title: The prognosis of pulmonary metastasectomy depends on the location of the primary colorectal cancer.
abstract: BACKGROUND
  Rectal cancer has a higher risk of developing lung metastasis compared with colon cancer. It is unclear whether the prognosis after pulmonary metastasectomy for these distinct tumors is different.
  
  
  METHODS
  Patients who underwent pulmonary metastasectomy for colorectal carcinoma were analyzed for survival and patterns of recurrence depending on the location of the primary colorectal cancer. Multivariate regression analysis was performed to identify clinical variables predictive of survival after pulmonary metastasectomy.
  
  
  RESULTS
  Between 1985 and 2012, 698 patients underwent pulmonary metastasectomy for metastatic colorectal cancer. Complete information was available in 626 patients. These patients were divided into groups based on whether the primary tumor was colon or rectal in origin. Median follow-up was 45.5 months (range, 23 to 287 months). There were no statistical differences between the two groups in terms of number of lung metastases, tumor size, or lymph node involvement. There was no difference in overall survival (p = 0.545). Five-year disease-free survival for colon cancer patients was 67.2% compared with 60.1% for rectal cancer (p = 0.004). The most common sites of recurrence after pulmonary metastasectomy were liver in colon cancer and lung in rectal cancer. Multivariate Cox proportional hazards analysis indicated that rectal cancer (hazard ratio, 1.39; 95% confidence interval, 1.07 to 1.83; p = 0.015) and multiple metastases (>3; hazard ratio, 1.41; 95% confidence interval, 1.04 to 1.89; p = 0.027) were independent adverse risk factors affecting disease-free survival after pulmonary metastasectomy.
  
  
  CONCLUSIONS
  Disease-free survival and site of recurrence after pulmonary metastasectomy for colorectal carcinoma are dependent on the site of the primary tumor. Lung metastases from rectal cancer have a worse disease-free survival compared with colon cancer. This may influence treatment and follow-up strategies.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hamaji
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: deschamps.claude@mayo.edu.
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D016016:Proportional Hazards Models