Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma.
BACKGROUND
A pulmonary metastasectomy for colorectal carcinoma is a generally accepted procedure, although several prognostic predictors have been reported. The aim of this study is to define the patients who benefit from pulmonary metastasectomy for colorectal carcinoma.


METHODS
Retrospective survival analysis was performed using 128 patients who underwent curative pulmonary resection.


RESULTS
The overall 5-year survival rate was 45.3%. Univariate analysis showed the number of metastases, location (unilateral or bilateral), prethoracotomy carcinoembryonic antigen (CEA) level, hilar or mediastinal lymph-node metastasis, and Dukes' stage to be considerable prognostic factors. Among these, Dukes' A for the primary lesion and unilateral pulmonary metastasis were shown to be independent predictors of longer survival by multivariate analysis (p = 0.0093 and p = 0.0182, respectively). In patients treated with both pulmonary and hepatic metastastasectomies, a better prognosis was observed in those who received metachronous resection. Recurrence after a pulmonary metastasectomy frequently occurred in the thorax and the 3-year survival rate was 44.6% in patients who underwent a repeat thoracotomy.


CONCLUSIONS
Patients with unilateral metastasis and Dukes' A for the primary tumor benefit most from the resection of pulmonary metastasis from colorectal carcinoma. Further, the number of metastases, prethoracotomy CEA level, and hilar or mediastinal lymph-node involvement should be considered to determine the operative indication. Finally, periodic follow-up examinations for thoracic recurrence should be carefully performed as these patients may have a heightened risk of requiring a repeat thoracotomy.
Inoue
Masayoshi
M
Department of Surgery, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka 560-8552, Osaka, Japan. masa@surg1.med.osaka-u.ac.jp
Ohta
Mitsunori
M
Iuchi
Keiji
K
Matsumura
Akihide
A
Ideguchi
Kan
K
Yasumitsu
Tsutomu
T
Nakagawa
Katsuhiro
K
Fukuhara
Kenjiro
K
Maeda
Hajime
H
Takeda
Shin-ichi
S
Minami
Masato
M
Ohno
Yuko
Y
Matsuda
Hikaru
H
D000230:Adenocarcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002272:Carcinoembryonic Antigen / Q000032:analysis; D015179:Colorectal Neoplasms / Q000473:pathology*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data; D006801:Humans; D015993:Life Tables; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen