Past, present, and future perspectives of pulmonary metastasectomy for patients with advanced colorectal cancer
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REVIEW ARTICLE
Past, present, and future perspectives of pulmonary metastasectomy for patients with advanced colorectal cancer Tomohiro Murakawa1 Received: 6 June 2020 / Accepted: 15 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Over a half-century has passed since Thomford et al. proposed the selection criteria for pulmonary metastasectomy, and several prognostic factors have been identified. Although screening modalities and operations have changed dramatically, the important concepts of the selection criteria remain unchanged. Recent improvements in the survival outcomes of colorectal cancer patients undergoing pulmonary metastasectomy may be the result of strict adherence to the selection criteria for oligometastatic lung tumors, which can mimic local disease. Pulmonary metastasectomy has become an important option for selected patients with oligometastasis, based mainly on a large amount of retrospective data, but its effect on survival remains unclear. Curable pulmonary metastasis might be regarded as a “semi-local disease” under the spontaneous control of an acquired alteration in host immune status. The current practice of pulmonary metastasectomy for colorectal cancer focuses on selecting the most appropriate operation for selected patients. However, in the rapidly evolving era of immunotherapy, treatment-naïve patients for whom surgery is not suitable might be pre-conditioned by immunotherapy so that they may be considered for salvage surgery. Keywords Lung metastasectomy · Colorectal cancer · Outcomes · Video-assisted thoracoscopic surgery · Thoracotomy
Introduction According to a recent annual report by the Japanese Association for Thoracic Surgery, in 2017, surgeries for metastatic lung tumors were performed in 8950 patients and 4240 of these tumors were of colorectal origin [1]. Most of the patients (3965 of 4240) underwent video-assisted surgery. In 2007, 5047 cases of metastatic lung tumors were reported, 2461 of which were of colorectal origin and approximately 64% (1580 cases) were managed via video-assisted surgery [2]. In a 1999 report, 2412 operations were performed for metastatic lung tumors, 946 of which were of colorectal origin and approximately 30% (287) of these operations were performed under video assistance [3]. Lung resection for metastasis from colorectal cancer has been doubling every 10 years, and video-assisted surgery has become the standard procedure.
* Tomohiro Murakawa murakawa‑[email protected] 1
Department of Thoracic Surgery, Kansai Medical University, 2‑3‑1 Shin‑machi, Hirakata, Osaka 573‑1010, Japan
How many patients with advanced colorectal cancer have been referred for lung surgery? In 2017, colorectal cancer was diagnosed in 130,124 patients in Japan, 24,305 (18.7%) of whom had stage III disease and 17,099 had stage IV disease, as documented in the Annual Report of Hospital-Based Cancer Registries reported by the Cancer Information Service, National Cancer Center, Japan [4]. It is accepted that pulmonary metastasectomy is suitable for only a limit
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