Predicting survival after pulmonary metastasectomy for colorectal cancer: previous liver metastases matter.
BACKGROUND
Few patients with lung metastases from colorectal cancer (CRC) are candidates for surgical therapy with a curative intent, and it is currently impossible to identify those who may benefit the most from thoracotomy. The aim of this study was to determine the impact of various parameters on survival after pulmonary metastasectomy for CRC.


METHODS
We performed a retrospective analysis of 40 consecutive patients (median age 63.5 [range 33-82] years) who underwent resection of pulmonary metastases from CRC in our institution from 1996 to 2009.


RESULTS
Median follow-up was 33 (range 4-139) months. Twenty-four (60%) patients did not have previous liver metastases before undergoing lung surgery. Median disease-free interval between primary colorectal tumor and development of lung metastases was 32.5 months. 3- and 5-year overall survival after thoracotomy was 70.1% and 43.4%, respectively. In multivariate analysis, the following parameters were correlated with tumor recurrence after thoracotomy; a history of previous liver metastases (HR = 3.8, 95%CI 1.4-9.8); and lung surgery other than wedge resection (HR = 3.0, 95%CI 1.1-7.8). Prior resection of liver metastases was also correlated with an increased risk of death (HR = 5.1, 95% CI 1.1-24.8, p = 0.04). Median survival after thoracotomy was 87 (range 34-139) months in the group of patients without liver metastases versus 40 (range 28-51) months in patients who had undergone prior hepatectomy (p = 0.09).


CONCLUSIONS
The main parameter associated with poor outcome after lung resection of CRC metastases is a history of liver metastases.
Department of Surgery, Geneva University Hospital and Medical School, Geneva, Switzerland.
Ulrich
U
Landes
John
J
Robert
Thomas
T
Perneger
Gilles
G
Mentha
Vincent
V
Ott
Philippe
P
Morel
Pascal
P
Gervaz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006498:Hepatectomy / Q000379:methods / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary* / Q000601:surgery; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis