Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR).
Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection.



Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model.



A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome.



Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results.
Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona jhes.82@gmail.com.
J
J
Hernández
Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona.
L
L
Molins
Thoracic Surgery Units, Hospital Universitari del Sagrat Cor, Barcelona.
J J
JJ
Fibla
Thoracic Surgery Units, Hospital General Universitario de Valladolid, Valladolid.
F
F
Heras
Thoracic Surgery Units, Hospital Universitario Miguel Servet Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
R
R
Embún
Thoracic Surgery Units, Hospital Universitario Miguel Servet Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
J J
JJ
Rivas
D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D011013:Pneumonectomy / Q000379:methods; D016016:Proportional Hazards Models; D013030:Spain; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods
VATS; colorectal carcinoma; lobectomy; lung metastasis; pneumonectomy; wedge resection