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eComment: The role of lymph node dissection in pulmonary resection for metastases from colorectal cancer

Department of Thoracic Surgery, Theagenio Cancer Hospital, Simeonidi 2, 54007 Thessaloniki, Greece

Pulmonary resection for metastases from colorectal carcinoma

We read with great interest the article by Maeda et al. concerning pulmonary resection for metastases from colorectal cancer [1].

The role of lymph node dissection in pulmonary metastasectomy from extrapulmonary malignancies is a debatable issue. Few articles are written about the need of lymphadenectomy accompanying metastasectomy [2, 3]. Performing systematic lymph node dissection Loehe et al. found unexpected metastases in nine patients (14.3%) resulting in a worse survival, which was not significant. Welter et al. found a significant prognostic difference in patients with or without lymph node involvement, having performed a sampling only in case of suspicious enlarged nodes [4]. Saito et al. emphasized the need for a prospective study to investigate whether lymph node dissection improves the survival with pulmonary metastases from colorectal carcinoma [5]. Okumura et al. reported that systematic dissection of involved mediastinal nodes is not helpful in controlling the systemic disease [2].

Our policy is to do lymph node sampling during metastasectomy and not a systemic lymph node dissection. According to our institute’s experience, mediastinal nodal involvement has definitely a negative impact on survival.

It is well established that lung metastases are predecessors of further systemic spread. So, our policy is to offer adjuvant chemotherapy in all cases, even though the resected metastasis is solitary and preoperative biomarkers are within normal range.

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1. Maeda R, Isowa N, Onuma H, Miura H, Harada T, Touge H, Tokuyasu H, Kawasaki Y. Pulmonary resection for metastases from colorectal carcinoma. Interact CardioVasc Thorac Surg 2009;9:640–644.[Abstract/Free Full Text]
2. Okumura S, Kondo H, Tsuboi M, Nakayama H, Asamura H, Tsuchiya R, Naruke T. Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients. J Thorac Cardiovasc Surg 1996;112:867–874.[Abstract/Free Full Text]
3. Loehe F, Kobinger S, Hatz RA, Helmberger T, Loehrs U, Fuerst H. Value of systematic mediastinal lymph node dissection during pulmonary metastasectomy. Ann Thorac Surg 2001;72:225–229.[Abstract/Free Full Text]
4. 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 2007;31:167–172.[Abstract/Free Full Text]
5. Saito Y, Omiya H, Kohno K, Kobayashi T, Itoi K, Teramachi M, Sasaki M, Suzuki H, Takao H, Nakade M. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg 2002;124:1007–1013.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nikolaos Barbetakis Christos Asteriou Permission Requests Google Scholar Articles by Barbetakis, N. Articles by Tsilikas, C. PubMed PubMed Citation Articles by Barbetakis, N. Articles by Tsilikas, C. Related Collections Related Article