title: Pulmonary metastasectomy in colorectal cancer patients with previously resected liver metastasis: pooled analysis.
abstract: BACKGROUND
  Data addressing the outcomes and patterns of recurrence after pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) and previously resected liver metastasis are limited.
  
  
  METHODS
  We searched the PubMed database for studies assessing PM in CRC and gathered individual data for patients who had PM and a previous curative liver resection. The influence of potential factors on overall survival (OS) was analyzed through univariate and multivariate analysis.
  
  
  RESULTS
  Between 1983 and 2009, 146 patients from five studies underwent PM and had previous liver resection. The median interval from resection of liver metastasis until detection of lung metastasis and the median follow-up from PM were 23 and 48 months, respectively. Five-year OS and recurrence-free survival rates calculated from the date of PM were 54.4 and 29.3 %, respectively. Factors predicting inferior OS in univariate analysis included thoracic lymph node (LN) involvement and size of largest lung nodule ≥2 cm. Adjuvant chemotherapy and whether lung metastasis was detected synchronous or metachronous to liver metastasis had no influence on survival. In multivariate analysis, thoracic LN involvement emerged as the only independent factor (hazard ratio 4.86, 95 % confidence interval 1.56-15.14, p = 0.006).
  
  
  CONCLUSIONS
  PM offers a chance for long-term survival in selected patients with CRC and previously resected liver metastasis. Thoracic LN involvement predicted poor prognosis; therefore, significant efforts should be undertaken for adequate staging of the mediastinum before PM. In addition, adequate intraoperative LN sampling allows proper prognostic stratification and enrollment in novel adjuvant therapy trials.
authors.affiliation: Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan, ssalah@khcc.jo.
authors.forename: Samer
authors.initials: S
authors.lastname: Salah
authors.forename: Francesco
authors.initials: F
authors.lastname: Ardissone
authors.forename: Michel
authors.initials: M
authors.lastname: Gonzalez
authors.forename: Pascal
authors.initials: P
authors.lastname: Gervaz
authors.forename: Marc
authors.initials: M
authors.lastname: Riquet
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Jon
authors.initials: J
authors.lastname: Zabaleta
authors.forename: Dalia
authors.initials: D
authors.lastname: Al-Rimawi
authors.forename: Samar
authors.initials: S
authors.lastname: Toubasi
authors.forename: Ehab
authors.initials: E
authors.lastname: Massad
authors.forename: Elena
authors.initials: E
authors.lastname: Lisi
authors.forename: Osama H
authors.initials: OH
authors.lastname: Hamed
mesh_terms: D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D015201:Meta-Analysis as Topic; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D015996:Survival Rate