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Clin Colon Rectal Surg 2009; 22(4): 233-241
DOI: 10.1055/s-0029-1242463
© Thieme Medical Publishers

Surgical Management of Colorectal Lung Metastasis

P. James Villeneuve1 , R. Sudhir Sundaresan1
  • 1Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
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Publication History

Publication Date:
06 November 2009 (online)

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ABSTRACT

Colon cancer is a systemic disease in 19% of patients and metastasizes most frequently to the liver and the lung. Survival is enhanced with complete surgical resection of pulmonary metastases. Comprehensive restaging and verification of preoperative fitness must precede resection. The operative approach is dictated by the anatomic location of the metastases, whereas the extent of resection remains a balance between complete removal of metastatic deposits while preserving as much lung parenchyma as possible. The presence of metastatic involvement of hilar and mediastinal lymph nodes is ominous. Multidisciplinary care is highly recommended. An evidence-based algorithm for the identification assessment and treatment of patients with pulmonary metastases is proposed.

KEYWORDS

Pulmonary metastases - colorectal cancer - surgical management - outcomes

REFERENCES

  • 1 Horner M, Ries L, Krapcho M et al.. SEER Cancer Stat Fact Sheets. SEER Cancer Statistics Review, 1976–2006. Atlanta, GA; Centers for Disease Control and Prevention, Division of Cancer Prevention and Control 2009
    PubMedGoogle Scholar
  • 2 Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series.  Ann Thorac Surg. 2007;  84(1) 324-338
    CrossrefPubMedGoogle Scholar
  • 3 The International Registry of Lung Metastases . Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases.  J Thorac Cardiovasc Surg. 1997;  113(1) 37-49
    CrossrefPubMedGoogle Scholar
  • 4 Weinlechner J. Tumoren an der brustwand und deren behnadlung resection der rippeneroffnung der brusthohle und partielle entfernung der lunge.  Wien Med Wochenschr. 1882;  32 589-591
    PubMedGoogle Scholar
  • 5 Divis G. Einbertrag zur operativen, Behandlung der lungengeschuuliste.  Acta Chir Scand. 1927;  62 329-334
    PubMedGoogle Scholar
  • 6 Edwards A. Malignant disease of the lung.  J Thorac Surg. 1934;  4 107-124
    PubMedGoogle Scholar
  • 7 Barney J D, Churchill E D. Adenocarcinoma of the kidney with metastases to the lung: cured by nephrectomy and lobectomy.  J Urol. 1939;  43 269-276
    PubMedGoogle Scholar
  • 8 Blalock A. Recent advances in surgery.  N Engl J Med. 1944;  231 261-267
    CrossrefPubMedGoogle Scholar
  • 9 Rusch V W. Pulmonary metastasectomy. Current indications.  Chest. 1995;  107(6, Suppl) 322S-331S
    CrossrefPubMedGoogle Scholar
  • 10 NCCN Colon Cancer Panel .Practice Guidelines in Oncology - Colon Cancer. Vol. 2. Fort Washington, PA; National Comprehensive Cancer Network 2009: 1-71
    PubMedGoogle Scholar
  • 11 Klippenstein D L, Lamonica D M. Preoperative imaging for metastasectomy.  Surg Oncol Clin N Am. 2007;  16(3) 471-492, vii
    CrossrefPubMedGoogle Scholar
  • 12 Pastorino U, Veronesi G, Landoni C et al.. Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis.  J Thorac Cardiovasc Surg. 2003;  126(6) 1906-1910
    CrossrefPubMedGoogle Scholar
  • 13 Hung G U, Shiau Y C, Tsai S C, Chao T H, Ho Y J, Kao C H et al.. Value of 18F-fluoro-2-deoxyglucose positron emission tomography in the evaluation of recurrent colorectal cancer.  Anticancer Res. 2001;  21(2B) 1375-1378
    PubMedGoogle Scholar
  • 14 Beets G, Penninckx F, Schiepers C et al.. Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer.  Br J Surg. 1994;  81(11) 1666-1670
    CrossrefPubMedGoogle Scholar
  • 15 Cerfolio R J, McCarty T, Bryant A S. Non-imaged pulmonary nodules discovered during thoracotomy for metastasectomy by lung palpation.  Eur J Cardiothorac Surg. 2009;  35(5) 786-791 discussion 791
    CrossrefPubMedGoogle Scholar
  • 16 Ciriaco P, Negri G, Puglisi A, Nicoletti R, Del Maschio A, Zannini P et al.. Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization.  Eur J Cardiothorac Surg. 2004;  25(3) 429-433
    CrossrefPubMedGoogle Scholar
  • 17 Gonfiotti A, Davini F, Vaggelli L et al.. Thoracoscopic localization techniques for patients with solitary pulmonary nodule: hookwire versus radio-guided surgery.  Eur J Cardiothorac Surg. 2007;  32(6) 843-847
    CrossrefPubMedGoogle Scholar
  • 18 Lenglinger F X, Schwarz C D, Artmann W. Localization of pulmonary nodules before thoracoscopic surgery: value of percutaneous staining with methylene blue.  AJR Am J Roentgenol. 1994;  163(2) 297-300
    CrossrefPubMedGoogle Scholar
  • 19 Mayo J R, Clifton J C, Powell T I et al.. Lung nodules: CT-guided placement of microcoils to direct video-assisted thoracoscopic surgical resection.  Radiology. 2009;  250(2) 576-585
    CrossrefPubMedGoogle Scholar
  • 20 Sortini D, Feo C V, Carcoforo P et al.. Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy.  Ann Thorac Surg. 2005;  79(1) 258-262 discussion 262
    CrossrefPubMedGoogle Scholar
  • 21 Chen W, Chen L, Yang S et al.. A novel technique for localization of small pulmonary nodules.  Chest. 2007;  131(5) 1526-1531
    CrossrefPubMedGoogle Scholar
  • 22 Grogan E L, Jones D R, Kozower B D, Simmons W D, Daniel T M. Identification of small lung nodules: technique of radiotracer-guided thoracoscopic biopsy.  Ann Thorac Surg. 2008;  85(2) S772-S777
    CrossrefPubMedGoogle Scholar
  • 23 Dennis J L, Hvidsten T R, Wit E C et al.. Markers of adenocarcinoma characteristic of the site of origin: development of a diagnostic algorithm.  Clin Cancer Res. 2005;  11(10) 3766-3772
    CrossrefPubMedGoogle Scholar
  • 24 Bapoje S R, Whitaker J F, Schulz T, Chu E S, Albert R K. Preoperative evaluation of the patient with pulmonary disease.  Chest. 2007;  132(5) 1637-1645
    CrossrefPubMedGoogle Scholar
  • 25 Greelish J P, Friedberg J S. Secondary pulmonary malignancy.  Surg Clin North Am. 2000;  80(2) 633-657
    CrossrefPubMedGoogle Scholar
  • 26 Conlon N P, Shaw A D, Grichnik K P. Postthoracotomy paravertebral analgesia: will it replace epidural analgesia?.  Anesthesiol Clin. 2008;  26(2) 369-380
    PubMedGoogle Scholar
  • 27 Ginsberg R J. Alternative (muscle-sparing) incisions in thoracic surgery.  Ann Thorac Surg. 1993;  56(3) 752-754
    CrossrefPubMedGoogle Scholar
  • 28 Thomford N R, Woolner L B, Clagett O T. The surgical treatment of metastatic tumours in the lungs.  J Thorac Cardiovasc Surg. 1965;  49 357-363
    CrossrefPubMedGoogle Scholar
  • 29 Alexander J, Haight C. Pulmonary resection for solitary metastatic sarcomas and carcinomas.  Surg Gynecol Obstet. 1947;  85 129-146
    PubMedGoogle Scholar
  • 30 Pfannschmidt J, Klode J, Muley T, Dienemann H, Hoffmann H. Nodal involvement at the time of pulmonary metastasectomy: experiences in 245 patients.  Ann Thorac Surg. 2006;  81(2) 448-454
    CrossrefPubMedGoogle Scholar
  • 31 Bains M S, Ginsberg R J, Jones II W G et al.. The clamshell incision: an improved approach to bilateral pulmonary and mediastinal tumor.  Ann Thorac Surg. 1994;  58(1) 30-32 discussion 33
    CrossrefPubMedGoogle Scholar
  • 32 van der Veen A H, van Geel A N, Hop W C, Wiggers T. Median sternotomy: the preferred incision for resection of lung metastases.  Eur J Surg. 1998;  164(7) 507-512
    CrossrefPubMedGoogle Scholar
  • 33 Sternberg D I, Sonett J R. Surgical therapy of lung metastases.  Semin Oncol. 2007;  34(3) 186-196
    CrossrefPubMedGoogle Scholar
  • 34 Roth J A, Pass H I, Wesley M N, White D, Putnam J B, Seipp C et al.. Comparison of median sternotomy and thoracotomy for resection of pulmonary metastases in patients with adult soft-tissue sarcomas.  Ann Thorac Surg. 1986;  42(2) 134-138
    CrossrefPubMedGoogle Scholar
  • 35 Togo S, Fujii S, Yamaguchi S, Ike H, Ooki S, Shimada H et al.. Thoracoscopic lung resection for lung metastasis of colorectal cancer.  Surg Laparosc Endosc. 1996;  6(6) 480-484
    CrossrefPubMedGoogle Scholar
  • 36 Nakajima J, Murakawa T, Fukami T, Takamoto S. Is thoracoscopic surgery justified to treat pulmonary metastasis from colorectal cancer?.  Interact Cardiovasc Thorac Surg. 2008;  7(2) 212-216 discussion 216-217
    CrossrefPubMedGoogle Scholar
  • 37 Landreneau R J, De Giacomo T, Mack M J et al.. Therapeutic video-assisted thoracoscopic surgical resection of colorectal pulmonary metastases.  Eur J Cardiothorac Surg. 2000;  18(6) 671-676 discussion 676-677
    CrossrefPubMedGoogle Scholar
  • 38 Johnstone P A, Rohde D C, Swartz S E, Fetter J E, Wexner S D. Port site recurrences after laparoscopic and thoracoscopic procedures in malignancy.  J Clin Oncol. 1996;  14(6) 1950-1956
    CrossrefPubMedGoogle Scholar
  • 39 Saisho S, Nakata M, Sawada S et al.. Evaluation of video-assisted thoracoscopic surgery for pulmonary metastases: 11-years of experience.  Surg Endosc. 2009;  23(1) 55-61
    CrossrefPubMedGoogle Scholar
  • 40 Spaggiari L, Grunenwald D H, Girard P, Solli P, Le Chevalier T. Pneumonectomy for lung metastases: indications, risks, and outcome.  Ann Thorac Surg. 1998;  66(6) 1930-1933
    CrossrefPubMedGoogle Scholar
  • 41 Grunenwald D, Spaggiari L, Girard P, Baldeyrou P, Filaire M, Dennewald G et al.. Completion pneumonectomy for lung metastases: is it justified?.  Eur J Cardiothorac Surg. 1997;  12(5) 694-697
    CrossrefPubMedGoogle Scholar
  • 42 Pennathur A, Abbas G, Qureshi I et al.. Radiofrequency ablation for the treatment of pulmonary metastases.  Ann Thorac Surg. 2009;  87(4) 1030-1036 discussion 1036-1039
    CrossrefPubMedGoogle Scholar
  • 43 Okuma T, Okamura T, Matsuoka T et al.. Fluorine-18-fluorodeoxyglucose positron emission tomography for assessment of patients with unresectable recurrent or metastatic lung cancers after CT-guided radiofrequency ablation: preliminary results.  Ann Nucl Med. 2006;  20(2) 115-121
    CrossrefPubMedGoogle Scholar
  • 44 Mineo T C, Ambrogi V, Tonini G et al.. Longterm results after resection of simultaneous and sequential lung and liver metastases from colorectal carcinoma.  J Am Coll Surg. 2003;  197(3) 386-391
    CrossrefPubMedGoogle Scholar
  • 45 Robinson B J, Rice T W, Strong S A, Rybicki L A, Blackstone E H. Is resection of pulmonary and hepatic metastases warranted in patients with colorectal cancer?.  J Thorac Cardiovasc Surg. 1999;  117(1) 66-75 discussion 75-76
    CrossrefPubMedGoogle Scholar
  • 46 Veronesi G, Petrella F, Leo F et al.. Prognostic role of lymph node involvement in lung metastasectomy.  J Thorac Cardiovasc Surg. 2007;  133(4) 967-972
    CrossrefPubMedGoogle Scholar
  • 47 Higashiyama M, Kodama K, Higaki N et al.. Surgery for pulmonary metastases from colorectal cancer: the importance of prethoracotomy serum carcinoembryonic antigen as an indicator of prognosis.  Jpn J Thorac Cardiovasc Surg. 2003;  51(7) 289-296
    CrossrefPubMedGoogle Scholar
  • 48 Tomimaru Y, Noura S, Ohue M et al.. Metastatic tumor doubling time is an independent predictor of intrapulmonary recurrence after pulmonary resection of solitary pulmonary metastasis from colorectal cancer.  Dig Surg. 2008;  25(3) 220-225
    CrossrefPubMedGoogle Scholar
  • 49 Shiono S, Ishii G, Nagai K et al.. Immunohistochemical prognostic factors in resected colorectal lung metastases using tissue microarray analysis.  Eur J Surg Oncol. 2006;  32(3) 308-309
    CrossrefPubMedGoogle Scholar
  • 50 Shiono S, Ishii G, Nagai K et al.. Histopathologic prognostic factors in resected colorectal lung metastases.  Ann Thorac Surg. 2005;  79(1) 278-282 discussion 283
    CrossrefPubMedGoogle Scholar
  • 51 Welter S, Jacobs J, Krbek T, Krebs B, Stamatis G. Long-term survival after repeated resection of pulmonary metastases from colorectal cancer.  Ann Thorac Surg. 2007;  84(1) 203-210
    CrossrefPubMedGoogle Scholar
  • 52 Yano T, Fukuyama Y, Yokoyama H et al.. Failure in resection of multiple pulmonary metastases from colorectal cancer.  J Am Coll Surg. 1997;  185(2) 120-122
    CrossrefPubMedGoogle Scholar
  • 53 Kim A W, Faber L P, Warren W H et al.. Repeat pulmonary resection for metachronous colorectal carcinoma is beneficial.  Surgery. 2008;  144(4) 712-717 discussion 717-718
    CrossrefPubMedGoogle Scholar
  • 54 Pfannschmidt J, Muley T, Hoffmann H, Dienemann H. Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients.  J Thorac Cardiovasc Surg. 2003;  126(3) 732-739
    CrossrefPubMedGoogle Scholar

R. Sudhir SundaresanM.D. 

Ottawa Hospital–General Campus, 501 Smyth Rd.

Rm. 6361, Ottawa, Ontario, Canada K1H 8L6

Email: ssundaresan@ottawahospital.on.ca

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