title: Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience.
abstract: OBJECTIVE
  We reviewed our experience in the surgical management of 80 patients with colorectal pulmonary metastases and investigated factors affecting survival.
  
  
  METHODS
  From January 1980 to December 2000, 80 patients, 43 women and 37 men with median age 63 years (range 38-79 years) underwent 98 open surgical procedure (96 muscle-sparing thoracotomy, one clamshell and one median sternotomy) for pulmonary metastases from colorectal cancer (three pneumonectomy, 17 lobectomy, seven lobectomy plus wedge resection, six segmentectomy, three segmentectomy plus wedge resection and 62 wedge resection). Pulmonary metastases were identified at a median interval of 37.5 months (range 0-167) from primary colorectal resection. Second and third resections for recurrent metastases were done in seven and in four patients, respectively.
  
  
  RESULTS
  Operative mortality rate was 2%. Overall, 5-year survival was 41.1%. Five-year survival was 43.6% for patients submitted to single metastasectomy and 34% for those submitted to multiple ones. Five-year survival was 55% for patients with disease-free interval (DFI) of 36 months or more, 38% for those with DFI of 0-11 months and 22.6% for those with DFI of 12-35 months (P=0.04). Five-year survival was 58.2% for patients with normal preoperative carcino-embryonic antigen (CEA) levels and 0% for those with pathologic ones (P=0.0001). Patients submitted to second-stage operation for recurrent local disease had 5-year survival rate of 50 vs. 41.1% of those submitted to single resection (P=0.326).
  
  
  CONCLUSIONS
  Pulmonary resection for metastases from colorectal cancer may help survival in selected patients. Single metastasis, DFI>36 months, normal preoperative CEA levels are important prognostic factors. When feasible, re-operation is a safe procedure with satisfactory long-term results.
authors.affiliation: Department of General Thoracic Surgery, University of Torino, Ospedale San Giovanni Battista, v. Genova 3, 10126, Turin, Italy. ottavio.rena@tiscalinet.it
authors.forename: Ottavio
authors.initials: O
authors.lastname: Rena
authors.forename: Caterina
authors.initials: C
authors.lastname: Casadio
authors.forename: Franco
authors.initials: F
authors.lastname: Viano
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cristofori
authors.forename: Enrico
authors.initials: E
authors.lastname: Ruffini
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Filosso
authors.forename: Giuliano
authors.initials: G
authors.lastname: Maggi
mesh_terms: D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D002272:Carcinoembryonic Antigen