title: Forty-Two Years' Experience with Pulmonary Resections of Metastases from Colorectal Cancer.
abstract: BackgroundPulmonary metastasectomy is a commonly performed surgery in patients with controlled metastatic colorectal cancer (CRC). We reviewed our long-term single institution experience with lung resections for colorectal metastases to assess the factors influencing patient survival.Materials and MethodsA cohort of 220 patients (138 men and 82 women; median age, 59 years) who underwent complete pulmonary metastasectomy for CRC with curative intent between 1972 and 2014 was retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on patient survival was assessed.ResultsTwo postoperative inhospital deaths occurred. The median interoperative interval was 26 months. The overall 5-year survival rate after pulmonary metastasectomy was 49.4%. In univariable analysis, bilateral pulmonary metastases (log rankp= 0.02), multiple metastases (log rankp= 0.005), and stage IV UICC (the International Union Against Cancer) CRC at the time of initial presentation (log rankp= 0.008) were significantly associated with poor outcome. Multivariable Cox analysis demonstrated that stage IV CRC (p= 0.02) and multiple metastases (p= 0.0019) were statistically significant predictors of survival after the pulmonary metastasectomy. There was no significant difference in survival between patients with high versus low preoperative carcinoembryonic antigen serum level (p= 0.149), high versus low preoperative carbohydrate antigen 19-9 serum level (p= 0.291), and primary tumor location in rectum versus colon (p= 0.845).ConclusionPatients with unilateral metastasis and stages I to III primary tumor benefited most from pulmonary metastasectomy for CRC.
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.|Division of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Dudek
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.|Division of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Schreiner
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.|Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.|Department of Surgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Klein
authors.affiliation: Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.|Division of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Horia
authors.initials: H
authors.lastname: Sirbu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D015179:Colorectal Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000097:blood / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen