery remains today the gold standard although, and according to our knowledge, there is no solid randomized study to demonstrate so and the subject remains controversial. Surgery is more sensitive to detect small tumor through bidigital palpation of the remaining lung. It remains today the best strategy for metastatic patients with pulmonary function suitable for lung resection. In that field, mediastinoscopy clearly plays a key role in the therapeutic strategy by specifying the node staging. Radiofrequency ablation and stereotactic ablative radiotherapy are also suitable alternatives for local control. For fragile patients, this treatment is acceptable.

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Authors and Affiliations

  1. Service de chirurgie thoracique, cardiaque et vasculaire, CHU Pontchaillou, centre cardiopneumologique, 2, rue Henri-Le-Guillou, F-35033, Rennes cedex, France

    B. de Latour, J. Guihaire, S. Dang Van, E. Flecher & J.-P. Verhoye

  2. Service de radiologie, CHU Pontchaillou, 2, rue Henri-Le-Guillou, F-35033, Rennes cedex, France

    C. Meunier

  3. Service de pneumologie, CHU Pontchaillou, centre cardiopneumologique, 2, rue Henri-Le-Guillou, F-35033, Rennes cedex, France

    H. Lena

  4. Service de radiothérapie, centre Eugène-Marquis, 2, rue Henri-Le-Guillou, F-35033, Rennes cedex, France

    E. Chajon

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  1. B. de Latour
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  2. J. Guihaire
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  8. J.-P. Verhoye
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de Latour, B., Guihaire, J., Dang Van, S. et al. Exérèse chirurgicale des métastases pulmonaires de cancer colorectal : quelle stratégie en 2014 ?. Oncologie 16, 549–555 (2014). https://doi.org/10.1007/s10269-014-2466-z

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  • DOI: https://doi.org/10.1007/s10269-014-2466-z

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