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  • br Please cite this article as Yang KM

    2020-08-07


    Please cite this article as: Yang KM et al., Benefits of repeated resections for liver and lung metastases from colorectal cancer, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.03.002
    + MODEL
    OS
    RFS1
    Non-surgical Treatment (n=13)
    RFS3
    Figure 1 Study workflow profile. Multiple sites include peritoneal seeding. LR; local recurrence, DLNs; distant Fulvestrant (ICI 182,780) node metastasis.
    Among the 248 patients who underwent first meta-stasectomy, 197 (79.4%) underwent adjuvant chemo-therapy. Because almost 80% of patients underwent chemotherapy, it was difficult to compare these patients to those who did not undergo chemotherapy. The 3-year RFS rates and 5-year OS rates were not significantly different between patients who underwent adjuvant chemotherapy and those who did not undergo chemotherapy (54.2% vs. 48.5%, p Z 0.736; 75.4% vs. 43.4%, p Z 0.732).
    3.2. OS and RFS rates after initial and repeat metastasectomies
    respectively (p Z 0.028, Fig. 2C). There were no statisti-cally significant differences in RFS between the patients who underwent a first metastasectomy and those who un-derwent a second metastasectomy; however, those who underwent a third metastasectomy showed a significantly lower RFS rate than to those who underwent only a single repeated resection (p Z 0.028).
    3.3. Multivariate analysis of OS rate after first metastasectomy
    p Z 0.028) were the significant risk factors for OS. Resected number of metastases >1, resected number of organs, TNM stage of the primary tumor, location of the primary tumor, preoperative serum CEA levels (>6 ng/mL), and presence of lymphovascular or perineural invasion had no statistically significant association with OS1 (see Table 3).
    4. Discussion
    Approximately 50e60% and 10e20% of patients who un-dergo curative resections for CRC will develop liver and
    Please cite this article as: Yang KM et al., Benefits of repeated resections for liver and lung metastases from colorectal cancer, Asian Journal of Surgery, https://doi.org/10.1016/j.asjsur.2019.03.002
    + MODEL
    Repeat metastasectomy from colorectal cancer 5
    Table 2 Profile of the repeat resections.
    Variable 1st metastasectomy
    2nd metastasectomy
    3rd metastasectomy P-value
    Resection organ site, n (%)
    Liver or lung and others
    Others only
    Resected tumor number (lung), n
    Resected tumor number (liver), n
    Type of pulmonary resection, n (%)
    Type of hepatic resection, n (%)
    Complications (Clavien-Dindo), n
    lung metastases, respectively.2,3 Although resections for recurrent liver or lung metastases with curative intent may result in greater long-term survival, recurrence was com-mon after initial metastasectomy.3e6,8 Patients with limited-recurrent liver or lung metastases that are consid-
    ered for repeated resections have favorable out-comes.5,9,11,12 However, controversies remain when
    metastases are found concomitantly in both organs or develop in other organs.
    Until recently, resection for metastatic CRC has mostly been performed in patients with isolated hepatic or pul-monary metastases. Since the liver and lung are the most common sites of metastasis, surgery might be indicated for patients with limited liver-only or lung-only metastases, while a systemic treatment might be more suitable for patients with liver metastases and extrahepatic disease or concurrent lung metastasis. However, recent studies have demonstrated that the resection of liver metastases and limited-resectable concurrent extrahepatic disease can result in higher long-term survival.13e18 Indeed, surgical managements in patients with both hepatic and pulmonary metastases has shown survival benefits that are comparable to those of hepatic or pulmonary metastasectomies.19,20 Therefore, the presence of extrahepatic disease and con-current hepatic and pulmonary metastases should no longer be considered an absolute contraindication for curative
    surgery. In our study, if a resection was possible, then we performed a metastasectomy, even if the metastases developed in both the liver and lungs or the liver with concurrent extrahepatic disease. Furthermore, if there were extrahepatic or extrapulmonary metastases after the first metastasectomy, we performed metastasectomies in cases with a solitary metastasis or a metastasis that was limited to a single organ. Indeed, we tried to analyze the liver and lung together, even though these are different entities. It is meaningful to know the oncologic outcomes for both organs because the liver and lung are the most common sites for colorectal cancer metastasis.
    Our study demonstrated that repeat metastasectomies in patients who underwent previous liver and/or lung re-sections for CRC metastases can be performed Fulvestrant (ICI 182,780) safely, and good long-term survival can be achieved in select patients. There were no statistically significant differences in OS1 and OS2 (74.8% vs. 62.4%, p Z 0.207) or in OS2 and OS3 (62.4% vs. 45.6%, p Z 0.207) rates. This observation sug-gests that the survival benefits of repeat metastasectomies for recurrent metastases are consistent, regardless of the number of previous metastasectomies.