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Tom Treasure - One of the best experts on this subject based on the ideXlab platform.
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national variation in pulmonary Metastasectomy for colorectal cancer
Colorectal Disease, 2021Co-Authors: Hayley M. Fenton, Tom Treasure, Paul J. Finan, Richard Milton, Michael Shackcloth, John C. Taylor, Eva MorrisAbstract:AIM Evidence on patterns of use of pulmonary Metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary Metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome. METHODS All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013 were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary Metastasectomy, occurring within 3 years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organizational factors associated with the use of pulmonary Metastasectomy for colorectal cancer, and Kaplan-Meier and Cox models were used to assess survival following pulmonary Metastasectomy. RESULTS In all, 173 354 individuals had a major colorectal resection over the study period, with 3434 (2.0%) undergoing pulmonary resection within 3 years. The frequency of pulmonary Metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary Metastasectomy (0.0%-6.8% of patients). Overall 5-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively. CONCLUSIONS This study shows significant variation in the rates of pulmonary Metastasectomy for colorectal cancer across the English NHS.
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National variation in pulmonary Metastasectomy for colorectal cancer.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2020Co-Authors: Hayley M. Fenton, Tom Treasure, Paul J. Finan, Richard Milton, Michael Shackcloth, John C. Taylor, Eva J.a. MorrisAbstract:AIM Evidence on patterns of use of pulmonary Metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary Metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome. METHODS All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013, were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary Metastasectomy, occurring within three years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organisational factors associated with the use of pulmonary Metastasectomy for colorectal cancer and Kaplan-Meier and Cox models used to assess survival following pulmonary Metastasectomy. RESULTS 173,354 individuals had a major colorectal resection over the study period, with 3,434 (2.0%) undergoing pulmonary resection within three years. The frequency of pulmonary Metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary Metastasectomy (0.0-6.8% of patients). Overall five-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively. CONCLUSIONS This study shows significant variation in the rates of pulmonary Metastasectomy for colorectal cancer across the English NHS.
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Is survival really better after repeated lung Metastasectomy?
Clinical & Experimental Metastasis, 2020Co-Authors: Francesca Fiorentino, Tom TreasureAbstract:Several groups have observed that average survival time after a second lung Metastasectomy is longer than after a first Metastasectomy. The randomised controlled trial Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) found no survival benefit from lung Metastasectomy. In fact, median survival was longer, and four-year overall survival was higher, in the control group than in those randomly assigned to Metastasectomy, although not significantly so. The illusion of benefit is because survival without Metastasectomy has been assumed to be near zero, as stated in Society of Thoracic Surgeons’ Expert Consensus Document on Pulmonary Metastasectomy 2019. It has been repeatedly found that survival is influenced by the selection of patients who have characteristics associated with better prognosis. The passage of time while monitoring and assessing patients, and observing their rate of progression, provides for immortal time bias. Reselection of the most favourable patients for repeated Metastasectomy is the likely reason for any differences in survival between first and repeated Metastasectomy operations.
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Comment on: 'KRAS and BRAF mutations are prognostic biomarkers in patients undergoing lung Metastasectomy of colorectal cancer.' Variation in survival associated with proto-oncongenes is not evidence for effectiveness of lung Metastasectomy.
British journal of cancer, 2015Co-Authors: Giuseppe Cardillo, Fergus Macbeth, Sahar Mokhles, Norman R. Williams, Chris Russell, Tom TreasureAbstract:Comment on: ‘KRAS and BRAF mutations are prognostic biomarkers in patients undergoing lung Metastasectomy of colorectal cancer.’ Variation in survival associated with proto-oncongenes is not evidence for effectiveness of lung Metastasectomy
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Pulmonary Metastasectomy: what is the practice and where is the evidence for effectiveness?
Thorax, 2014Co-Authors: Tom Treasure, Francesca Fiorentino, Misel Milosevic, Fergus MacbethAbstract:Pulmonary Metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of Metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to Metastasectomy intervals longer than 2–3 years. Five-year survival rates of 30–50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between Metastasectomy and survival cannot be interpreted as causation. Cancers for which lung Metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary Metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver Metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.
Toshiki Hirata - One of the best experts on this subject based on the ideXlab platform.
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significance of tumor recurrence before pulmonary metastasis in pulmonary Metastasectomy for soft tissue sarcoma
Ejso, 2009Co-Authors: Fengshi Chen, T Fujinaga, Kiyoshi Sato, Makoto Sonobe, Tsuyoshi Shoji, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Kenichi Okubo, Toshiki HirataAbstract:Abstract Background Resection for pulmonary metastasis from soft tissue sarcomas is an accepted method for treatment, but it is still debatable which patients will benefit from surgical intervention. To find an entity of patients benefiting from pulmonary Metastasectomy, we reviewed our institutional experience. Methods Between 1990 and 2007, 23 patients with pulmonary metastases from soft tissue sarcomas underwent complete pulmonary resection. All patients had obtained locoregional control of their primary tumors. Various perioperative variables were investigated retrospectively to confirm the role of pulmonary Metastasectomy and to identify possible prognostic factors for survival after Metastasectomy. Results Overall survival rate after Metastasectomy was 43% and 29% at 5 and 10 years, respectively. Disease-free survival rate was 9% at 1 year after pulmonary resection. On multivariate analysis, no tumor recurrence (neither locoregional recurrence nor extrapulmonary metastasis) before pulmonary metastasis provided a significantly favorable overall survival ( P = 0.038). In addition, repeat Metastasectomy for recurrent pulmonary metastasis also provided a favorable overall survival ( P = 0.041). Conclusions Our data suggested that patients most likely to benefit from pulmonary Metastasectomy for soft tissue sarcoma have no tumor recurrence before pulmonary metastasis. Furthermore, patients with repeat Metastasectomy for recurrent pulmonary metastasis also presented a significantly longer survival.
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clinical features of surgical resection for pulmonary metastasis from breast cancer
Ejso, 2009Co-Authors: Fengshi Chen, T Fujinaga, Kiyoshi Sato, Makoto Sonobe, Tsuyoshi Shoji, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Kenichi Okubo, Toshiki HirataAbstract:Abstract Background and objectives Metastatic breast cancer has been defined as a systemic disease. The discussion concerning the resection of lung metastases in patients with breast cancer is controversial. To confirm the role of resection of pulmonary metastases from breast cancer and to identify possible prognostic factors, we reviewed our institutional experience. Methods Between 1991 and 2007, 41 patients with pulmonary metastases from breast cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary tumors. Various perioperative variables were investigated retrospectively to confirm the role of Metastasectomy and to analyze prognostic factors for overall survival after Metastasectomy. Results All patients were female with a median age of 55 years (range, 35–81 years). The overall survival rate after Metastasectomy was 51% at 5 and 10 years. On multivariate analysis, fewer than four pulmonary metastases and a disease-free interval of more than 3 years were significantly favorable prognostic factors for overall survival ( p = 0.023 and 0.024, respectively). Conclusions The current practice of pulmonary Metastasectomy for breast cancers in our institution was well justified. Pulmonary Metastasectomy in patients with previous breast cancer might be justified when fewer than four pulmonary metastases or a disease-free interval of more than 3 years.
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pulmonary resection for metastasis from esophageal carcinoma
Interactive Cardiovascular and Thoracic Surgery, 2008Co-Authors: Fengshi Chen, Kiyoshi Sato, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Kenichi Okubo, Toshiki Hirata, Hiroshi DateAbstract:: Pulmonary Metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, few data have been available regarding lung Metastasectomy for esophageal carcinoma. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. Between 2001 and 2007, five patients with pulmonary metastases from esophageal carcinoma underwent complete pulmonary resection. All patients had undergone curative resection of their primary esophageal carcinomas and also had obtained locoregional control of their primaries. Disease-free interval varied from 13 to 56 months, with a median of 21 months. In three patients, lung metastases were found to be unilateral and solitary. The other two patients presented several metastases in the unilateral or bilateral lungs. All patients underwent wedge resection or segmentectomy. Currently, four patients are alive without evidence of disease and one patient has died of disease. All patients undertook or were going to undertake chemotherapy after the pulmonary Metastasectomy. Three patients with solitary metastasis are all alive without disease 13, 48, and 90 months after the first pulmonary Metastasectomy, respectively. Pulmonary Metastasectomy for esophageal carcinoma with postoperative chemotherapy was seemingly justified. Solitary pulmonary metastasis might be a good candidate for favorable prognostic factor.
Scott T. Tagawa - One of the best experts on this subject based on the ideXlab platform.
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Metastasectomy in older adults with urothelial carcinoma: Population-based analysis of use and outcomes
Urologic Oncology-seminars and Original Investigations, 2017Co-Authors: Bishoy Faltas, Renee L. Gennarelli, Elena B. Elkin, Daniel P. Nguyen, Scott T. TagawaAbstract:Abstract Background Metastatic urothelial carcinoma of the bladder, ureter, or renal pelvis is a highly aggressive disease with poor outcomes. Even with platinum-based chemotherapy, the median overall survival is 15 months and the 5-year survival is only 15%. The role of Metastasectomy in urothelial carcinoma is currently undefined. Objective To examine the use and outcomes of Metastasectomy in older patients with urothelial carcinoma in a large population-based dataset. Design, setting, and participants We conducted a SEER-Medicare study, and from 70,648 urothelial carcinoma patients who met inclusion criteria, we identified 497 patients who had at least 1 Metastasectomy during a median follow-up of 40 months. Outcome measurements and statistical analysis The primary study endpoints were Metastasectomy use, the length of stay for Metastasectomy, complications, and overall survival following Metastasectomy. Secondary outcomes included 30-day mortality and readmission rate following Metastasectomy. Results and limitations We identified 497 patients meeting inclusion criteria who had at least 1 Metastasectomy during the study period including 24 patients who had more than 1 procedure resulting in a total of 523 metastasectomies. The median overall survival after the first Metastasectomy was 19 months (95% CI: 15–23; interquartile range: 4–74). In this selected patient population, over a third of patients were alive at 3 years. In the 476 patients who had evaluable discharge dates, the median length of stay after Metastasectomy was 7 days (IQR: 4–12), and 10% of patients had at least 1 complication within 30 days of discharge. Thirty-day mortality after Metastasectomy was 10% (n = 53/523) and was largely driven by the mortality associated with resections of urothelial cancer brain metastases. Conclusions In well-selected patients with urothelial carcinoma with a reasonable life expectancy, resection of metastatic lesions is safe and is associated with long-term survival and potential cures.
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Metastasectomy in older adults with urothelial carcinoma: Population-based analysis of use and outcomes.
Urologic oncology, 2017Co-Authors: Bishoy Faltas, Renee L. Gennarelli, Daniel P. Nguyen, Elena Elkin, Scott T. TagawaAbstract:Metastatic urothelial carcinoma of the bladder, ureter, or renal pelvis is a highly aggressive disease with poor outcomes. Even with platinum-based chemotherapy, the median overall survival is 15 months and the 5-year survival is only 15%. The role of Metastasectomy in urothelial carcinoma is currently undefined. To examine the use and outcomes of Metastasectomy in older patients with urothelial carcinoma in a large population-based dataset. We conducted a SEER-Medicare study, and from 70,648 urothelial carcinoma patients who met inclusion criteria, we identified 497 patients who had at least 1 Metastasectomy during a median follow-up of 40 months. The primary study endpoints were Metastasectomy use, the length of stay for Metastasectomy, complications, and overall survival following Metastasectomy. Secondary outcomes included 30-day mortality and readmission rate following Metastasectomy. We identified 497 patients meeting inclusion criteria who had at least 1 Metastasectomy during the study period including 24 patients who had more than 1 procedure resulting in a total of 523 metastasectomies. The median overall survival after the first Metastasectomy was 19 months (95% CI: 15-23; interquartile range: 4-74). In this selected patient population, over a third of patients were alive at 3 years. In the 476 patients who had evaluable discharge dates, the median length of stay after Metastasectomy was 7 days (IQR: 4-12), and 10% of patients had at least 1 complication within 30 days of discharge. Thirty-day mortality after Metastasectomy was 10% (n = 53/523) and was largely driven by the mortality associated with resections of urothelial cancer brain metastases. In well-selected patients with urothelial carcinoma with a reasonable life expectancy, resection of metastatic lesions is safe and is associated with long-term survival and potential cures. Copyright © 2018 Elsevier Inc. All rights reserved.
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Use and outcomes of Metastasectomy in older patients with urothelial cancers.
Journal of Clinical Oncology, 2015Co-Authors: Bishoy Faltas, Renee L. Gennarelli, Daniel P. Nguyen, Scott T. Tagawa, Elena B. ElkinAbstract:e15506 Background: Small single-institution series suggest that some patients with advanced urothelial cancer (UC) who have Metastasectomy may have long-term survival. However, this procedure may also be associated with morbidity and mortality. Our objective was to examine use and outcomes of Metastasectomy in older patients with UC in a large population-based dataset. Methods: We identified all patients with UC of the bladder, ureter and renal pelvis diagnosed 2001-2009 in the population-based SEER-Medicare dataset. Patients with a history of another solid tumor were excluded. Metastasectomy, identified in inpatient, outpatient and physician claims, was defined as resection of a metastatic lesion in a distant organ (brain, lung or liver) at any time after diagnosis or pelvic exenteration more than 6 months after first cystectomy. We examined hospital readmissions within 7 days of the procedure, 30-day mortality, and overall survival from first Metastasectomy. Results: Of 70,648 patients with UC, 1,725 ha...
Fengshi Chen - One of the best experts on this subject based on the ideXlab platform.
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significance of tumor recurrence before pulmonary metastasis in pulmonary Metastasectomy for soft tissue sarcoma
Ejso, 2009Co-Authors: Fengshi Chen, T Fujinaga, Kiyoshi Sato, Makoto Sonobe, Tsuyoshi Shoji, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Kenichi Okubo, Toshiki HirataAbstract:Abstract Background Resection for pulmonary metastasis from soft tissue sarcomas is an accepted method for treatment, but it is still debatable which patients will benefit from surgical intervention. To find an entity of patients benefiting from pulmonary Metastasectomy, we reviewed our institutional experience. Methods Between 1990 and 2007, 23 patients with pulmonary metastases from soft tissue sarcomas underwent complete pulmonary resection. All patients had obtained locoregional control of their primary tumors. Various perioperative variables were investigated retrospectively to confirm the role of pulmonary Metastasectomy and to identify possible prognostic factors for survival after Metastasectomy. Results Overall survival rate after Metastasectomy was 43% and 29% at 5 and 10 years, respectively. Disease-free survival rate was 9% at 1 year after pulmonary resection. On multivariate analysis, no tumor recurrence (neither locoregional recurrence nor extrapulmonary metastasis) before pulmonary metastasis provided a significantly favorable overall survival ( P = 0.038). In addition, repeat Metastasectomy for recurrent pulmonary metastasis also provided a favorable overall survival ( P = 0.041). Conclusions Our data suggested that patients most likely to benefit from pulmonary Metastasectomy for soft tissue sarcoma have no tumor recurrence before pulmonary metastasis. Furthermore, patients with repeat Metastasectomy for recurrent pulmonary metastasis also presented a significantly longer survival.
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clinical features of surgical resection for pulmonary metastasis from breast cancer
Ejso, 2009Co-Authors: Fengshi Chen, T Fujinaga, Kiyoshi Sato, Makoto Sonobe, Tsuyoshi Shoji, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Kenichi Okubo, Toshiki HirataAbstract:Abstract Background and objectives Metastatic breast cancer has been defined as a systemic disease. The discussion concerning the resection of lung metastases in patients with breast cancer is controversial. To confirm the role of resection of pulmonary metastases from breast cancer and to identify possible prognostic factors, we reviewed our institutional experience. Methods Between 1991 and 2007, 41 patients with pulmonary metastases from breast cancers underwent complete pulmonary resection. All patients had obtained or had obtainable locoregional control of their primary tumors. Various perioperative variables were investigated retrospectively to confirm the role of Metastasectomy and to analyze prognostic factors for overall survival after Metastasectomy. Results All patients were female with a median age of 55 years (range, 35–81 years). The overall survival rate after Metastasectomy was 51% at 5 and 10 years. On multivariate analysis, fewer than four pulmonary metastases and a disease-free interval of more than 3 years were significantly favorable prognostic factors for overall survival ( p = 0.023 and 0.024, respectively). Conclusions The current practice of pulmonary Metastasectomy for breast cancers in our institution was well justified. Pulmonary Metastasectomy in patients with previous breast cancer might be justified when fewer than four pulmonary metastases or a disease-free interval of more than 3 years.
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Prognostic factors of pulmonary Metastasectomy for colorectal carcinomas.
World journal of surgery, 2009Co-Authors: Fengshi Chen, Kiyoshi Sato, Makoto Sonobe, Tsuyoshi Shoji, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Nobuharu Hanaoka, Takuji Fujinaga, Kenichi OkuboAbstract:Background Pulmonary Metastasectomy for colorectal carcinoma is a well-accepted procedure; however, reports on indications and prognostic factors are inconsistent. This study was designed to clarify a role for resection of pulmonary metastases for such tumors and to define the patients who benefit from pulmonary Metastasectomy.
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pulmonary resection for metastasis from esophageal carcinoma
Interactive Cardiovascular and Thoracic Surgery, 2008Co-Authors: Fengshi Chen, Kiyoshi Sato, Hiroaki Sakai, Ryo Miyahara, Toru Bando, Kenichi Okubo, Toshiki Hirata, Hiroshi DateAbstract:: Pulmonary Metastasectomy has become the standard therapy for various metastatic malignancies to the lungs; however, few data have been available regarding lung Metastasectomy for esophageal carcinoma. To confirm a role for resection of pulmonary metastases for such tumors, we reviewed our institutional experience. Between 2001 and 2007, five patients with pulmonary metastases from esophageal carcinoma underwent complete pulmonary resection. All patients had undergone curative resection of their primary esophageal carcinomas and also had obtained locoregional control of their primaries. Disease-free interval varied from 13 to 56 months, with a median of 21 months. In three patients, lung metastases were found to be unilateral and solitary. The other two patients presented several metastases in the unilateral or bilateral lungs. All patients underwent wedge resection or segmentectomy. Currently, four patients are alive without evidence of disease and one patient has died of disease. All patients undertook or were going to undertake chemotherapy after the pulmonary Metastasectomy. Three patients with solitary metastasis are all alive without disease 13, 48, and 90 months after the first pulmonary Metastasectomy, respectively. Pulmonary Metastasectomy for esophageal carcinoma with postoperative chemotherapy was seemingly justified. Solitary pulmonary metastasis might be a good candidate for favorable prognostic factor.
Francesca Fiorentino - One of the best experts on this subject based on the ideXlab platform.
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Is survival really better after repeated lung Metastasectomy?
Clinical & Experimental Metastasis, 2020Co-Authors: Francesca Fiorentino, Tom TreasureAbstract:Several groups have observed that average survival time after a second lung Metastasectomy is longer than after a first Metastasectomy. The randomised controlled trial Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) found no survival benefit from lung Metastasectomy. In fact, median survival was longer, and four-year overall survival was higher, in the control group than in those randomly assigned to Metastasectomy, although not significantly so. The illusion of benefit is because survival without Metastasectomy has been assumed to be near zero, as stated in Society of Thoracic Surgeons’ Expert Consensus Document on Pulmonary Metastasectomy 2019. It has been repeatedly found that survival is influenced by the selection of patients who have characteristics associated with better prognosis. The passage of time while monitoring and assessing patients, and observing their rate of progression, provides for immortal time bias. Reselection of the most favourable patients for repeated Metastasectomy is the likely reason for any differences in survival between first and repeated Metastasectomy operations.
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Pulmonary Metastasectomy: what is the practice and where is the evidence for effectiveness?
Thorax, 2014Co-Authors: Tom Treasure, Francesca Fiorentino, Misel Milosevic, Fergus MacbethAbstract:Pulmonary Metastasectomy is a commonly performed operation and is tending to increase as part of a concept of personalised treatment for advanced cancer. There have been no randomised trials; belief in effectiveness of Metastasectomy is based on registry data and surgical follow-up studies. These retrospective series are comprised predominately of solitary or few metastases with primary resection to Metastasectomy intervals longer than 2–3 years. Five-year survival rates of 30–50% are recorded, but as case selection is based on favourable prognostic features, an apparent association between Metastasectomy and survival cannot be interpreted as causation. Cancers for which lung Metastasectomy is used are considered in four pathological groups. In non-seminomatous germ cell tumour, for which chemotherapy is highly effective, excision of residual pulmonary disease guides future treatment and in particular allows an informed decisions as to further chemotherapy. Sarcoma metastasises predominately to lung and pulmonary Metastasectomy for both bone and soft tissues sarcoma is routinely considered as a treatment option but without randomised data. The commonest circumstance for lung and liver Metastasectomy is colorectal cancer. Repeated resections and ablations are commonplace but without evidence of effectiveness for either. For melanoma, results are particularly poor, but lung metastases are resected when no other treatment options are available. In this review, the available evidence is considered and the conclusion reached is that in the absence of randomised trials there is uncertainty about effectiveness. A randomised controlled trial, Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), is in progress and randomised trials in sarcoma seem warranted.
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pulmonary Metastasectomy for colorectal cancer making the case for a randomized controlled trial in the zone of uncertainty
The Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Francesca Fiorentino, Tom TreasureAbstract:Survival after pulmonary Metastasectomy, from the earliest to the most recent reports, has been related to the number of metastases and the time to their appearance. The fewer the metastases and the longer the interval between primary surgery and Metastasectomy, the better is survival. 1 Many clinical reports (by now there are>100 for colorectal cancer) have implied that survival is gained by pulmonary Metastasectomy and have encouraged widening the indications. A survey of members of the European Society of Thoracic Surgeons, from November 2006 through January 2007, found that the large majority of responding surgeons (86%) placed no upper limit on the number of pulmonary metastases they were prepared to resect and 64% would perform a Metastasectomy within a year of the primary cancer surgery. 2 An alternative explanation for the association between Metastasectomy and longer survival is that careful selection of patients with favorable prognostic features, which is central to the management of these patients, gathers in patients likely to survive longer. Observational studies with larger numbers of patients and better statistical analyses have shown that the old rules still apply and a more liberal implementation of pulmonary Metastasectomy is associated with diminishing returns or worse, and it becomes evident that benefit in these patients is improbable and therefore they should be excluded. 1,3 In this brief review we examine observational data and mathematic modeling. We conclude that a clinical trial, focusing on the zone of uncertainty, is needed. The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial, based on that reasoning, is recruiting patients in Europe (http://www. rbht.nhs.uk/research/cteu/projects/respiratory-disease/ pulmicc/).
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Pulmonary Metastasectomy in colorectal cancer: a prospective study of demography and clinical characteristics of 543 patients in the Spanish colorectal Metastasectomy registry (GECMP-CCR)
BMJ open, 2013Co-Authors: Raul Embun, Francesca Fiorentino, Tom Treasure, J.j. Rivas, Laureano MolinsAbstract: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 Espanol de Cirugia Metastasis 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.
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pulmonary Metastasectomy for sarcoma a systematic review of reported outcomes in the context of thames cancer registry data
BMJ Open, 2012Co-Authors: Tom Treasure, Francesca Fiorentino, Marco Scarci, Henrik Moller, Martin UtleyAbstract:Objectives Sarcoma has a predilection to metastasis to the lungs. Surgical excision of these metastases (pulmonary Metastasectomy) when possible has become standard practice. We reviewed the published selection and outcome data. Design Systematic review of published reports that include survival rates or any other outcome data. Survival data were put in the context of those in a cancer registry. Setting Specialist thoracic surgical centres reporting the selection and outcome for pulmonary Metastasectomy in 18 follow-up studies published 1991–2010. Participants Patients having one or more of 1357 pulmonary Metastasectomy operations performed between 1980 and 2006. Interventions All patients had surgical pulmonary Metastasectomy. A first operation was reported in 1196 patients. Of 1357 patients, 43% had subsequent Metastasectomy, some having 10 or more thoracotomies. Three studies were confined to patients having repeated pulmonary Metastasectomy. Primary and secondary outcome measures Survival data to various time points usually 5 years and sometimes 3 or 10 years. No symptomatic or quality of life data were reported. Results About 34% and 25% of patients were alive 5 years after a first Metastasectomy operation for bone or soft tissues sarcoma respectively. Better survival was reported with fewer metastases and longer intervals between diagnosis and the appearance of metastases. In the Thames Cancer Registry for 1985–1994 and 1995–2004 5 year survival rates for all patients with metastatic sarcoma were 20% and 25% for bone, and for soft tissue sarcoma 13% and 15%. Conclusions The 5 year survival rate among sarcoma patients who are selected to have pulmonary Metastasectomy is higher than that observed among unselected registry data for patients with any metastatic disease at diagnosis. There is no evidence that survival difference is attributable to Metastasectomy. No data were found on respiratory or any other symptomatic benefit. Given the certain harm associated with thoracotomy, often repeated, better evidence is required.