Original article
General thoracic
Long-Term Outcomes After Surgical Resection of Pulmonary Metastases From Colorectal Cancer

https://doi.org/10.1016/j.athoracsur.2014.09.027Get rights and content

Background

Surgical resection has been widely performed on patients with pulmonary metastases from colorectal cancer with favorable outcomes. However, there are currently no standard surgical indications for pulmonary metastases.

Methods

We reviewed 94 patients who underwent complete resection of pulmonary metastases from colorectal cancer between November 1991 and April 2013. The cumulative survival rate after pulmonary metastasectomy was calculated, and prognostic factors for long-term survival were analyzed.

Results

There were 60 men and 34 women, and their median age was 66 years. The 5-year survival rate was 45.5% after pulmonary metastasectomy. The 5-year survival of patients with colon and rectal cancers was 62.4% and 33.8%, respectively (p = 0.030), and the 5-year survival of those with normal and high carcinoembryonic antigen (CEA) levels before pulmonary resection was 57.0% and 30.9%, respectively (p = 0.038). Multivariate analysis revealed the preoperative CEA level was an independent prognostic factor. Recurrence was identified in 65 of the 94 patients (69.1%) after pulmonary metastasectomy, and the patients who underwent surgical resection for recurrent lesions in the liver or lungs, or both, had better survival than those who received other treatments or palliative care.

Conclusions

Surgical resection offers a chance to prolong survival in colorectal cancer patients with resectable pulmonary metastases. Owing to the high recurrence rate, careful postoperative follow-up for early detection is recommended, and even for recurrence, surgical resection should be considered for better survival if the lesions are limited to the liver or lungs, or both.

Section snippets

Patients and Methods

Between November 1991 and April 2013, 136 surgical resections were performed at Ibaraki Prefectural Central Hospital in 102 patients for pulmonary metastases from colorectal cancer. The study excluded patients with a history of pulmonary metastasectomy at other hospitals or with incomplete resection. The medical records of the remaining 94 patients who underwent complete resection of pulmonary metastases were reviewed.

Our criteria for resection of pulmonary metastases included unilateral or

Patient Characteristics

Included were 60 men and 34 women, and the median age at pulmonary resection was 66 years (range, 43 to 82 years). The primary cancer was located in the colon in 41 patients and in the rectum in 53. Synchronous metastases with primary tumor, or stage IV colorectal cancer, were initially present in 30 patients (liver in 16 patients, lungs in 12, and both in 2). Forty patients had a short disease-free interval (<1 year) before the detection of pulmonary metastases, and 54 patients had long

Comment

In this study we retrospectively investigated survival of 94 colorectal cancer patients who underwent complete resection of pulmonary metastases, and multivariate analysis indicated the preoperative CEA level was an independent prognostic factor. Despite the high incident rate of recurrence after pulmonary metastasectomy, surgical resection of the recurrent lesions in the liver or lungs, or both, provided longer survival.

The criteria for resection of pulmonary metastases were first described by

References (21)

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