Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR).

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.

Pulmonary metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal metastasectomy registry (GECMP-CCR).

OBJECTIVES: To capture an accurate contemporary description of the practice of pulmonary metastasectomy for colorectal carcinoma in one national healthcare system. DESIGN: A national registry set up in Spain by Grupo Español de Cirugía Metástasis Pulmonares de Carcinoma Colo-Rectal (GECMP-CCR). SETTING: 32 Spanish thoracic units. PARTICIPANTS: All patients with one or more histologically proven lung metastasis removed by surgery between March 2008 and February 2010. INTERVENTIONS: Pulmonary metastasectomy for one or more pulmonary nodules proven to be metastatic colorectal carcinoma. PRIMARY AND SECONDARY OUTCOME MEASURES: The age and sex of the patients having this surgery were recorded with the number of metastases removed, the interval between the primary colorectal cancer operation and the pulmonary metastasectomy, and the carcinoembryonic antigen level. Also recorded were the practices with respect to mediastinal lymphadenopathy and coexisting liver metastases. RESULTS: Data were available on 543 patients from 32 units (6-43/unit). They were aged 32-88 (mean 65) years, and 65% were men. In 55% of patients, there was a solitary metastasis. The median interval between the primary cancer resection and metastasectomy was 28 months and the serum carcinoembryonic antigen was low/normal in the majority. Liver metastatic disease was present in 29% of patients at some point prior to pulmonary metastasectomy. Mediastinal lymphadenectomy varied from 9% to 100% of patients. CONCLUSIONS: The data represent a prospective comprehensive national data collection on pulmonary metastasectomy. The practice is more conservative than the impression gained when members of the European Society of Thoracic Surgeons were surveyed in 2006/2007 but is more inclusive than would be recommended on the basis of recent outcome analyses. Further analyses on the morbidity associated with this surgery and the correlation between imaging studies and pathological findings are being published separately by GECMP-CCR.

Tumores malignos de la pared torácica / No disponible

Los tumores de la pared torácica son poco frecuentes. Con la finalidad de revisar los resultados obtenidos en el tratamiento, se presentan los casos tratados quirúrgicamente entre 1992 y 2009. La serie viene constituida por 35 pacientes (23 varones), con una edad media de 55 años (rangos 21-82). La presentación fue con síntomas de duración media de 8,9 meses en 30 casos. El diagnóstico se basó en los medios de imagen (radiografía simple 100%, tomografía computarizada 85,7%, gammagrafía ósea 20,1%, ecografía 17,1%, resonancia magnética 14,3%) y la biopsia de la masa (punción transtorácica 37,1%, biopsia incisional en el 5,7% y en el 62,9% biopsia escisional previa a lacirugía completa). El tratamiento quirúrgico fue la escisión completa con márgenes libres de 3-5 cm, cuando ello fue posible y la ulterior reconstrucción con mallas de pared y mioplastias. Se realizó un análisis de la supervivencia, valorándola en función de parámetros como la edad, sexo, tamaño del tumor y grado de malignidad del tumor. En 2 casos (5,7%) se quedaron márgenes afectos. Recibieron tratamiento adyuvante 11 pacientes (5 quimioterapia y 6 radioterapia). Se produjeron complicaciones postoperatorias en 6 casos (17,3%) y no hubo mortalidad postoperatoria. En cuanto al seguimiento, hubo recidiva locorregional en 6 casos (17,3%) y metástasis en 7 (20%). La supervivencia no se relacionó estadísticamente con el grado de malignidad del tumor. Se concluye que la cirugía de resección de los tumores primarios malignos de la pared torácica no tiene mortalidad en nuestra experiencia. Tiene una escasa morbilidad postoperatoria. Tienen una supervivencia no relacionada con el grado de malignidad de la neoplasia, siempre que se obtengan unos márgenes quirúrgicos correctos (AU)

tumors, we present our cases surgically treated between 1992 and 2009. The series is formed by 35 cases (23 males), with a mean age of 55 (ranges 21-82). The presentation was with symptoms of 8,9 month of average duration in 30 cases. Diagnosis was based in imaging test (chest radiography 100%, computed tomography 85,7%, bone scintigraphy 20,1%, ultrasonography 17,1%, magnetic resonance 14,3%) and tumor biopsy (transthoracic punction 37,1%, incisional biopsy 5,7% and excisional biopsy in 62,9% previous to complete surgical resection). Surgical reatment was complete excision with margin free tumor of 3-5 cm when it was possible and chest wall reconstruction with mesh and myoplastia. Survival analysis was made evaluating age, sex, tumor size and grade. There were affected margins in 2 cases (5,7%). Adjuvant treatment was used in 11 patients (5 chemotherapy, 6 radiotherapy). Postoperative complications were present in 6 cases (17,3%). There was not mortality. Local relapses were present in 6 patients (17,3%) and metastases in 7 (20%). Survival was not related with the tumor grade. We conclude that surgical treatment of malignant chest wall tumors has not mortality in our experience. Postoperative morbidity is low. Survival is not related to tumor grade if enough free tumor margins is obtained (AU)