Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR)
| Autor: | Antonio Arnau, Carlos Rombolá, Juan J. Fibla, Akiko Tamura, Rafael Peñalver, José M. Mier, José Ramón Jarabo, J.J. Rivas, Guillermo Carriquiry, Félix Heras, Juan J. Rivas, Emilio Canalís, Santiago García Barajas, F. Rivas, David R. Smith, Montse Blanco, Alberto Rodríguez, Laureano Molins, Sergi Call, R. Embun, Moisés Rosenberg, Richard Wins, Javier de la Cruz, J M Hernández, Raul Embun, J. Hernández, Federico Gómez de las Heras, L. Molins, M. Carmen Marron, Esther Fernández, Jorge Freixinet, Gemma Muñoz, Beatriz de Olaiz, Diego Gonzalez-Rivas, Miguel Carbajo Carbajo, Andrés Arroyo, Javier Ruiz, M. Rubio, Sergio Bolufer, José M. García Prim, Carlos Pagás |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Lung Neoplasms Colorectal cancer medicine.medical_treatment Disease-Free Survival 03 medical and health sciences Pneumonectomy 0302 clinical medicine medicine Humans Survival analysis Aged Proportional Hazards Models Thoracic Surgery Video-Assisted Proportional hazards model business.industry Hazard ratio Metastasectomy Hematology Middle Aged medicine.disease Surgery 030228 respiratory system Oncology Spain 030220 oncology & carcinogenesis Lymph Node Excision Female Lymphadenectomy Neoplasm Recurrence Local Colorectal Neoplasms business Wedge resection (lung) |
| Zdroj: | Annals of Oncology. 27:850-855 |
| ISSN: | 0923-7534 |
| Popis: | BACKGROUND Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection. PATIENTS AND METHODS Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model. RESULTS A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome. CONCLUSION Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results. |
| Databáze: | OpenAIRE |
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