Survival Outcomes Similar with Repeat Pulmonary Resection

Patients undergoing multiple pulmonary resections for metastasis of colorectal carcinoma have the same survival rates as those who have had a single resection with no recurrence, according to a recent study. “There is a small percentage of patients who have an isolated metastasis to the thoracic cavity,” said author Anthony Kim, MD, assistant professor of thoracic surgery at the Rush University Medical Center in Chicago, Illinois. “While surgical dictum indicates that you remove the growth, what happens if the patient comes back with recurrent disease is not as well established. Intuitively, the answer is [to] resect the disease if the patient can tolerate another surgery, but there is little objective data to back it up.”

This retrospective study included patients who underwent pulmonary metastectomy at Rush University Medical Center between January 1, 1985, and December 31, 2007. A total of 69 patients were identified as having undergone at least 1 pulmonary metastectomy during that timeframe. Of these 69 patients, 41 had a single operation while 28 underwent at least 1 additional surgical metastectomy. Of the 28 patients who had multiple pulmonary resections, 17 underwent a second procedure, 6 a third, 4 a fourth and a single patient had 5 pulmonary surgeries. No perioperative mortalities were recorded.

From the time of the initial colorectal resection, 5-year survival for all patients was 59%. For those having only 1 resection, the 5-year survival from the time of the pulmonary resection was 23%. The 5-year survival rate was 29% for patients who underwent repeat procedures. The covariate analysis found no parameters that had a significant impact on survival.

“Our results suggest that those with recurrent disease can be resected again and still enjoy the same survival as those patients with one-time metastasis,” said Dr. Kim. “This means that the thoracic surgeon should be called in to evaluate the patient with recurrent disease in the thorax. Our results suggest that a repeat resection can be beneficial and has survival results on par with someone who did not [experience recurrence].”

Axel Grothey, MD, professor of oncology at the Mayo Clinic in Rochester, Minnesota, thinks this is an interesting article that shows it is possible to cure some patients who have stage IV colorectal cancer. “It has been long accepted for patients with limited liver disease that we can send surgeons in 2 or 3 times and still have the potential to cure the cancer,” he said. “A highlight of this study is that you can cure not only those with liver disease, but also those with pulmonary disease. The other re-resection makes sense.”

He stressed, however, that the accrual period for the study took place when medical treatment modalities were changing dramatically. He suggested that to combine this approach with the better medical treatments now available offered a strong possibility that results from a follow-up study could exceed those seen in this study.

Dr.Grothey said that medical oncologists might see patients like those in the study and think they require palliative care rather than active disease management. He indicated that the study disproves this notion. “The most important lesson is to treat those with limited metastatic disease with a multi-modality approach involving those surgical disciplines appropriate to where the metastasis is located,” he said.

Surgery

Kim AW, et al. Repeat pulmonary resection for metachronous colorectal carcinoma is beneficial. . 2008;144:712-718.

Kurt Ullman is a freelance health and medical writer based out of Indianapolis.