The impact of pulmonary metastasectomy in patients with previously resected colorectal cancer liver metastases.
BACKGROUND
40-50% of patients with colorectal cancer (CRC) will develop liver metastases (CRLM) during the course of the disease. One third of these patients will additionally develop pulmonary metastases.


METHODS
137 consecutive patients with CRLM, were analyzed regarding survival data, clinical, histological data and treatment. Results were stratified according to the occurrence of pulmonary metastases and metastases resection.


RESULTS
39% of all patients with liver resection due to CRLM developed additional lung metastases. 44% of these patients underwent subsequent pulmonary resection. Patients undergoing pulmonary metastasectomy showed a significantly better five-year survival compared to patients not qualified for curative resection (5-year survival 71.2% vs. 28.0%; p = 0.001). Interestingly, the 5-year survival of these patients was even superior to all patients with CRLM, who did not develop pulmonary metastases (77.5% vs. 63.5%; p = 0.015). Patients, whose pulmonary metastases were not resected, were more likely to redevelop liver metastases (50.0% vs 78.6%; p = 0.034). However, the rate of distant metastases did not differ between both groups (54.5 vs.53.6; p = 0.945).


CONCLUSIONS
The occurrence of colorectal lung metastases after curative liver resection does not impact patient survival if pulmonary metastasectomy is feasible. Those patients clearly benefit from repeated resections of the liver and the lung metastases.
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.|Department of Biochemistry and Molecular Biology, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.
Armin
http://orcid.org/0000-0001-7777-0909
A
Wiegering
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.
Johannes
J
Riegel
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.
Johanna
J
Wagner
Department of Internal Medicine II, University of Wuerzburg Medical Center, Oberduerrbacherstr. Wuerzburg, Germany.|Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. Wuerzburg, Germany.
Volker
V
Kunzmann
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.
Johannes
J
Baur
Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. Wuerzburg, Germany.|Department of Cardiothoracic Surgery, University of Wuerzburg Medical Center, Oberduerrbacherstr. Wuerzburg, Germany.
Thorsten
T
Walles
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.
Ulrich
U
Dietz
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.
Stefan
S
Loeb
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.|Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. Wuerzburg, Germany.
Christoph-Thomas
CT
Germer
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.|Mathias-Spital Rheine, Frankenburgerstr. Rheine; Germany.
Ulrich
U
Steger
Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Wuerzburg, Oberduerrbacherstr. Wuerzburg, Germany.|Comprehensive Cancer Centre Mainfranken, University of Wuerzburg Medical Center, Josef-Schneiderstr. Wuerzburg, Germany.
Ingo
I
Klein
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies