Lung Metastasis
Lung metastases from colorectal cancer occur in approximately 10–20% of patients. In the absence of extrapulmonary metastases, the surgical removal of lung metastases can be curative treatment in selected patients. The actuarial survival after completed r
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Dae Joon Kim
Abstract
Lung metastases from colorectal cancer occur in approximately 10–20% of patients. In the absence of extrapulmonary metastases, the surgical removal of lung metastases can be curative treatment in selected patients. The actuarial survival after completed resection was 36% at 5 years according to the International Registry of Lung Metastases, and Thomford criteria for pulmonary metastasectomy have been widely accepted by thoracic surgeons. The standard procedure for peripherally located lesion is wedge resection, but lobectomy can be done for central lesion in highly selected patients. However, there have been controversies in the optimal timing of surgery, the role of mediastinal lymphadenectomy, and the survival benefit after repeated pulmonary metastasectomy. The nonsurgical intervention such as RFA or SABR can be applied to the patients who are not physiologically unfit for surgery. Keywords
Colorectal cancer · Lung metastasis · Surgical resection
D. J. Kim Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, South Korea e-mail: [email protected]
35.1 Introduction Lung metastases from colorectal cancer occur in approximately 10–20% of patients [1, 2]. Although the liver has been regarded as the first site of metastases, metastases bypassing the liver have been reported over the years. Unlike bone or lymph node metastases, lung metastasis is influenced by the primary site. Rectal cancers are more likely to present the lung metastasis than colon cancers, and even in rectal cancers, lung metastases are more common in patients with mid- or distal rectal cancers [3]. The isolated lung metastases were observed in 1–5.9% of colon cancer and in up to 11.7% in rectal cancer [1]. It is unclear why rectal cancers show more frequent lung metastases and anatomical factors as well as molecular genetics play an important role. Considering that lung metastases are thought to occur via hematogenous spread rather than via lymphogenous spread, vascular anatomy might be particularly important. The distal rectum drains into the inferior rectal vein which drains directly into the inferior vena cava and reaches the lung quickly. On the contrary, the colon and upper rectum drain into the portal venous system, and cancer cells arising from these areas reach the liver as the first site of metastases [4]. In the absence of extrapulmonary metastases, the surgical removal of lung metastases can be curative treatment in some patients. The multidisciplinary approach with surgical resection,
© Springer Nature Singapore Pte Ltd. 2018 N. K. Kim et al. (eds.), Surgical Treatment of Colorectal Cancer, https://doi.org/10.1007/978-981-10-5143-2_35
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chemotherapy, and interventional procedures provides the best treatment option in this subset of patients, and it should begin with the assessment of resectability. Although there is no prospective, randomized trial comparing the pulmonary metastasectomy to control, the surgical resection of lung metastases fro
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