Percutaneous lung ablation of pulmonary recurrence may improve survival in selected patients undergoing cytoreductive surgery for colorectal cancer with peritoneal carcinomatosis. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Bin Traiki, T.A.; Fisher, O.M.; Valle, S.J.; Parikh, R.N.; Kozman, M.A.; Glenn, D.; Power, M.; Liauw, W.; Alzahrani, N.A.; Morris, D.L.
• Is Part Of: European journal of surgical oncology. Volume 43:Issue 10(2017:Oct.)
• Page Start: 1939
• Page End: 1948
• Publication Date: 2017-10
• Subjects: Colorectal cancer -- Cytoreductive surgery -- Heated intraperitoneal chemotherapy -- Lung metastasis -- Percutaneous lung ablation therapy -- Radiofrequency & microwave ablation; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2017.08.005
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Purpose: To analyze the outcomes of patients developing pulmonary metastases (PM) following cytoreductive surgery (CRS) and perioperative intra-peritoneal chemotherapy (IPC) for colorectal cancer (CRC) with peritoneal carcinomatosis. Patients and methods: A retrospective analysis of patients undergoing CRS/IPC for CRC from 1996 to 2016 was performed. Lung-specific disease-free and patient overall survival was analyzed. Patients undergoing percutaneous lung ablative therapy (PLAT) for PM were compared to patients receiving systemic chemotherapy alone. Results: 273 patients underwent CRS/IPC for CRC. Of these, 61 (22%) developed PM. Median time to development of PM was 8 months (range 0–52 months) and 41 patients (67%) had metachronous lesions. Twenty-one PM patients underwent PLAT, either by radio-frequency or micro-wave ablation, for an average of 3 lesions (range 1–12) and 13 (62%) had bilobar disease. The most common post-interventional complication was the development of pneumothorax (71%). Overall survival following development of PM was 18 months and higher in patients undergoing PLAT compared to those treated with systemic chemotherapy (26 vs. 14 months, p = 0.03). In eight cases (38%) local tumor recurrence developed post-PLAT. A peritoneal carcinomatosis index >10 (HR 3.48, 95% CI 1.69–7.19), presence of liver metastases (HR 2.49, 95% CI 1.24–5.03) and PLAT (HR 0.43, 95% CI 0.20–0.93) were identified as significant predictors of overall survival following diagnosis of PM. Conclusion: PM develop in approximately a fourth of patients undergoing CRS/IPC for CRC. Of these, about 1/3 may be eligible for PLAT. PLAT is a valuable treatment option providing good local control and potentially prolongation of overall survival.