Percutaneous lung ablation of pulmonary recurrence may improve survival in selected patients undergoing cytoreductive surgery for colorectal cancer with peritoneal carcinomatosis

Publication date: Available online 31 August 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Thamer A. Bin Traiki, Oliver M. Fisher, Sarah J. Valle, Roneil N. Parikh, Mathew A. Kozman, Derek Glenn, Mark Power, Winston Liauw, Nayef A. Alzahrani, David L. Morris
PurposeTo 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 MethodsA retrospective analysis of patients undergoing CRS/IPC for CRC from 1996-2016 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.Results273 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.ConclusionPM 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.



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