title: Repeat resection for recurrent pulmonary metastasis of colorectal cancer.
abstract: OBJECTIVE
  Resection of recurrent lung metastases from colorectal cancer is not completely investigated. We analyzed overall survival and prognosticators after metastasectomy.
  
  
  METHODS
  We retrospectively reviewed our database of 238 patients with lung metastases of colorectal cancer, undergoing metastasectomy with systematic lymph node dissection from 1999 to 2014. Lymph node metastases were found in 55 patients, and liver metastases were found in 79 patients.
  
  
  RESULTS
  The 5- and 10-year survival rates for all patients were 48 and 32%. Of the 238 patients included in the study, 101 developed recurrent lung metastases (42.4%). Recurrence had no impact on survival (p = 0.474). The 5- and 10-year survival rates from the beginning of recurrence for all patients with recurrence were 40 and 25%. Overall, 52 patients had been reoperated for recurrent lung metastases. 5-year survival for reoperated patients was 75% and significantly prolonged compared with nonreoperated patients (p < 0.001). Also, survival from beginning of recurrence was significantly longer (p < 0.001). Recurrence was more often detected in the case of multiple metastases (p = 0.002) and atypical resections (p = 0.029) at first metastasectomy. Lymph node metastases (p = 0.084) and liver metastases (p = 0.195) had no influence on recurrence. For reoperated patients, lower grading of the primary tumor was the only independent prognosticator for survival in multivariate analyses (p = 0.044).
  
  
  CONCLUSIONS
  Good long-term survival is achievable for patients with resectable recurrent lung metastases. Multiple metastases and atypical resection at first metastasectomy were associated with recurrent disease. Neither lymph node metastases nor liver metastases were significantly associated with recurrence. Lower grading of the primary tumor was the only independent prognosticator for survival. All in all, the factors that can be influenced by the surgeon are patient selection and R0 resection.
authors.affiliation: Department of Thoracic Surgery, Helios Dr. Horst Schmidt Klinik, Helios Kliniken Gruppe, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany. Stefan.sponholz@helios-kliniken.de.
authors.forename: Stefan
authors.identifier: http://orcid.org/0000-0001-7123-1963
authors.initials: S
authors.lastname: Sponholz
authors.affiliation: Department of Thoracic Surgery, Helios Dr. Horst Schmidt Klinik, Helios Kliniken Gruppe, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schirren
authors.affiliation: Department of Thoracic Surgery, Helios Dr. Horst Schmidt Klinik, Helios Kliniken Gruppe, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany.
authors.forename: Natalie
authors.initials: N
authors.lastname: Baldes
authors.affiliation: Department of Thoracic Surgery, Helios Dr. Horst Schmidt Klinik, Helios Kliniken Gruppe, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany.
authors.forename: Selma
authors.initials: S
authors.lastname: Oguzhan
authors.affiliation: Department of Thoracic Surgery, Helios Dr. Horst Schmidt Klinik, Helios Kliniken Gruppe, Ludwig-Erhard-Straße 100, 65199, Wiesbaden, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schirren
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D011013:Pneumonectomy; D015995:Prevalence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Colorectal cancer; Pulmonary metastases; Recurrent lung metastases; Repeat metastasectomy