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KMID : 1188520130090010013
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Korean Journal of Clinical Oncology
2013 Volume.9 No. 1 p.13 ~ p.16
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Surgical resection for pulmonary metastasis
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Kim Dong-Kwan
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Abstract
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The lung is the most frequent extra-abdominal metastatic site for hepatocellular carcinoma (HCC) and colorectal cancer. Pulmonary metastasis was reported in 10% of the patients treated with curative surgery for colorectal cancer. Extrahepatic metastases of HCC have been reported to occur in 14%-42% of the patients with pulmonary metastasis occurring in 50%-60%. Systemic chemotherapy has largely been ineffective in the management of pulmonary metastasis leaving surgery as the proven treatment of choice for treating resectable lung metastasis. Patient selection is the key to achieving successful surgical resection of pulmonary metastases. All pulmonary metastases should be removed when perfoming the metastasectomy and wedge resection has usually been found to be sufficient although pneumonectomy may be necessary in some cases. Factors to consider in determining the surgical approach include the size, number and location of the metastatic lesion. At the time of surgery, obtaining a clear resection margin with as little normal lung tissue as possible is mandatory to reduce the possibility of local recurrence. While the median survival and 1-year survival rate of HCC patients with pulmonary metastasis treated with chemotherapy were 4.6-14.0 months and 20%-30%, respectively, the 5-year survival rate of patients undergoing metastasectomy was reported to be about 25%-35%. The reported 5-year survival rates of patients with colorectal cancer after metastasectomy ranged between 24% and 63%. Although several studies have investigated the prognostic factors for survival in HCC patients undergoing pulmonary metastasectomy, the prognostic factors remain undefined. In case of colorectal cancer, completeness of the pulmonary metastases resection, preoperative carcinoembryonic antigen level, and presence of intrathoracic lymph node metastasis were found to be significant prognostic factors. Resection of pulmonary metastases confers a survival benefit to a select patient and
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KEYWORD
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Hepatocellular carcinoma, Colorectal cancer, Pulmonary metastasis, Metastasectomy
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