title: Prognostic factors after pulmonary metastasectomy of colorectal cancers: influence of liver metastasis.
abstract: BACKGROUND
  Our objective was to evaluate the influence of liver metastasis on survival after pulmonary metastasectomy in patients with colorectal cancer (CRC).
  
  
  METHODS
  We retrospectively reviewed a total of 524 patients and were classified into two groups based on the presence of liver metastasis. Group HM + PM (n = 106) included patients who previously received a hepatic metastasectomy and then received pulmonary metastasectomy. Group PM (n = 418) included patients who only received pulmonary metastasectomy with no liver metastasis.
  
  
  RESULTS
  There were more male patients (70 vs. 57 %; P = 0.02) and more patients with colon cancer (60 vs. 42 %, P = 0.001) in group HM + PM than in group PM. Otherwise, there was no significant difference between the two groups in clinicopathologic characteristics and extent of surgery. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 58 and 31 %, respectively. There was no significant difference in OS (group HM + PM, 54 % vs. group PM, 59 %; P = 0.085) and in DFS (group HM + PM, 28 % vs. group PM, 32 %; P = 0.12). For the entire patient cohort, a multivariate analysis revealed that the presence of liver metastasis, CRC T and N stages, disease-free interval, and number and size of lung metastases were significantly associated with OS and DFS.
  
  
  CONCLUSIONS
  Our findings suggest that previous or present liver metastasis should not exclude a patient from pulmonary metastasectomy. When lung metastasis is detected in patients with a history of hepatic metastasectomy, pulmonary metastasectomy is still a viable treatment option especially in patients with a long disease-free interval and a small number of lung metastases.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea.
authors.forename: Seok
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea. hkts.kim@samsung.com.
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, 13620, South Korea.
authors.forename: Kwhanmien
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea.
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea.
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery; Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, 06351, South Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Heo
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
authors.forename: Woo Yong
authors.initials: WY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: Colorectal cancer; Disease-free survival; Liver metastasis; Metastasectomy; Pulmonary metastasectomy