Low Rates of Intrapulmonary Local Recurrence After Laser Metastasectomy: A Single-Center Retrospective Cohort Study of Colorectal Cancer Metastases

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2025 Feb 26

PMID 40002277

Authors

Ahmad Shalabi

Sundus F Shalabi

Thomas Graeter

Stefan Welter

Ahmed Ehab

Jonas Kuon

Affiliations

Soon will be listed here.

Abstract

Colorectal pulmonary metastasis is the most common resected metastatic disease of the lung. Pulmonary metastasectomy (PM) for colorectal oligometastases is a well-established intervention with curative intent. Local recurrence at the resection site in the lung is a problem, with an impact on survival. The use of a 1320 nm neodymium:yttrium aluminum garnet (Nd:YAG) laser causes the vaporization and coagulation at the resection line and thereby increases safety margins around the nodule. We aimed to evaluate the local recurrence rate after laser-assisted pulmonary metastasectomy (LPM) for colorectal metastases. We conducted a retrospective analysis of 49 patients treated with laser-assisted pulmonary metastasectomy for 139 metastatic nodules from colorectal cancer from 2010 to 2018. All nodules were resected using Nd:YAG 1320 nm laser, aiming for a safety margin of five mm. The minimum follow-up time after PM was 24 months. Local intrapulmonary recurrence developed at 7 of the 139 (5.0%) resection sites in 5 of the 49 patients (10.2%). Microscopically incomplete resection was a significant risk factor for recurrence ( = 0.023). Larger nodule size (>12 mm) negatively impacted local recurrence ( = 0.024). Nodules larger or equal to 12 mm in size also lowered the patients' probability of survival by 67.29% (HR: 0.3271, 95% CI: 0.1265-0.846, = 0.018). The rate of local recurrence at the resection site after LPM for colorectal metastases is low. Complete resection is a positive predictor of survival without local recurrence. Microscopic complete resection with the addition of vaporization and coagulation at the resection margin seems to be sufficient to prevent local recurrence. However, larger nodules may require larger safety margins.

References

Shiono S, Okumura T, Boku N, Hishida T, Ohde Y, Sakao Y . Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg. 2016; 51(3):504-510. DOI: 10.1093/ejcts/ezw322. View

Handy J, Bremner R, Crocenzi T, Detterbeck F, Fernando H, Fidias P . Expert Consensus Document on Pulmonary Metastasectomy. Ann Thorac Surg. 2018; 107(2):631-649. DOI: 10.1016/j.athoracsur.2018.10.028. View

Rolle A, Kozlowski M . Laser resection of lung parenchyma--a new technical and clinical approach. Rocz Akad Med Bialymst. 2005; 50:193-6. View

Stefani A, Oricchio F, Cinquepalmi A, Aramini B, Morandi U . Is laser-assisted resection preferable to lobectomy for pulmonary metastasectomy?. Lasers Med Sci. 2019; 35(3):611-620. DOI: 10.1007/s10103-019-02856-8. View

Manfredi S, Bouvier A, Lepage C, Hatem C, Dancourt V, Faivre J . Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg. 2006; 93(9):1115-22. DOI: 10.1002/bjs.5349. View

Welter S, Arfanis E, Christoph D, Hager T, Roesel C, Aigner C . Growth patterns of pulmonary metastases: should we adjust resection techniques to primary histology and size?. Eur J Cardiothorac Surg. 2017; 52(1):39-46. DOI: 10.1093/ejcts/ezx063. View

Rolle A, Koch R, Alpard S, Zwischenberger J . Lobe-sparing resection of multiple pulmonary metastases with a new 1318-nm Nd:YAG laser--first 100 patients. Ann Thorac Surg. 2002; 74(3):865-9. DOI: 10.1016/s0003-4975(02)03805-5. View

Forster C, Ojanguren A, Perentes J, Zellweger M, Krueger T, Abdelnour-Berchtold E . Survival prognostic and recurrence risk factors after single pulmonary metastasectomy. J Cardiothorac Surg. 2021; 16(1):357. PMC: 8713404. DOI: 10.1186/s13019-021-01740-3. View

Claramunt N, Hwang D, de Perrot M, Yasufuku K, Darling G, Pierre A . Incidence of Ipsilateral Side Recurrence After Open or Video-Assisted Thoracic Surgery Resection of Colorectal Lung Metastases. Ann Thorac Surg. 2020; 109(5):1591-1597. DOI: 10.1016/j.athoracsur.2019.11.031. View

10.

Pastorino U, Buyse M, Friedel G, Ginsberg R, Girard P, Goldstraw P . Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg. 1997; 113(1):37-49. DOI: 10.1016/s0022-5223(97)70397-0. View

11.

Gerull W, Puri V, Kozower B . The epidemiology and biology of pulmonary metastases. J Thorac Dis. 2021; 13(4):2585-2589. PMC: 8107531. DOI: 10.21037/jtd.2020.04.28. View

12.

Shishido Y, Ishii M, Maeda T, Kokado Y, Masuya D, Kusama T . Survival outcomes of lung metastases from colorectal cancer treated with pulmonary metastasectomy or modern systemic chemotherapy: a single institution experience. J Cardiothorac Surg. 2023; 18(1):327. PMC: 10647062. DOI: 10.1186/s13019-023-02434-8. View

13.

Prisciandaro E, Bertolaccini L, Fieuws S, Cara A, Spaggiari L, Huang L . Multicentre retrospective analysis on pulmonary metastasectomy: an European perspective. Eur J Cardiothorac Surg. 2024; 65(4). DOI: 10.1093/ejcts/ezae141. View

14.

Chung J, Lee S, Yi E, Lim J, Jung J, Son H . Impact of resection margin length and tumor depth on the local recurrence after thoracoscopic pulmonary wedge resection of a single colorectal metastasis. J Thorac Dis. 2019; 11(5):1879-1887. PMC: 6588790. DOI: 10.21037/jtd.2019.05.12. View

15.

Macherey S, Doerr F, Wahlers T, Hekmat K . [Role of Laser Resection in Pulmonary Metastasectomy]. Pneumologie. 2017; 71(7):475-479. DOI: 10.1055/s-0043-102534. View

16.

Baum D, Rolle A, Koschel D, Rostock L, Decker R, Sombati M . Long-Term Follow-Up after Laser-Assisted Pulmonary Metastasectomy Shows Complete Lung Function Recovery. Cancers (Basel). 2024; 16(9). PMC: 11083535. DOI: 10.3390/cancers16091762. View

17.

Welter S, Jacobs J, Krbek T, Poettgen C, Stamatis G . Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer. Eur J Cardiothorac Surg. 2006; 31(2):167-72. DOI: 10.1016/j.ejcts.2006.11.004. View

18.

Brandi G, Derenzini E, Falcone A, Masi G, Loupakis F, Pietrabissa A . Adjuvant systemic chemotherapy after putative curative resection of colorectal liver and lung metastases. Clin Colorectal Cancer. 2013; 12(3):188-94. DOI: 10.1016/j.clcc.2013.04.002. View

19.

Ambrogi M, Aprile V, Sanna S, Forti Parri S, Rizzardi G, Fanucchi O . Reply to Treasure et al. Comment on "Ambrogi et al. Lung Metastasectomy: Where Do We Stand? Results from an Italian Multicentric Prospective Database. 2024, , 3106". J Clin Med. 2024; 13(23). PMC: 11642140. DOI: 10.3390/jcm13237183. View

20.

Higashiyama M, Tokunaga T, Nakagiri T, Ishida D, Kuno H, Okami J . Pulmonary metastasectomy: outcomes and issues according to the type of surgical resection. Gen Thorac Cardiovasc Surg. 2015; 63(6):320-30. DOI: 10.1007/s11748-015-0544-9. View