Surgical resection of pulmonary metastases from colorectal cancer: Four favourable prognostic factors.
BACKGROUND
Surgical resection has been the first choice for treatment of pulmonary metastases from colorectal cancer; however, indications for surgery have yet to be adequately clarified. In considering strategies for the treatment of pulmonary metastases from colorectal carcinoma, determination of disease status as either systemic or pre-systemic is of primary importance. The aim of this study is to define the characteristics of those patients who are most likely to benefit from surgical resection.


METHODS
Fifty-eight patients who underwent pulmonary resection for colorectal metastases were retrospectively reviewed and examined for clinicopathological factors.


RESULTS
Overall, 5-year survival rates were 29%, with a median survival time (MST) of 27 months. Multivariate analysis identified four factors that indicate independent and favourable prognostic impact: three or less tumours, metachronous metastasis, negative hilar and/or mediastinal lymph node metastasis and normal prethoracotomy serum carcinoembryonic antigen level. The 5-year survival rate for 16 patients who satisfied all of these favourable characteristics was 62% (MST = 86 months), which was significantly better than those patients lacking these characteristics. The 5-year survival rate for 13 patients who underwent repeated metastasectomy was 37% (MST = 32 months).


CONCLUSIONS
The four factors selected in our multivariate analysis appear to be favourable factors for the practical identification of those patients who are most likely to benefit from surgical resection. Repeated pulmonary resection for lung-only recurrence may benefit carefully selected patients.
Koga
Rintaro
R
Department of Gastrointestinal Surgery, Cancer Institute Hospital, Tokyo, Japan. rintaro.koga@jfcr.or.jp
Yamamoto
Junji
J
Saiura
Akio
A
Yamaguchi
Toshiharu
T
Hata
Enjo
E
Sakamoto
Masayoshi
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate