title: Risk factors for survival and recurrence after lung metastasectomy.
abstract: Colorectal cancer (CRC) is the third most diagnosed cancer worldwide, with up to 25% of patients who will develop metastases. Pulmonary metastases (PMs) resection for CRC might improve long-term survival, but the selection criteria for patients who would benefit remain unclear. The aim of this study was to identify preoperative predictive factors in patients eligible for this surgical strategy.
  
  
  
  We retrospectively reviewed data of patients from five thoracic surgery departments who underwent PM resection for CRC with intent to cure between 2005 and 2010. Univariate and multivariate analyses were performed to identify predictive factors influencing long-term survival and recurrence after pulmonary resection.
  
  
  
  Three hundred fifty-four patients were eligible. Forty-eight patients had pulmonary recurrence (13.5%). Thirty-day postoperative mortality was 0.3% (n = 1). Five- and 8-y overall survival (OS) were 64.3 ± 3.99% and 60.72 ± 4.5%, respectively. In univariate analysis, 5-y OS was significantly associated with an American Society of Anesthesiologists score of 1 (P = 0.02), a low number of PM (P = 0.001), and single wedge resection (P = 0.00001). In multivariate analysis, an American Society of Anesthesiologists score of 3 or higher (P = 0.05), two or more PMs (P = 0.034) and pneumonectomy (P = 0.021) were significant predictors of a poor outcome. In univariate analysis, 5-y cumulative recurrence was significantly associated with the absence of mediastinal lymph node dissection (P = 0.01).
  
  
  
  Given its high 5-y OS with low postoperative morbidity, thus allowing repeat surgical management, resection of PM could be performed. Resection of PM could improve long-term survival.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Bocage Hospital, Dijon, France. Electronic address: pierrebenoit.pages@chu-dijon.fr.
authors.forename: Pierre-Benoit
authors.initials: PB
authors.lastname: Pagès
authors.affiliation: Department of Thoracic Surgery, Larrey Hospital, Toulouse, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Serayssol
authors.affiliation: Department of Thoracic Surgery, North Hospital, Marseille, France.
authors.forename: Goeffrey
authors.initials: G
authors.lastname: Brioude
authors.affiliation: Department of Thoracic Surgery, Civil Hospital, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Department of Thoracic Surgery, Larrey Hospital, Toulouse, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Brouchet
authors.affiliation: Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris, France.
authors.forename: Francoise
authors.initials: F
authors.lastname: Le Pimpec-Barthes
authors.affiliation: Department of Thoracic Surgery, North Hospital, Marseille, France.
authors.forename: Pascal-Alexandre
authors.initials: PA
authors.lastname: Thomas
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Bocage Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D018579:Patient Selection; D011013:Pneumonectomy; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Colorectal cancer; Metastasectomy; Overall survival; Predictive factors; Pulmonary metastases; Recurrence