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Kumar NAN, Verma K, Shinde RS, Kammar P, Dusane R, Desouza A, Ostwal V, Patil P, Engineer R, Karimundackal G, Pramesh CS, Saklani A. Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes. J Surg Oncol 2018; 118:1292-1300. [PMID: 30332511 DOI: 10.1002/jso.25273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study was undertaken to evaluate the effect of change in policy of computed tomography (CT) scan of the thorax in staging and follow-up of colorectal cancer (CRC). Another objective was to review the outcomes following pulmonary metastasectomies (Pmets) and to determine the prognostic factors affecting outcomes. METHODS This is a retrospective analysis from a prospective cohort database of patients, who underwent Pmet for CRC origin from August 2004 to February 2016. The outcome measures were number of Pmets per year, overall survival (OS), disease-free survival (DFS), and prognostic factors affecting survival. RESULTS Of 71 patients, 38% (n = 27) underwent Pmet before 2013 and 62% ( n = 44) had surgery after 2013. The 2-year DFS after Pmet was 49.3% and estimated 5-year OS was 51.4% at a median follow-up of 28 months. There was a significant increase in number of Pmets/year ( P = 0.0015), increased detection of synchronous pulmonary metastasis (PM) ( P = 0.005), increased diagnosis of extra-pulmonary metastases (EPM) ( P = 0.005), and improved OS ( P = 0.026) after introduction of CT scan as staging tool. Site of primary tumor (colon) ( P = 0.045), primary nodal stage ( P = 0.009), and the presence of EPM ( P = 0.01) were independent important prognostic factors affecting survival. CONCLUSION The CT scan of thorax as a baseline tool for staging and follow-up in CRC increases referral for pulmonary metastasectomy. Surgery achieves excellent prognosis and long-term survival outcomes in CRC with isolated PM and carefully selected patients with solitary liver metastasis.
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Affiliation(s)
- Naveena A N Kumar
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Kamlesh Verma
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rajesh S Shinde
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Praveen Kammar
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rohit Dusane
- Division of Clinical Research and Statistics, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashwin Desouza
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Medical Gastroenterology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - George Karimundackal
- Department of Thoracic surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Thoracic surgery, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Avanish Saklani
- Department of Colorectal Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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