Role of surgical resection in colorectal lung metastases: analysis of 137 patients.
OBJECTIVE
The aim of this study is to investigate clinicopathologic characteristics and to identify prognostic factors in patients undergoing pulmonary metastasectomy for colorectal carcinoma.


METHODS
This study is a single-institution retrospective study of 137 consecutive patients who underwent 158 pulmonary resections for metastatic colorectal carcinoma between January 1989 and June 2008.


RESULTS
Median disease-free interval between colorectal resection and pulmonary metastasectomy was 35.6 months (range, 0.6 to 154.3 months). No perioperative deaths occurred. Follow-up was 100% complete and mean follow-up was 41.6 ± 27.6 months. Median survival was 36.2 months (range, 4.6 to 126 months). Overall 5- and 10-year survival rates were 55.4% and 30.8%, respectively, after pulmonary metastasectomy. At univariate analysis of patient survival, number of lung metastases (p = 0.002), disease-free interval of more than 24 month (p = 0.013), and absence of residual tumor (p = 0.024) were significant prognostic factors. At multivariate analysis, presence of solitary lung metastasis and disease-free interval of more than 24 months remained significant prognostic factors. There was no significant difference in the 5-year survival for 121 patients undergoing single thoracotomy compared with 16 patients undergoing repeated resection(s) for recurrent colorectal lung metastasis (55.1% vs 59.5%; p = 0.79). Nor was the presence of hepatic metastasis associated with lower outcome (p = 0.77).


CONCLUSIONS
Disease-free interval and number of metastases are the most significant prognostic factors for survival after pulmonary metastasectomy for colorectal carcinoma. Recurrent pulmonary disease can benefit from repeated resection. Prior hepatectomy for liver involvement does not influence survival.
Borasio
Piero
P
Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Turin, Italy.
Gisabella
Mara
M
Billé
Andrea
A
Righi
Luisella
L
Longo
Marina
M
Tampellini
Marco
M
Ardissone
Francesco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003710:Demography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis