title: Does Repeated Lung Resection Provide Long-Term Survival for Recurrent Pulmonary Metastases of Colorectal Cancer? Results of a Retrospective Japanese Multicenter Study.
abstract: BACKGROUND
  The purpose of this study was to clarify the long-term survival outcomes after repeated lung resection (RLR) of pulmonary metastases from colorectal cancer (PM-CRC) using data from a Japanese nationwide investigation.
  
  
  METHODS
  Among 898 patients who underwent R0 resection of PM-CRC at 46 Japanese institutions between 2004 and 2008, we analyzed the data of 216 patients who experienced recurrence limited to the lung after initial resection of PM-CRC. Overall survival (OS) after RLR was analyzed, and prognostic factors were explored using a multivariate Cox analysis.
  
  
  RESULTS
  Of a total 216 patients, 132 (61%) received RLR, and their 5-year OS rate was 75.3%. Twenty-two patients underwent a second RLR, and 2 patients underwent a third RLR; a favorable survival outcome was observed even after a second RLR (5-year OS rate, 55.1%). The prognostic factors associated with worse survival after RLR were concomitant liver metastasis, which had been completely resected or ablated at the initial lung metastasectomy (hazard ratio [HR], 4.84; 95% confidence interval [CI], 1.48-14.8) and location of the primary tumor in the rectum (HR, 3.16; 95% CI, 1.17-9.35). Patients without these 2 poor prognostic factors (n = 58) showed a 5-year OS rate of 82.6% after RLR.
  
  
  CONCLUSIONS
  This nationwide database study showed that RLR for resectable lung-limited recurrence after PM-CRC resection could provide favorable survival, especially for patients with colon cancer without liver metastases at the initial PM-CRC resection.
authors: Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan. Electronic address: thishida@nifty.com.
authors: Tomoyuki
authors: T
authors: Hishida
authors: Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
authors: Masahiro
authors: M
authors: Tsuboi
authors: Department of Surgery, University Hospital Mizonokuchi, Teikyo University School of Medicine, Kanagawa, Japan.
authors: Takehiro
authors: T
authors: Okumura
authors: Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors: Narikazu
authors: N
authors: Boku
authors: Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Yasuhisa
authors: Y
authors: Ohde
authors: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
authors: Yukinori
authors: Y
authors: Sakao
authors: Department of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
authors: Katsuo
authors: K
authors: Yoshiya
authors: Division of Gastroenterology Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
authors: Ichinosuke
authors: I
authors: Hyodo
authors: Clinical Research Support Center, Shizuoka Cancer Center, Shizuoka, Japan.
authors: Keita
authors: K
authors: Mori
authors: General Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors: Haruhiko
authors: H
authors: Kondo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011013:Pneumonectomy / Q000379:methods*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome