International journal of surgery (London, England) · 2025
Long-term outcomes of ablation versus surgery in patients with colorectal carcinoma pulmonary oligometastases: a single-center, retrospective cohort study.
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Cao Yu-Zhe, Fu Xia-Yu, Zheng Xin, Wang Zi-Xian, Hou Ying-Wen, Fan Wei-Jun, Wu Pei-Hong, Huang Jin-Hua, Zhang Tian-Qi
Аннотация
BACKGROUND: Pulmonary metastases are common in patients with colorectal carcinoma. Both surgery and ablation have been used with some success to locally target colorectal carcinoma pulmonary oligometastases (CRPOM).
PURPOSE: We aimed to compare the long-term outcomes and safety of surgery and ablation for treating CRPOM.
METHODS: Patients treated between January 2012 and December 2018 for CRPOM using surgery or ablation were evaluated through May 2023, and the two groups were retrospectively analyzed for survival outcomes, complications, and lengths of hospitalization. Calculations were performed using the Kaplan-Meier method and Cox regression.
RESULT: The study included 96 patients (mean age 58.2 ± 11.1 years; 71 [74.0%] male). All patients had received primary resection of colorectal carcinoma, then 41 had ablation and 55 had surgery for CRPOM. Median follow-up was 58.3 (IQR 38.6-73.7) months. The proportions of patients with multiple (53.7% vs. 46.3%; P = 0.01) and bilateral (56.1% vs 43.9%; P = 0.006) pulmonary metastases were significantly higher in the ablation group than in the surgery group, respectively. Median overall survival for ablation and surgery was 73.3 months and 70.4 months; 3-year overall survival rates were 82.6% and 79.8%; and 5-year overall survival rates were 59.9% and 58.7%; all respectively (P = 0.64). Median progression-free survival (PFS) was 12.1 and 11.5 months, respectively (P = 0.48). Lesion-specific in situ recurrence rates were 26.7% and 22.0%, respectively (P = 0.68), and median lung-specific PFS was 14.5 and 14.1 months, respectively (P = 0.95). Based on Clavien-Dindo grades in 91 evaluable patients, the complication rate was 58.5% after ablation and 96.0% after surgery (P<0.001). Median hospitalization was 3.0 days after ablation and 6.5 days after surgery (P<0.001).
CONCLUSION: For CRPOM patients, there was no significant difference in long-term survival between surgery and ablation for pulmonary metastases, despite those who received ablation having a higher tumor burden. Ablation resulted in fewer complications and shorter hospitalizations.
PURPOSE: We aimed to compare the long-term outcomes and safety of surgery and ablation for treating CRPOM.
METHODS: Patients treated between January 2012 and December 2018 for CRPOM using surgery or ablation were evaluated through May 2023, and the two groups were retrospectively analyzed for survival outcomes, complications, and lengths of hospitalization. Calculations were performed using the Kaplan-Meier method and Cox regression.
RESULT: The study included 96 patients (mean age 58.2 ± 11.1 years; 71 [74.0%] male). All patients had received primary resection of colorectal carcinoma, then 41 had ablation and 55 had surgery for CRPOM. Median follow-up was 58.3 (IQR 38.6-73.7) months. The proportions of patients with multiple (53.7% vs. 46.3%; P = 0.01) and bilateral (56.1% vs 43.9%; P = 0.006) pulmonary metastases were significantly higher in the ablation group than in the surgery group, respectively. Median overall survival for ablation and surgery was 73.3 months and 70.4 months; 3-year overall survival rates were 82.6% and 79.8%; and 5-year overall survival rates were 59.9% and 58.7%; all respectively (P = 0.64). Median progression-free survival (PFS) was 12.1 and 11.5 months, respectively (P = 0.48). Lesion-specific in situ recurrence rates were 26.7% and 22.0%, respectively (P = 0.68), and median lung-specific PFS was 14.5 and 14.1 months, respectively (P = 0.95). Based on Clavien-Dindo grades in 91 evaluable patients, the complication rate was 58.5% after ablation and 96.0% after surgery (P<0.001). Median hospitalization was 3.0 days after ablation and 6.5 days after surgery (P<0.001).
CONCLUSION: For CRPOM patients, there was no significant difference in long-term survival between surgery and ablation for pulmonary metastases, despite those who received ablation having a higher tumor burden. Ablation resulted in fewer complications and shorter hospitalizations.