Radical Surgery beneficial in metastatic Colorectal Cancer: IJS study

There lies an overall survival benefit following a radical surgery in patients with colorectal cancer having synchronous metastasis to both lung and liver- reveals a latest study published in the Indian Journal of Surgery.

Colorectal cancer (CRC) leads to metastatic disease in approximately 30% of patients. In patients with newly diagnosed CRC with both liver and lung metastases, curative resection is rarely possible. The liver and lung are the most frequent sites of metastatic spread in these patients. CRC with synchronous metastasis has an unfavorable prognosis, and the overall survival (OS) is reduced in comparison to metachronous metastases (5-year OS of 39% vs 48%).

Up to 42% of patients with liver metastases also develop lung metastases. In patients with metachronous liver and lung metastases, resection of metastases is a well-established strategy leading to prolonged survival or even potential cure in some cases. However, the increased number of metastases as well as the sites of the metastatic spread means more systemic disease and decreases the chance for curative resection while also leading to a worse overall prognosis

Conduct of study

The indication for resection was made on an individual basis and depended on the likelihood to achieve R0 resection for the primary tumour and all metastases, sufficient liver remnant volume after the liver resection, and sufficient cardio-pulmonary function for the planned lung resection.

Lung surgery: All patients were treated with either a wedge or segment resection. Video-assisted thoracoscopic resection (VATS) was performed in 4 patients. Liver resection: The primary resection was the first surgical step in one patient, with subsequent liver metastasectomy performed after 13 months. The liver metastases were resected as a liver first concept in 3 patients with advanced liver findings and the risk of becoming not resectable. The time span between liver metastasectomy and primary resection were 2, 3 and 3 months. Simultaneous colorectal and liver resections were performed in 4 patients.

The patients also received various protocols of systemic therapy, and the treatment was performed at the oncological department. Neoadjuvant therapy was performed in 6 patients with 3 to 11 cycles of various schemes (FOLFOX + bevacizumab, Xelox + bevacizumab).

Study design

The researchers conducted a retrospective analysis of colorectal cancer patients (n=8, median age 54.3 years) with simultaneous liver and lung metastasis undergoing resection with curative intent and evaluated the overall (OS) and relapse-free survival (RFS) rates of these patients. Follow-up of patients: during the first 2 postoperative years, patients underwent clinical examination, computed tomography of chest and abdomen, and CEA testing every 3 months and, after that, every half a year until 5 years postoperatively.

Results

• Colon was the primary tumour site in 2 patients and rectum in 6 patients.

• The median number of liver and lung metastases was 3 and 2, respectively.

• R0 resection was achieved after all but one procedure.

• Two severe Clavien-Dindo grade IIIb complications were present.

• Median hospital stay was 9 (3–24) days per procedure.

• Tumour relapse was observed in all patients with median RFS of 9 (3–28) months and median OS of 40 (17–52) months. In 4 cases, where repeated resection of recurrent metastases (3 liver and 1 lung) was possible, the median OS was 43 months.

Conclusion

This study suggests that patients seem to benefit from resection with curative intent, with tendency to prolonged OS and with acceptable complication rate. Tumour recurrence occurred in all patients. Repeated resection was beneficial and led to further prolonged OS.

Take home message: All the patients who are fit for surgery, with possibility of R0 resection of all tumours should be offered the radical resection. a systemic chemotherapy therapy offers surgery further overall survival benefit

Source: "Outcome of Radical Surgery for Simultaneous Liver and Lung Metastases Synchronous with Primary Colorectal Cancer"

https://link.springer.com/article/10.1007/s12262-021-02848-5