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Abstract
Introduction. Pulmonary metastasectomy is not part of the standard treatment for colorectal cancer, but it is widely used in practice, although the question of its real effectiveness remains open. The effect of isolated lung chemoperfusion (ILCP) for colorectal cancer lung metastases on metastasectomy outcomes has also not been studied.
Aim. To identify a subgroup (cluster) of patients with colorectal cancer metastases in the lung for whom pulmonary metastasectomy followed by ILCP improves overall survival (OS) compared with standard metastasectomy.
Materials and Methods. The study material was data from 133 patients with colorectal cancer metastases in the lung who underwent metastasectomy between 2016 and 2023 at the Thoracic Surgery Department of the N.N. Petrov NMRC of Oncology. Open metastasectomy followed by ILCP was performed in 59 (44.4 %) patients. In 74 (55.6 %) patients, standard video-assisted and open metastasectomies were performed. The general selection criteria for metastasectomy were cured primary tumor and secondary liver lesions, absence of locoregional recurrence and functional resectability of the patients. Indications for ILCP were resectable pulmonary recurrence, multiple and bilateral lung lesions.
Results. Five-year OS in all patients who underwent metastasectomy (133) was 48.2 ± 6.4 % with a median of 58.5 months. In patients selected from the general cohort for metastasectomy using ILCP, median OS was 54.1 months. After standard metastasectomy, the median overall survival was 60.6 months. The use of ILCP with cisplatin did not offset the effects of the adverse selection factors. A cluster of patients was found who had an increase in OS after ILCP.
Conclusion. In colorectal cancer, metastasectomy followed by ILCP increases OS compared to standard metastasectomy in patients younger than 56 years with no liver metastases and fewer than 6 lung lesions. In our study, there were 15 of 59 such observations (25.4 ± 5.7 %). In the general cohort of patients with pulmonary metastases of colorectal cancer who received modern drug treatment, ILCP with cisplatin as a method of one-time and short-term regional chemotherapy did not significantly affect OS.
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