Original article
General thoracic
Pulmonary Resection for Metastases of Colorectal Adenocarcinoma

https://doi.org/10.1016/j.athoracsur.2009.10.005Get rights and content

Background

Surgery is a safe and effective treatment for patients with lung metastases from colorectal carcinoma. Combining chemotherapy and surgery seems to prolong survival time after metastasectomy. Our purpose was to review the effectiveness of surgery with time and evolving managements.

Methods

The records of 127 patients were retrospectively analyzed. The characteristics of primary cancer, lung metastases, resections, and associated therapy were studied according to their incidence on survival.

Results

There were 74 male and 53 female patients (mean age, 65 years); 223 operations were performed and 314 metastases were resected. Completeness of surgery (n = 117) was the main factor for prolonged survival (5- and 10-year survival, 41% and 27%, versus 0%). There was no factor of significantly better prognosis, but a tendency to higher survival rates was observed in cases of single metastasis, in patients undergoing several lung operations, and in patients in whom liver metastases were previously removed. Three of 7 patients with mediastinal lymph node involvement survived more than 5 years; 58 patients were operated on before January 2000, and 59 between January 2000 and December 2007. Five-year survival rates were 35.1% versus 63.5%, respectively (p = 0.0096), probably related to better selection with modern workup, more frequent use of chemotherapy, and repeated pulmonary resections.

Conclusions

Different treatment protocols were reported in the literature and in our series with time, resulting in better survival rates and a more aggressive surgical tendency. The beneficial role of such combined therapy justifies further research, including prospective trials.

Section snippets

Patients and Methods

The records of 127 consecutive patients who underwent pulmonary resection for metastases of colorectal adenocarcinomas between 1985 and 2007 at Georges Pompidou European Hospital, Paris, and Cedar Surgical Centre, Bois-Guillaume, were reviewed. Both institutional review boards waived obtaining patient consent for this retrospective study. Preoperative selection criteria were as follows: completely resectable lesions, no evidence of synchronous extrathoracic metastasis, and controlled primary

Results

There were 74 men and 53 women. The median age was 65 years (range, 36 to 85 years). The primary tumor was located in the rectum in 61 patients (47.3%) and in the colon in 52 patients (40.3%), and the precise location was not available in 14 (“colorectal” carcinomas, 12.4%). The mean interval between colon and lung surgery was 37.8 months (±21.5 months), and the median was 36 months (range, 1 to 134 months). Lung metastases were diagnosed during colorectal cancer workup (synchronous metastases)

Comment

The first case series of resection for pulmonary metastases was published in 1947 [5]. Thirty years later, at the end of the 1970s, more generous indication for lung metastases was advocated [6, 7]. In 1997, the International Registry of Lung Metastases was established and reported on 5,206 patients who underwent metastasectomy [8]. Bowel metastases represented the most important cohort, accounting for 12.4% of the patients (n = 645). When considering colorectal cancer, approximately 10% of all

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  • Prognostic differences between oligometastatic and polymetastatic disease after resection in patients with colorectal cancer and hepatic or lung metastases: Retrospective analysis of a large cohort at a single institution

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    In recent reports, 5-year overall survival (OS) rates after hepatic metastasectomy have ranged from 50% to 58%.2–4 About 8% to 10% of patients with CRC develop pulmonary metastases, for which pulmonary metastasectomy is considered beneficial, with reported 5-year OS rates in the range of 24% to 68%.5–8 Given these good outcomes, surgical resection has become an established procedure for patients with CRC and hepatic or pulmonary metastases alone.

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