RATIONALE: The liver is the most common site of metastasis from colorectal cancer. Curative intent liver metastasectomy has shown improvement in overall survival. This manuscript will present the long-term oncologic outcomes of hepatic metastasectomy for colorectal cancer with resectable liver metastasis. METHODS: Data of patients with resectable liver metastases from colorectal cancer who underwent hepatic resection at the Philippine General Hospital over a 10-year period was reviewed. The primary outcome investigated was overall survival. RESULTS: Thirty patients were included in the study. The median overall survival was 20 months, with a 2-year and 5-year overall survival rate of 40% and 6.67% respectively. Eleven (36.67%) patients had disease recurrence, with a median disease-free survival of 16 months. A significant difference in survival was seen between patients with synchronous and metachronous liver metastasis (20.38 and 36.78 months respectively, p=0.0393) and in patients given adjuvant chemotherapy at any time in relation to the occurrence of the liver metastases versus patients who did not receive any adjuvant treatment (34.08 and 18.59 months respectively, p=0.0349). Trends towards improved overall survival were seen in patients 50 years old or less (36.86 versus 21.78 months, p=0.0837) and in patients with a clinical risk score of 2 or less (29.65 versus 19.62 months, p=0.1823), which may show significance in a higher powered study CONCLUSION Improved overall survival was observed among patients with colorectal liver metastases undergoing hepatic metastasectomy compared to no liver resection.
Metastasectomy ; Philippines

The lung is a common site for metastasis of malignant tumors from other organs. The metastatic cascade is a complex process that involves a series of events. Tumors can spread to the lung through hematogenous or lymphangitic routes. In the absence of extrathoracic metastasis, complete resection is associated with increased survival, regardless of histology. With appropriate patient selection, life expectancy is often improved with pulmonary metastasectomy. Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) are 2 approaches that have been increasingly reported for pulmonary tumors. Although these new therapies have yet to match the long-term success rates of surgical therapy, the techniques demonstrate good results in treating high-risk surgical candidates with metastatic lesions to the lungs that would otherwise be considered with resection. This review will focus on the role of local therapy in oligometastasis that arise in the lung.
Life Expectancy ; Lung ; Metastasectomy ; Neoplasm Metastasis ; Patient Selection

PURPOSE: We performed a comparative analysis of the clinicopathologic features and oncologic outcomes of colorectal cancer patients with metachronous versus synchronous metastasis, according to the prognostic factors. METHODS: Ninety-three patients who underwent curative resection for distant metastatic colorectal cancer were included in the study between December 2001 and December 2011. We assessed recurrence-free survival and overall survival in patients with distant metastasis who underwent curative surgery. RESULTS: The most common site of distant metastasis was lung alone (n = 19, 51.4%) in patients with metachronous metastasis, while liver alone was most common in those with synchronous metastasis (n = 40, 71.4%). Overall survival rate was significantly different between patients with synchronous metastasis and metachronous metastasis (34.0% vs. 53.7%; P = 0.013). Incomplete resection of the metastatic lesion was significantly related to poor overall survival in both, patients with synchronous metastasis, and metachronous metastasis. CONCLUSION: Our study indicates that patients developing distant metastasis after initial treatment show a different metastatic pattern and better oncologic outcomes, as compared to those presenting with distant metastasis. Resection with tumor free margins significantly improves survival in patients with metachronous as well as synchronous metastasis.
Colorectal Neoplasms* ; Humans ; Liver ; Lung ; Metastasectomy* ; Neoplasm Metastasis* ; Survival Rate

PURPOSE: To evaluate the effect of pelvic radiotherapy (RT) in patients with stage IV rectal cancer treated with resection of primary tumor with or without metastasectomy. MATERIALS AND METHODS: Medical records of 112 patients with stage IV rectal cancer treated with resection of primary tumor between 1990 and 2011 were retrospectively reviewed. Fifty-nine patients received synchronous or staged metastasectomy whereas fifty-three patients did not. Twenty-six patients received pelvic radiotherapy. RESULTS: Median overall survival (OS), locoregional recurrence-free survival (LRFS), and progression-free survival (PFS) of all patients was 27, 70, and 11 months, respectively. Pathologic T (pT), N (pN) classification and complete metastasectomy were statistically significant factors in OS (p = 0.040, 0.020, and 0.002, respectively). RT did not improve OS or LRFS. There were no significant factors in LRFS. pT and pN classification were also significant prognostic factors in PFS (p = 0.010 and p = 0.033, respectively). In the subgroup analysis, RT improved LRFS in patients with pT4 disease (p = 0.026). The locoregional failure rate of the RT group and the non-RT group were 23.1% and 33.7%, showing no difference in the failure pattern of both groups (p = 0.260). CONCLUSION: Postoperative pelvic RT did not improve LRFS of all metastatic rectal cancer patients; however, it can be recommended to patients with pT4 disease. A complete resection of metastatic masses should be performed if possible.
Disease-Free Survival ; Humans ; Medical Records ; Metastasectomy ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Rectal Neoplasms ; Retrospective Studies

BACKGROUND: This study assessed the efficacy of pulmonary metastasectomy for synovial sarcoma in adult patients. METHODS: Fifty patients, diagnosed with pulmonary metastasis from June 1990 to August 2010, were reviewed retrospectively. Twenty-eight patients underwent complete pulmonary metastasectomy, and their survival was evaluated. Age, sex, time to metastatic progression, laterality, number of tumors, size of largest nodule, and number of metastasectomies were analyzed as potential prognostic factors. RESULTS: In all, 29 patients underwent at least one pulmonary metastasectomy, and 51 resections were performed. One intraoperative mortality occurred, and the 5-year survival rate was 58.4%. Bilateral metastases and early metastatic progression were associated with poor survival in multivariate analyses. CONCLUSION: Surgical resection can be a good option for treating pulmonary metastasis in patients with synovial sarcoma. Repeated resection was feasible with low mortality and morbidity.
Adult* ; Humans ; Metastasectomy* ; Mortality ; Multivariate Analysis ; Neoplasm Metastasis ; Retrospective Studies ; Sarcoma ; Sarcoma, Synovial* ; Survival Rate

BACKGROUND: The new stage of metastatic lung cancer based upon resectability, disease-free interval, and the number of pulmonary metastases was proposed in 1998 by Ginsberg, et al. We evaluated the validity of the new staging proposal for pulmonary metastases through the analysis of experiences at Severance Hospital. MATERIAL AND METHOD: The cases of 111 patients who underwent resection of metastatic lung cancer during the eleven-year period (1990-2000) were reviewed. Of these patients, 103(92.8%) underwent complete surgical resection. The primary tumor was carcinoma in 60 cases, sarcoma in 46, and others in 5. The disease-free interval(DFI) was 0 to 35 months in 79 cases and more than 36 months in 32 cases. Single metastasis accounted for 53 cases and multiple lesions for 58 cases. Mean follow-up was 49 months. RESULT: The actuarial survival after complete metastasectomy was 48.2% at 3 years and 32.6% at 5 years; the corresponding values for incomplete resection were 21.9% at 3 years. The 3-year survival rate(3-YSR) for complete resection was 40.5% and 5-year survival rate(5-YSR) was 30.4% for patients with a DFI less than 36 months, the 3-YSR, 75.8% and 5-YSR, 39.0% for those with a DFI equal or more than 36 months ; 45.8% and 30.5% for single lesions, 50.0% and 34.4% for multiple lesions. The 3-YSR and 5-YSR were 58.5% and 43.8% for stage I patients, 54.0% and 37.4% for stage II, 38.2% and 27.9% for stage III and 21.9% for stage IV. CONCLUSION: The result of the analysis of new stage of pulmonary metastases showed that the survival rate was different according to stage and there was no statistical significance. We need more experiences and long-term follow up to determine the prognostic factor of metastatic lung cancer surgery.
Follow-Up Studies ; Humans ; Lung Neoplasms ; Metastasectomy ; Neoplasm Metastasis* ; Sarcoma ; Survival Rate

Surgical resection of colorectal cancer metastasis to the liver results in a 5-year survival rate of around 40%. Liver metastasis from other cancers such as neuroendocrine carcinoma and genitourinary tumors are also treated effectively with combined liver resection. However, hepatic metastasectomy for liver tumor from gastric cancer hasn't been considered as a standard treatment, and the benefit for this treatment has not been established. We report here on two cases of gastrectomy and combined liver resection for synchronous liver metastasis without any evidence of other metastatic lesions, and these two patients have survived for more than 7 years without evidence of disease recurrence. In conclusion, for patients with hepatic metastasis from gastric cancer, combined surgical resection of the liver metastasis should be considered as a treatment option when metastasis to other sites can be excluded.
Carcinoma, Neuroendocrine ; Colorectal Neoplasms ; Gastrectomy ; Humans ; Liver* ; Metastasectomy ; Neoplasm Metastasis* ; Recurrence ; Stomach Neoplasms* ; Survival Rate

Patients with stage IV metastatic melanoma have been traditionally managed with mainly palliative therapy such as chemotherapy, radiation therapy or biologic therapy, yet their overall survival is unsatisfactory. Several recent series have indicated a long-term survival benefit after complete resection, (termed "metastasectomy") of distant metastatic foci in patients with metastatic melanoma. Unlike other palliative modalities, surgery like metastasectomy can rapidly render a patient clinically disease-free with rather minimal morbidity, a short-term of hospitalization and a quick recovery time. This may prolong the survival and improve the quality of life of patients with stage IV melanoma if all the clinicoradiologically-evident tumors can be completely resected. We report herein on a case of performing metastasectomy in a patient who had malignant melanoma with soft tissue metastasis of the breast (T3a/bN0M1a), even though there was a regrettable result.
Biological Therapy ; Breast ; Hospitalization ; Humans ; Melanoma ; Metastasectomy ; Neoplasm Metastasis ; Palliative Care ; Quality of Life

PURPOSE: We reviewed clinical feature and survival rates of metastatic renal cell carcinoma(RCCa) and analyzed the prognostic factors and surgical outcomes in patients who underwent surgical resection of metastatic RCCa. MATERIALS AND METHODS: Among 287 patients who underwent radical nephrectomy for RCCa from January 1990 to June 1997, 65 patients had metastatic disease. In 31 patients, metastatic lesions were surgically removed. Survival rates were analyzed according to various prognostic factors(the completeness of metastasectomy, synchronicity or metachronicity of metastasis, interval to metastasis after radical nephrectomy, Fuhrman`s grade of metastatic lesions and interval to the development of a new metastatic lesion after metastasectomy) RESULTS: The metastasectomy was complete in 18 and incomplete in 13, and 3-year survival rates were 59% and 8%, respectively(p=0.0013). In the group of patients who underwent complete resection of metastatic lesion, time to recurrence was significantly influential on survival with 3 year survival rate of 100% and 15% for those whose disease recurred after and before 12 months, respectively(p=0.001). For those who underwent curative resection of the metastatic lesion, synchronicity or metachronicity of metastasis, time to metastasis and Fuhrman`s grade did not influence survival after complete resection (p=0.675, p=0.607 and p=0.074). CONCLUSIONS: Aggressive surgical treatment should be considered in selected cases in whom complete resection of the metastatic lesion is feasible for the purpose of long term survival. If no newly developed lesion is found within 1 year after operation, favorable prognosis could be expected.
Carcinoma, Renal Cell* ; Humans ; Metastasectomy* ; Neoplasm Metastasis ; Nephrectomy ; Prognosis ; Recurrence ; Survival Rate

Nasopharyngeal carcinoma is a rare cancer with a relatively poor prognosis because patients tend to be diagnosed in the advanced stage. Distant metastases have been recognized to be a major cause of treatment failure. However, because long-term survival has been reported in patients with lung metastasis alone, an aggressive approach to treatment for this group of patients should be considered. We report four cases of metastasectomy for pulmonary metastasis of nasopharyngeal carcinoma. The metastatic lesions were confined to the lung with or without regional lymph nodes. The patients underwent a pulmonary metastasectomy following adjuvant chemotherapy with or without radiotherapy, and all patients are now disease-free.
Chemotherapy, Adjuvant ; Humans ; Lung ; Lymph Nodes ; Metastasectomy ; Nasopharyngeal Neoplasms ; Neoplasm Metastasis ; Prognosis ; Treatment Failure