Ann Thorac Surg 2010;89:380. doi:10.1016/j.athoracsur.2009.10.038
© 2010 The Society of Thoracic Surgeons
Original Articles: General Thoracic
Invited Commentary
Joachim Pfannschmidt, MD, PhD
Department of Surgery, Thoraxklinik am Universitätsklinikum, Amalienstr 5, Heidelberg, 69126 Germany
(Email: joachim.pfannschmidt{at}thoraxklinik-heidelberg.de).
The question of whether to operate on patients who have been diagnosed with pulmonary metastases of colorectal cancer gets more complex as modern chemotherapy and molecular-targeted therapies evolve. It is well known that pulmonary metastasectomy can offer long-term survival rates that are significantly higher than those of the average in-patient with stage IV disease.
The past 2 decades have witnessed tremendous growth in the interest of pulmonary metastasectomy in patients with colorectal cancer. The article by Riquet and colleagues [1] reports their experience with 117 patients who had complete resections (58 patients were operated on before 2000; 59 patients were operated on between 2000 and 2008). There was a significant increase in interest in the treatment with chemotherapy in the more recent time period. This may reflect the more favorable results of the multi-drug regimes with oxaliplatin combined with 5-fluorouracil and leucovorin (FOLFOX), and irinotecan combined with 5-fluorouracil and leucovorin (FOLFIRI), which became available after Food and Drug Administration approval on irinotecan in 1998. The results demonstrate that surgery is becoming more and more part of multi-modality treatment regimes. This should lead the readership toward consideration of a prospective trial to outline the treatment options of surgery and adjuvant modern chemotherapy.
The identification and assessment of prognostic factors is one of the major tasks in clinical cancer research. Riquet and colleagues [1] detailed established clinical factors, as well as infrequently studied factors, such as vascular and lymphatic invasion and visceral pleura invasion. Based on their findings and data of the literature, they suggested an algorithm for patient selection. The suggested algorithm certainly warrants further investigation to be validated and needs to be associated with a scoring system. Although this model is intriguing, stratification based on clinical prognostic factors would be improved by incorporating tumor-specific molecular prognostic factors. The dilemma of clinical prognostic factors is that they are a surrogate marker for the underlying tumor biology. A better understanding of the metastatic process and valid molecular markers may help us to identify patients with a less malignant tumor characteristic who may become candidates for consolidating pulmonary metastasectomy.
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- Riquet M, Foucault C, Cazes A, et al. Pulmonary resection for metastases of colorectal adenocarcinoma Ann Thorac Surg 2010;89:375-380.[Abstract/Free Full Text]
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Ann. Thorac. Surg. 2010 89: 375-380.
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