Surgical resection is an important form of treatment for pulmonary
metastases from colorectal carcinoma. We analyzed the clinical course, outcome,
and prognostic factors after surgery.
Methods
Between 1985 and 2000, 167 patients (103 men, 64 women) underwent
complete pulmonary resection of metastatic colorectal carcinoma. Only patients
who met the criteria for potentially curative operation, in particular, control
of the primary tumor, ability to resect all metastatic disease, and no other
extrapulmonary metastases, were included.
Results
The overall 5-year survival was 32.4%. A significantly longer
survival was observed in multivariate analysis in patients without lymph node
involvement compared with patients with pulmonary or mediastinal lymph node
metastases or both. The number of pulmonary metastases significantly influenced
survival. In patients with a solitary metastasis, we observed a 5-year survival
of 45%, whereas the rate was 19.8% in patients with more than a single
metastasis. In multivariate analysis, we also found the prethoracotomy
carcinoembryonic antigen serum level to be an independent significant prognostic
factor for survival. In patients with a serum carcinoembryonic antigen level
exceeding 5 ng/mL and in patients with a serum carcinoembryonic antigen level in
the normal range, the 5-year survivals were 22.7% and 48.3%,
respectively.
Conclusions
We conclude that pulmonary resection of metastatic colorectal
carcinoma is safe and results in long-term survival. Thoracic lymph node
metastases, serum carcinoembryonic antigen level before metastasectomy, and the
number of pulmonary metastases were identified as prognosis-related criteria for
surgery.