JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Haruhiko Kondo
Haruhiko Nakayama
Hisao Asamura
Ryosuke Tsuchiya
Tsuguo Naruke
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Okumura, S.
Right arrow Articles by Naruke, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Okumura, S.
Right arrow Articles by Naruke, T.

J Thorac Cardiovasc Surg 1996;112:867-874
© 1996 Mosby, Inc.

GENERAL THORACIC SURGERY

PULMONARY RESECTION FOR METASTATIC COLORECTAL CANCER: EXPERIENCES WITH 159 PATIENTS

Shinji Okumura, MD, Haruhiko Kondo, MD, Masahiro Tsuboi, MD, Haruhiko Nakayama, MD, Hisao Asamura, MD, Ryosuke Tsuchiya, MD, Tsuguo Naruke, MD

From the Division of Thoracic Surgery, National Cancer Center Hospital, 1-1, Tsukiji 5-chome, Chuo-ku, Tokyo, 104, Japan.

Received for publication Nov. 21, 1995 Revisions requested Jan. 9, 1996; revisions received April 8, 1996 Accepted for publication May 17, 1996. Address for reprints: Haruhiko Kondo, MD, Division of Thoracic Surgery, National Cancer Center Hospital, 1-1, Tsukiji 5-chome, Chuo-ku, Tokyo 104, Japan.

Abstract

We reviewed the clinical courses of 159 patients between February 1967 and May 1995 for the purpose of examining the survival of patients who had pulmonary resection for metastatic colorectal cancer. The cumulative survivals at 5 years and 10 years were 40.5% and 27.7%, respectively. Fifteen patients (10%) were alive more than 10 years after the thoracotomy without any evidence of recurrence. The cumulative survival at 5 years for 39 patients who had hepatic metastases before thoracotomy was 33%. There was a statistically significant difference in survival between patients with extrapulmonary metastases and those with only intrapulmonary metastases before thoracotomy. The number of pulmonary metastases and the presence of hilar or mediastinal lymph node metastases affected postthoracotomy survival. There was no significant difference in survival on the basis of sex, age, location of the primary cancer, size of the pulmonary tumors, mode of operation, or disease-free interval. Surgical treatment for pulmonary metastases from colorectal cancer in selected patients, even those who had hepatic metastases before thoracotomy, might improve prognosis. (J THORAC CARDIOVASC SURG 1996;112:867-74)

Surgical therapy has been attempted for metastatic lung tumors since Thomford, Woolner, and ClagettGo 1 published the principles for surgical treatment of metastatic lung tumors in 1965. As for resection of pulmonary metastases from colorectal cancer, documented 5-year survivals after resection of pulmonary metastases varied among institutions, ranging from 22% to 42%.Go Go 2-10 WeGo 7 also reported our experience with 62 patients who underwent resection of pulmonary metastases from colorectal cancer in 1988. In that series, we could not show that surgical resection of pulmonary metastases improved the cure rate. Furthermore, the significance of pulmonary metastatectomy for patients who had hepatic metastases before thoracotomy was unknown. In the present series, the clinical courses of 159 patients were reviewed and followed for a much longer time. In addition, this study included 39 patients who had hepatic metastases before thoracotomy. Therefore we believe it is possible to examine the significance of pulmonary resection for metastatic colorectal cancer more accurately than in our previous report.

Patients and methods

A total of 162 patients underwent pulmonary resection for metastatic lesions from colorectal cancer between February 1967 and May 1995 in the National Cancer Center Hospital in Japan. There were three hospital deaths within 30 days of the operation, and 159 patients were available for review in this study. Criteria for resection of pulmonary metastases were as follows: (1) The patient must be able to tolerate the required surgical procedure and the remaining respiratory function is considered to be good enough for ordinary life. (2) Unilateral or bilateral lung lesions can be seen on a chest roentgenogram or a computed tomographic scan and those lesions presumably could be completely resected. (3) There are no distant metastases without pulmonary lesions and there was no evidence of local recurrence of the primary cancer. (4) It is possible to completely remove both hepatic and pulmonary metastases, if present.

GoTable I summarizes the characteristics of the 159 patients. We divided the patients into three groups. Group A consisted of 111 patients who had no extrapulmonary metastatic lesions before thoracotomy. Group B included 39 patients who had hepatic metastases before or at the time of thoracotomy. Ten patients who underwent simultaneous resection of pulmonary and hepatic metastases were included in group B. Group C was composed of nine patients who had undergone resection of local recurrence before thoracotomy Go(Table I).


View this table:
[in this window]
[in a new window]
  		Table I. Characteristics of 159 patients who underwent resection of pulmonary metastases from colorectal cancer
 
The medical charts were examined for age; sex; stage and grade of the primary cancer; location, number, and size of the pulmonary metastases; mode of the operation Go(Table I). Also evaluated were the presence of hepatic metastasis or local recurrence (or both) and disease-free interval (DFI) between resection of the primary lesion and clinical detection of pulmonary metastases. The survival after thoracotomy was estimated by the method of Kaplan and Meier.Go 11 The significance of each prognostic factor was determined by the log-rank test.Go 12

Results

Five of the 159 patients (3.1%) underwent incomplete resection for pulmonary metastases because of numerous small lesions (four patients) or involvement of the main bronchus by metastatic lymph nodes (one patient).

The cumulative survivals at 5 years and 10 years were 40.5% and 27.7%, respectively (Fig. 1). Fifteen of the 16 10-year survivors were alive with no evidence of cancer recurrence and only one patient died of metastatic disease. Seven of the 37 patients who survived more than 5 years died of metastatic disease, and five patients died without recurrence. Two patients were alive with recurrent cancer at the time of this report. The other 23 5-year survivors were free of disease.



View larger version (11K):
[in this window]
[in a new window]
  		Fig. 1. Kaplan-Meier survival curve for all 159 patients who underwent resection of pulmonary metastases from colorectal cancer.

 
GoTable II shows survivals 5 years after thoracotomy based on potential prognostic factors. The cumulative survival for patients in group A was 44.9% at 5 years, but for patients in group B it was 33.0%. The difference between these two groups was statistically significant. The cumulative survival for patients in group C at 5 years was 25.0%. There was also a statistically significant difference between group A and group C but no significant difference between group B and group C Go(Table II, Fig. 2).


View this table:
[in this window]
[in a new window]
  		Table II. Survivals 5 years after thoracotomy on the basis of potential prognostic factors
 


View larger version (17K):
[in this window]
[in a new window]
  		Fig. 2. Kaplan-Meier survival curves based on the three groups. Group A, Patients without extrathoracic metastasis before thoracotomy. Group B, Patients with a history of hepatic metastases. Group C, Patients with a history of local recurrences. n, Number of patients.

 
In group A, the cumulative survival for 78 patients with a solitary pulmonary metastasis was 52.5% at 5 years, whereas that for 33 patients with multiple pulmonary metastases was 25.5% (Fig. 3). The difference between these two groups was statistically significant (p = 0.019). Wedge or segmental resection was adopted to preserve respiratory function, especially in the patients with multiple metastases. Fourteen patients (42%) with multiple metastases in group A underwent limited resection, 16 patients (49%) had lobectomy, and three patients (9%) had pneumonectomy. Among the patients with a solitary metastasis in group A, 23 patients (29%) underwent limited resection, 52 (66%) had lobectomy, and three (4%) pneumonectomy. For the patients with a solitary metastasis, the cumulative survivals for the lobectomy and limited resection groups were 45.6% and 73.3%, respectively, at 5 years (p = 0.080) (Fig. 4). The intrapulmonary recurrence rates after limited resection for the patients with multiple tumors and a solitary tumor were 50% (7/14) and 39% (9/23), respectively. In this series, we could not examine marginal recurrence after limited pulmonary resection. The cumulative survival for 52 patients with a DFI of more than 24 months was 50.1% at 5 years, whereas that for 57 patients with a DFI of less than 24 months was 40.6%. There was no significant difference in survival based on DFI for the patients in group A (p = 0.486).



View larger version (15K):
[in this window]
[in a new window]
  		Fig. 3. Kaplan-Meier survival curves for the patients with a solitary metastasis and the patients with multiple metastases in group A (p = 0.019).

 


View larger version (14K):
[in this window]
[in a new window]
  		Fig. 4. Kaplan-Meier survival curves for the patients who underwent limited resection and the patients who underwent lobectomy in group A with a solitary metastasis (p = 0.08). n, number of patients.

 
In group B, the 5-year survival even for the patients who had hepatic metastases before thoracotomy was 33.0%. Twenty patients had a solitary hepatic metastasis, three patients had two hepatic metastases, and four patients had three. In 12 patients the number of hepatic metastases was unknown. There was no significant difference in the survivals between the group of the patients with solitary hepatic metastases and those with multiple metastases (p = 0.26). Two of the four patients who survived more than 5 years died of metastatic disease and one patient was alive with recurrent cancer. The other patient was free of disease. The only statistically significant difference in survival for the patients in group B was that concerning the number of pulmonary metastases. The cumulative survival for 22 patients with a solitary pulmonary metastasis was 43.7% at 5 years, whereas that for 17 patients with multiple pulmonary metastases in group B was 22.3% (p = 0.047).

In this series, hilar or mediastinal lymph nodes of 100 patients were dissected or sampled and lymph node metastasis from the pulmonary metastases was observed in 15 patients Go(Table II). One of these 15 patients was alive after more than 5 years, but she had been receiving chemotherapy for bone metastasis. The other 14 patients died of metastatic disease within 5 years after the thoracotomy. There was a statistically significant difference in survival between the patients who had hilar or mediastinal lymph node metastases and those who did not (Fig. 5).



View larger version (17K):
[in this window]
[in a new window]
  		Fig. 5. Kaplan-Meier survival curves for patients with or without hilar and/or mediastinal lymph node metastases (p = 0.0004) n, Number of patients.

 
Although the number of patients whose primary cancer was Dukes' grade A was small (11/159), the 5-year survival for these patients was 74.1%. Dukes' A classification was a favorable prognostic factor Go(Table II).

WeGo 7 previously reported that there is a significant difference in survival on the basis of the size of pulmonary metastatic lesions, but in this series the size of the metastatic tumor had no significant bearing on the survival (Fig. 6). No significant differences in survival were based on sex, age, location of the primary lesion, or extent of the operation Go(Table II).



View larger version (16K):
[in this window]
[in a new window]
  		Fig. 6. Kaplan-Meier survival curves according to the size of the pulmonary metastasis (>3.0 cm vs. <3.0 cm) (p = 0.078). n, Number of patients.

 
In this series, there were three favorable prognostic factors or criteria: (1) The lung should be the first metastatic site after resection of the primary cancer; (2) there should be only one metastatic tumor at the time of thoracotomy; and (3) there should be no metastatic hilar or mediastinal lymph nodes. The survivals at 5 years and 10 years for 69 patients who satisfied these three criteria were 62.1% and 47.0%, respectively (Fig. 7). The survivals at 5 years and 10 years for the 90 patients who did not satisfy these criteria were 22.4% and 10.6%, respectively. There was a statistically significant difference between these two groups (p < 0.0001).



View larger version (16K):
[in this window]
[in a new window]
  		Fig. 7. Kaplan-Meier survival curves for 69 patients who satisfied the favorable three criteria given in the text and 90 patients who did not (p < 0.0001).

 
Discussion

The cumulative survivals for the 159 patients involved in this study at 5 years and at 10 years were 40.5% and 27.7%, respectively. These survivals are not dramatically different from those in earlier reports.Go Go 2-10 Wagner and colleaguesGo 13 reported on the significance of resection of hepatic metastases from colorectal cancer based on the difference between the clinical courses of patients with untreated metastases and those with resected metastases. There have been no similar reports on pulmonary metastases or any prospective trials. WeGo 7 also suggested that the survival of the individual patient might be predetermined by the biologic behavior of the primary tumor, or "length bias." Therefore is it not possible to determine the significance of resection of pulmonary metastases from colorectal cancer. Although several patients died of metastatic tumors in 5 to 10 years, 15 patients in this series were alive after more than 10 years with no evidence of cancer recurrence. In addition, 69 patients with favorable factors in our experience had a cumulative survivals of 62.1% and 47.0% at 5 years and 10 years, respectively (Fig. 7). In light of these results, surgical treatment for pulmonary metastases from colorectal cancer not only may have some survival benefit but also may allow potential cure in selected patients.

Although Thomford, Wollner, and ClagettGo 1 excluded patients with extrapulmonary metastases as candidates for thoracotomy, there have been several reports about pulmonary resection for patients with extrapulmonary metastases. McAfee and colleaguesGo 8 said that the presence of resectable extrapulmonary metastases before or at the time of thoracotomy was not associated with a decreased survival. Yano and colleaguesGo 9 also reported that the presence of resectable or controllable hepatic metastases did not decrease the survival. In our series, the presence of extrapulmonary metastases was the unfavorable prognostic factor. This difference was probably caused by the differences in the number of patients, the periods of follow-up, and the indications for resection. Muhe, Gall, and AngemannGo 14 reported the follow-up data of 67 patients who underwent resection for pulmonary metastases from colorectal cancer. That study included 18 patients who had hepatic metastases before thoracotomy, and their 5-year survival was only 18%. The 5-year survival for patients who underwent hepatic resection for metastases for colorectal cancer ranged from 25% to 47.9%.Go Go 15-17 In light of these results, metastatectomy might be beneficial only when the metastasis is confined to the organ that is the first hematogenic metastatic filter from the primary tumor, and it might be of no effect when the secondary metastasis from the first filter organ occurs or when two filter organs of different pathways are affected. However, in our series the cumulative survival at 5 years for 22 patients with a solitary metastasis in group B was as high as 43.7%. At present, it appears that a patient with a solitary pulmonary metastasis potentially benefits from pulmonary resection even when there is a history of hepatic metastasis. Regarding multiple pulmonary metastases in patients who have or had hepatic metastases, the significance of surgical treatment is still unknown. Therefore a prospective studies should be done to determine the significance of resection of pulmonary metastases for patients with extrapulmonary metastases.

As for the extent of pulmonary resection, our preliminary analysis in the middle of the 1980s showed a high incidence (about 30%) of local recurrence at the resected margin in the cases of limited resection. In view of this, we attempted to perform lobectomy in all patients with solitary pulmonary metastases who were expected to have a favorable prognosis. However, the results of this series, as well as of our former report,Go 7 show that the extent of pulmonary resection did not appear to affect the prognosis. Limited resection may be a preferable procedure for pulmonary metastatectomy if there is an adequate surgical margin around the tumor.

Cahan, Gastro, and HajduGo 18 found that 10 of 20 patients who underwent resection for pulmonary metastases from colon had hilar or mediastinal lymph node metastases (or both). On the basis of this finding, they advocated lobectomy and lymph node removal for these metastatic lesions. However, in their series, only one patient with metastatic lymph nodes survived more than 5 years. In our series, resecting pulmonary metastases was not worth while in the patients who had hilar or mediastinal lymph nodes metastases, because the dissection of hilar and mediastinal lymph nodes could not control the disease. We believe that pulmonary metastasis with subsequent lymph node metastasis is in advance of the first step in the "metastatic cascade" advocated by Viadana, Bross, and Pickren.Go 19 Therefore evaluation of hilar and mediastinal lymph nodes is important, and only sampling of those lymph nodes should be attempted to predict the clinical course after thoracotomy.

In conclusion, we believe that pulmonary resection for metastatic tumors from colorectal cancer can improve survival. Furthermore, there appears to be a chance for cure in selected patients with a solitary pulmonary metastasis. Pulmonary metastatectomy has a potential survival benefit to the patient who has multiple pulmonary metastases or who had hepatic metastases before thoracotomy.

References

  1. Thomford NR, Woolner LB, Clagett T. The surgical treatment of metastatic tumors in the lung. J Thorac Cardiovasc Surg 1965;49:357-63.
  2. McCormack PM, Attiyeh FF. Resected pulmonary metastases from colorectal cancer. Dis Colon Rectum 1979;22:536-6.[Medline]
  3. Mountain CF, McMurtrey MJ, Hermes KE. Surgery for pulmonary metastasis: a 20-year experience. Ann Thorac Surg 984;38:323-30.
  4. Mansel JK, Zinsmeister AR, Pairolero PC, Jett R. Pulmonary resection of metastatic colorectal adenocarcinoma: a ten-year experience. Chest 1986;30:109-12.
  5. Phil E, Hughes ES, McDermott FT, Johnson WR, Katrivesis H. Lung recurrence after curative surgery for colorectal cancer. Dis Colon Rectum 1987;30:417-9.[Medline]
  6. Brister SJ, De Varennes B, Gordon PH, Sheiner NM, Pym J. Contemporary operative management of pulmonary metastases of colorectal origin. Dis Colon Rectum 1988;31:786-92.[Medline]
  7. Goya T, Miyazawa N, Kondo H, Tsuchiya R, Naruke T, Suemasu K. Surgical resection of pulmonary metastases from colorectal cancer: 10-year follow-up. Cancer 1989;64:1418-21.[Medline]
  8. McAfee MK, Allen MS, Trastek VF, Ilstrup DM, Deschamps C, Pairolero PC. Colorectal lung metastases: results of surgical excision. Ann Thorac Surg 1992;53:780-6.[Abstract]
  9. Yano T, Hara N, Ichinose Y, Yokoyama H, Miura T, Ohta M. Results of pulmonary resection of metastatic colorectal cancer and its application. J Thorac Cardiovasc Surg 1993;106:875-9.[Abstract]
  10. Wilking N, Petrelli NJ, Herrere L, Regal AM, Mittelman A. Surgical resection of pulmonary metastases from colorectal adenocarcinoma. Dis Colon Rectum 1985;28:562-4.[Medline]
  11. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81.
  12. Peteo R, Peteo J. Asymptomaticlly efficient rank and in variant procedures. J R Stat Soc(A) 1972;135:185-207.
  13. Wagner JS, Adoson MA, Van Heerden JA, Adson MH, Ilstrup DM. The natural history of hepatic metastases from colorectal cancer. Ann Surg 1984;199:502-8.[Medline]
  14. Muhe E, Gall FP, Angemann B. Surgical treatment of metastases to lung and liver. Surg Gynecol Obstet 1981;152:211-4.[Medline]
  15. Nordlinger B, Parc R, Delva E, Quilichini M, Hannoun L, Huguet C. Hepatic resection for colorectal liver metastases. Ann Surg 1987;205:256-63.[Medline]
  16. Fortner JG. Recurrence of colorectal cancer after hepatic resection. Am J Surg 1988;155:378-82.[Medline]
  17. Sugihara K, Hojo K, Moriya Y, Yamasaki S, Kosuge T, Takayama T. Pattern of recurrence after hepatic resection for colorectal metastases. Br J Surg 1993;80:1032-5.[Medline]
  18. Cahan WG, Gastro EB, Hajdu SI. Therapeutic pulmonary resection of colonic carcinoma metastatic to lung. Dis Colon Rectum 1974;17:302-9.[Medline]
  19. Viadana E, Bross IJD, Pickren KW. Cascade spread of blood-borne metastases in solid and nonsolid cancers of human. In: Weiss I, Gilbert HA, editors: Pulmonary metastasis. Boston: Hall, 1978:142-67.



This article has been cited by other articles:


Home page
 Eur. J. Cardiothorac. Surg.Home page
Y. Tanaka, Y. Maniwa, W. Nishio, M. Yoshimura, and Y. Okita
The optimal timing to resect pulmonary metastasis
Eur. J. Cardiothorac. Surg., June 1, 2008; 33(6): 1135 - 1138.
[Abstract] [Full Text] [PDF]

Home page
 Am Soc Clin Oncol Ed BookHome page
H. I. Pass and C. S. Bizekis
Surgical Treatment of Sarcomatous Lung Metastases
ASCO Educational Book, January 1, 2008; 2008(1): 519 - 522.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. Nakajima, T. Murakawa, T. Fukami, A. Sano, M. Sugiura, and S. Takamoto
Is Finger Palpation at Operation Indispensable for Pulmonary Metastasectomy in Colorectal Cancer?
Ann. Thorac. Surg., November 1, 2007; 84(5): 1680 - 1684.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Welter, J. Jacobs, T. Krbek, B. Krebs, and G. Stamatis
Long-Term Survival After Repeated Resection of Pulmonary Metastases From Colorectal Cancer
Ann. Thorac. Surg., July 1, 2007; 84(1): 203 - 210.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
T. D. Yan, J. King, A. Sjarif, D. Glenn, K. Steinke, A. Al-Kindy, and D. L. Morris
Treatment Failure After Percutaneous Radiofrequency Ablation for Nonsurgical Candidates With Pulmonary Metastases From Colorectal Carcinoma
Ann. Surg. Oncol., May 1, 2007; 14(5): 1718 - 1726.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
J. Furak, I. Trojan, T. Szoke, L. Tiszlavicz, J. Eller, and G. Lazar
Visceral pleural infiltration as a negative prognostic factor in lung metastasis
Interactive CardioVascular and Thoracic Surgery, April 1, 2007; 6(2): 196 - 199.
[Abstract] [Full Text] [PDF]

Home page
 Jpn J Clin OncolHome page
M. Uehara, S. Yamamoto, S. Fujita, T. Akasu, Y. Moriya, and A. Morisue
Isolated Right External Iliac Lymph Node Recurrence from a Primary Cecum Carcinoma: Report of a Case
Jpn. J. Clin. Oncol., March 1, 2007; 37(3): 230 - 232.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
S. Welter, J. Jacobs, T. Krbek, C. Poettgen, and G. Stamatis
Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer
Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 167 - 172.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
A. J. Poncelet, A. Lurquin, B. Weynand, Y. Humblet, P. Noirhomme, and on behalf of the 'Groupe d' Oncologie Thoracique D
Prognostic factors for long-term survival in patients with thoracic metastatic disease: a 10-year experience
Eur. J. Cardiothorac. Surg., February 1, 2007; 31(2): 173 - 180.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
T. D. Yan, J. King, A. Sjarif, D. Glenn, K. Steinke, and D. L. Morris
Learning Curve for Percutaneous Radiofrequency Ablation of Pulmonary Metastases From Colorectal Carcinoma: A Prospective Study of 70 Consecutive Cases
Ann. Surg. Oncol., December 1, 2006; 13(12): 1588 - 1595.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
T. D. Yan, J. King, A. Sjarif, D. Glenn, K. Steinke, and D. L. Morris
Percutaneous Radiofrequency Ablation of Pulmonary Metastases from Colorectal Carcinoma: Prognostic Determinants for Survival
Ann. Surg. Oncol., November 1, 2006; 13(11): 1529 - 1537.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
S. Yedibela, P. Klein, K. Feuchter, M. Hoffmann, T. Meyer, T. Papadopoulos, J. Gohl, and W. Hohenberger
Surgical Management of Pulmonary Metastases from Colorectal Cancer in 153 Patients
Ann. Surg. Oncol., November 1, 2006; 13(11): 1538 - 1544.
[Abstract] [Full Text] [PDF]

Home page
 Jpn J Clin OncolHome page
R. Koga, J. Yamamoto, A. Saiura, T. Yamaguchi, E. Hata, and M. Sakamoto
Surgical Resection of Pulmonary Metastases From Colorectal Cancer: Four Favourable Prognostic Factors
Jpn. J. Clin. Oncol., October 1, 2006; 36(10): 643 - 648.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
T. Iizasa, M. Suzuki, S. Yoshida, S. Motohashi, K. Yasufuku, A. Iyoda, K. Shibuya, K. Hiroshima, Y. Nakatani, and T. Fujisawa
Prediction of prognosis and surgical indications for pulmonary metastasectomy from colorectal cancer.
Ann. Thorac. Surg., July 1, 2006; 82(1): 254 - 260.
[Abstract] [Full Text] [PDF]

Home page
 Jpn J Clin OncolHome page
M. Hamada, K. Ozaki, J. Iwata, Y. Nishioka, and T. Horimi
A Case of Rectosigmoid Cancer Metastasizing to a Fistula in ano
Jpn. J. Clin. Oncol., November 1, 2005; 35(11): 676 - 679.
[Abstract] [Full Text] [PDF]

Home page
 Br. J. Radiol.Home page
D Tait
Advances in chemoradiation therapy in rectal cancer: the impact of imaging
Br. J. Radiol., October 1, 2005; 78(Special_Issue_2): S131 - S137.
[Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Shiono, G. Ishii, K. Nagai, J. Yoshida, M. Nishimura, Y. Murata, K. Tsuta, Y. H. Kim, Y. Nishiwaki, T. Kodama, et al.
Predictive Factors for Local Recurrence of Resected Colorectal Lung Metastases
Ann. Thorac. Surg., September 1, 2005; 80(3): 1040 - 1045.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
S. Shiono, G. Ishii, K. Nagai, J. Yoshida, M. Nishimura, Y. Murata, K. Tsuta, Y. Nishiwaki, T. Kodama, and A. Ochiai
Histopathologic Prognostic Factors in Resected Colorectal Lung Metastases
Ann. Thorac. Surg., January 1, 2005; 79(1): 278 - 282.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Inoue, M. Ohta, K. Iuchi, A. Matsumura, K. Ideguchi, T. Yasumitsu, K. Nakagawa, K. Fukuhara, H. Maeda, S.-i. Takeda, et al.
Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma
Ann. Thorac. Surg., July 1, 2004; 78(1): 238 - 244.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Surg. Oncol.Home page
K. Steinke, D. Glenn, J. King, W. Clark, J. Zhao, P. Clingan, and D. L. Morris
Percutaneous Imaging-Guided Radiofrequency Ablation in Patients With Colorectal Pulmonary Metastases: 1-Year Follow-Up
Ann. Surg. Oncol., February 1, 2004; 11(2): 207 - 212.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
U. Pastorino, G. Veronesi, C. Landoni, M. Leon, M. Picchio, P. G. Solli, F. Leo, L. Spaggiari, G. Pelosi, M. Bellomi, et al.
Fluorodeoxyglucose positron emission tomography improves preoperative staging of resectable lung metastasis
J. Thorac. Cardiovasc. Surg., December 1, 2003; 126(6): 1906 - 1910.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
J. Pfannschmidt, T. Muley, H. Hoffmann, and H. Dienemann
Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: Experiences in 167 patients
J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 732 - 739.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
Y. Saito, H. Omiya, K. Kohno, T. Kobayashi, K. Itoi, M. Teramachi, M. Sasaki, H. Suzuki, H. Takao, and M. Nakade
Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment
J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 1007 - 1013.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
O. Rena, C. Casadio, F. Viano, R. Cristofori, E. Ruffini, P. L. Filosso, and G. Maggi
Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience
Eur. J. Cardiothorac. Surg., May 1, 2002; 21(5): 906 - 912.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
M. Higashiyama, K. Kodama, K. Takami, N. Higaki, H. Yokouchi, T. Nakayama, K. Murata, M. Kameyama, J.-i. Ashimura, Y. Naruse, et al.
Intraoperative Lavage Cytologic Analysis of Surgical Margins as a Predictor of Local Recurrence in Pulmonary Metastasectomy
Arch Surg, April 1, 2002; 137(4): 469 - 474.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
S. Zink, G. Kayser, H.-J. Gabius, and K. Kayser
Survival, disease-free interval, and associated tumor features in patients with colon/rectal carcinomas and their resected intra-pulmonary metastases
Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 908 - 913.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. Sakamoto, N. Tsubota, K. Iwanaga, T. Yuki, H. Matsuoka, and M. Yoshimura
Pulmonary Resection for Metastases From Colorectal Cancer
Chest, April 1, 2001; 119(4): 1069 - 1072.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. R. Headrick, D. L. Miller, D. M. Nagorney, M. S. Allen, C. Deschamps, V. F. Trastek, and P. C. Pairolero
Surgical treatment of hepatic and pulmonary metastases from colon cancer
Ann. Thorac. Surg., March 1, 2001; 71(3): 975 - 980.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
M. Inoue, Y. Kotake, K. Nakagawa, K. Fujiwara, K. Fukuhara, and T. Yasumitsu
Surgery for pulmonary metastases from colorectal carcinoma
Ann. Thorac. Surg., August 1, 2000; 70(2): 380 - 383.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
K. Kobayashi, M. Kawamura, and T. Ishihara
SURGICAL TREATMENT FOR BOTH PULMONARY AND HEPATIC METASTASES FROM COLORECTAL CANCER
J. Thorac. Cardiovasc. Surg., December 1, 1999; 118(6): 1090 - 1096.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. B. Zwischenberger and S. K. Alpard
Pulmonary metastasectomy
Ann. Thorac. Surg., July 1, 1999; 68(1): 287 - 288.
[Full Text] [PDF]

Home page
 ChestHome page
T. De Giacomo, E. A. Rendina, F. Venuta, A. M. Ciccone, and G. F. Coloni
Thoracoscopic Resection of Solitary Lung Metastases From Colorectal Cancer Is a Viable Therapeutic Option
Chest, May 1, 1999; 115(5): 1441 - 1443.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
J. M.H. Hendriks, P. E.Y. Van Schil, G. De Boeck, P. R.M. Lauwers, A. A.T. Van Oosterom, E. A.E. Van Marck, and E. J.M. Eyskens
Isolated lung perfusion with melphalan and tumor necrosis factor for metastatic pulmonary adenocarcinoma
Ann. Thorac. Surg., November 1, 1998; 66(5): 1719 - 1725.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
D. Kandioler, E. Kromer, H. Tuchler, A. End, M. R. Muller, E. Wolner, and F. Eckersberger
Long-Term Results After Repeated Surgical Removal of Pulmonary Metastases
Ann. Thorac. Surg., April 1, 1998; 65(4): 909 - 912.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Haruhiko Kondo
Haruhiko Nakayama
Hisao Asamura
Ryosuke Tsuchiya
Tsuguo Naruke
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Okumura, S.
Right arrow Articles by Naruke, T.
Right arrow