title: Long-term outcomes after surgical resection of pulmonary metastases from colorectal cancer.
abstract: BACKGROUND
  Surgical resection has been widely performed on patients with pulmonary metastases from colorectal cancer with favorable outcomes. However, there are currently no standard surgical indications for pulmonary metastases.
  
  
  METHODS
  We reviewed 94 patients who underwent complete resection of pulmonary metastases from colorectal cancer between November 1991 and April 2013. The cumulative survival rate after pulmonary metastasectomy was calculated, and prognostic factors for long-term survival were analyzed.
  
  
  RESULTS
  There were 60 men and 34 women, and their median age was 66 years. The 5-year survival rate was 45.5% after pulmonary metastasectomy. The 5-year survival of patients with colon and rectal cancers was 62.4% and 33.8%, respectively (p = 0.030), and the 5-year survival of those with normal and high carcinoembryonic antigen (CEA) levels before pulmonary resection was 57.0% and 30.9%, respectively (p = 0.038). Multivariate analysis revealed the preoperative CEA level was an independent prognostic factor. Recurrence was identified in 65 of the 94 patients (69.1%) after pulmonary metastasectomy, and the patients who underwent surgical resection for recurrent lesions in the liver or lungs, or both, had better survival than those who received other treatments or palliative care.
  
  
  CONCLUSIONS
  Surgical resection offers a chance to prolong survival in colorectal cancer patients with resectable pulmonary metastases. Owing to the high recurrence rate, careful postoperative follow-up for early detection is recommended, and even for recurrence, surgical resection should be considered for better survival if the lesions are limited to the liver or lungs, or both.
authors.affiliation: Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan. Electronic address: hsuzuki-jpn@umin.ac.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
authors.forename: Moriyuki
authors.initials: M
authors.lastname: Kiyoshima
authors.affiliation: Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kitahara
authors.affiliation: Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Asato
authors.affiliation: Department of Thoracic Surgery, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Amemiya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome