title: Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery.
abstract: BACKGROUND
  Surgery is considered an effective therapeutic option for patients with lung metastasis (MTS) of colorectal cancer (CRC). The purpose of the study was to evaluate efficacy and feasibility of lung metastasectomy in CRC patients and to explore factors of prognostic relevance.
  
  
  METHODS
  This is a retrospective study of patients operated for lung MTS of CRC from 2004 to 2012 in a single Institution. Overall survival (OS) was the primary endpoint. Secondary endpoints were progression free survival (PFS) in resection status R0 and OS in in patients submitted to re-resections. In order to evaluate prognostic factors, a multivariable Cox proportional hazard model was performed.
  
  
  RESULTS
  One-hundred eighty-eight consecutive patients were included in the final analysis. The median follow-up (FU) was 45 months. The 5-year OS and PFS were 53% (95% CI: 44-60%) and 33% (95% CI: 25-42%), respectively. Two- and 5-year survival after re-resection were 79% (95% CI: 63-89%) and 49% (95% CI: 31-65%), respectively. Multivariate adjusted analysis showed that primary CRC pathological TNM stages (P=0.019), number of resected MTS ≥5 (P=0.009) and lymph nodal involvement (P<0.0001) are independent predictors of poor prognosis.
  
  
  CONCLUSIONS
  Patients operated and re-operated for lung MTS from CRC cancers showed encouraging survival rates. Our results indicated that primary CRC stage, number of MTS and lymph nodal involvement are strong predictive factors. Prognosis after surgery remained comforting up to four resected MTS. Adjuvant chemotherapy seems to have a benefit on survival in patients affected by multiple metastases. Finally, according to the high rate of unidentified lymph node involvement in pre-operative setting, lymph node sampling should be advisable for a correct staging.
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Francesco
authors: F
authors: Guerrera
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Claudio
authors: C
authors: Mossetti
authors: Unit of Cancer Epidemiology and CPO Piedmont, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
authors: Manuela
authors: M
authors: Ceccarelli
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Maria Cristina
authors: MC
authors: Bruna
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Giulia
authors: G
authors: Bora
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Stefania
authors: S
authors: Olivetti
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Paolo Olivo
authors: PO
authors: Lausi
authors: Unit of Pulmunology, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
authors: Paolo
authors: P
authors: Solidoro
authors: Unit of Cancer Epidemiology and CPO Piedmont, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
authors: Giovannino
authors: G
authors: Ciccone
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Enrico
authors: E
authors: Ruffini
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Alberto
authors: A
authors: Oliaro
authors: Department of Thoracic Surgery, AOU Città della Salute e della Scienza di Torino - University of Torino, Torino, Italy ;
authors: Pier Luigi
authors: PL
authors: Filosso
keywords: Colorectal cancer (CRC); adjuvant chemotherapy; lung metastases; lymphnode; outcomes; positron emission tomography (PET); surgery