Biology of colorectal pulmonary metastasis: implications for surgical resection.

摘要: In colorectal cancer, little high grade evidence for cure, life extension, disease modification or palliation achieved by pulmonary metastasectomy exists. This has prompted the in cancer (PulMiCC) trial. Reappraisal of biological facts on metastasis may, however, shed light an alternative avenue clinical management. Early onset metastasis, short doubling time and a disease-free interval are all associated with poor outcomes. Selecting who will be cured (i.e. no occult metastasis) remains holy grail surgery. Serial CT scans can utilized to calculate tumour volumetric analysis. Knowing size largest which definition is first cell that successfully spread from primary site, initial predicted. More importantly, using time, calculating surgery point at metastases visible should possible. Perhaps watchful waiting, scanning, followed utilized, rather than opinion randomization trial based upon presentation.