title: Long-term survival after repeated resection of pulmonary metastases from colorectal cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate the outcome of patients undergoing repeated resection of pulmonary metastases from colorectal cancer and specify factors promising long-term survival.
  
  
  METHODS
  From January 1993 to December 2003, 175 patients were diagnosed and resected for pulmonary metastases of colorectal cancer. Follow-up information was collected for 169 patients, and 33 (19.5%) had had recurrent metastasectomies up to three times. Their follow-up information was updated in August 2006. The first repeated resection was performed for up to six bilateral metastases, the second and third metastasectomies were each unilateral and for a single metastasis only. Lymph node involvement was present in 5 patients who underwent repeat resections.
  
  
  RESULTS
  The overall (n = 169) median survival was 47.2 months after the first metastasectomy. The 33 patients with repeated resections had a median survival of 72.6 months, with survival of 53.8% at 5 years and 20.6% at 10 years. After reoperation, age, sex, primary tumor stage, preoperative carcinoembryonic antigen, disease-free interval, prior resection of liver metastases, and lymph node involvement were not found to be of prognostic importance. The only factor that significantly influenced survival was the number of metastases (hazard risk, 1.299). Perioperative mortality even for repeated resections was 0%.
  
  
  CONCLUSIONS
  Repeated resection of pulmonary metastases secondary to colorectal cancer is safe and can provide long-term survival for highly selected patients.
authors.affiliation: Department of Thoracic Surgery, Ruhrlandklinik, Essen, Germany. stefan.we@t-online.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Welter
authors.forename: Jan
authors.initials: J
authors.lastname: Jacobs
authors.forename: Thomas
authors.initials: T
authors.lastname: Krbek
authors.forename: Bettina
authors.initials: B
authors.lastname: Krebs
authors.forename: Georgios
authors.initials: G
authors.lastname: Stamatis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies