Abstract
Backgrounds
Pulmonary metastases occur in up to 10% of all patients who undergo curative resection. Surgical resection is an important part in the treatment of pulmonary metastasis from colorectal cancer. We analyzed the treatment outcome and prognostic factors affecting survival in this subset of patients.
Materials and methods
Between October 1994 and December 2004, 59 patients underwent curative resection for pulmonary metastases of colorectal cancer. Uncontrollable synchronous liver and lung metastasis or synchronous colorectal cancer with isolated lung metastasis were excluded from this study. A retrospective review of patient characteristics and factors influencing survival was performed. Survival was analyzed by the Kaplan–Meier method. Comparison between groups were performed by a log-rank analysis and the Cox proportional hazard model.
Results
The 5-year overall survival rate of all patients who received pulmonary resection was 50.3%. The number of pulmonary metastases was significantly related with survival in univariate analysis, but not in multivariate analysis (p = 0.032). Prethoracotomy carcinoembryonic antigen (CEA) level exceeding 5 ng/ml was related with poor survival (p = 0.001). A disease-free interval of greater than 2 years did not correlate with survival after thoracotomy (p = 0.3).
Conclusion
The prethoracotomy CEA level and the number of metastases were independent prognostic factors. Resection of pulmonary metastasis from colorectal cancer may result in improved survival or even healing in selected patients. Pulmonary resection of colorectal cancer is regarded as a safe and effective treatment with low morbidity and mortality rates.
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References
Goya T, Miyazawa N, Kondo H, Tsuchiya R, Naruke T, Suemasu K (1989) Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up. Cancer 64:1418–1421
Mansel JK, Zinsmeister AR, Pairolero PC, Jett JR (1986) Pulmonary resection of metastatic colorectal adenocarcinoma. A ten year experience. Chest 89:109–112
Saltz LB, Cox JV, Blanke C, Rosen LS, Fehrenbacher L, Moore MJ, Maroun JA, Ackland SP, Locker PK, Pirotta N, Elfring GL, Miller LL (2000) Irinotecan plus fluorouracil and leucovorin for metastatic colorectal cancer. Irinotecan Study Group. N Engl J Med 343:905–914
Divis G (1927) Einbertrag zur Operativen, Behandlung der Lungegeschuilste. Acta Chir Scand 62:329–334
Brister SJ, de Varennes B, Gordon PH, Sheiner NM, Pym J (1988) Contemporary operative management of pulmonary metastases of colorectal origin. Dis Colon Rectum 31:786–792
Lehnert T, Knaebel HP, Duck M, Bulzebruck H, Herfarth C (1999) Sequential hepatic and pulmonary resections for metastatic colorectal cancer. Br J Surg 86:241–243
Sakamoto T, Tsubota N, Iwanaga K, Yuki T, Matsuoka H, Yoshimura M (2001) Pulmonary resection for metastases from colorectal cancer. Chest 119:1069–1072
Girard P, Ducreux M, Baldeyrou P, Rougier P, Le Chevalier T, Bougaran J, Lasser P, Gayet B, Ruffie P, Grunenwald D (1996) Surgery for lung metastases from colorectal cancer: analysis of prognostic factors. J Clin Oncol 14:2047–2053
McAfee MK, Allen MS, Trastek VF, Ilstrup DM, Deschamps C, Pairolero PC (1992) Colorectal lung metastases: results of surgical excision. Ann Thorac Surg 53:780–785; discussion 785–786
McCormack PM, Ginsberg RJ (1998) Current management of colorectal metastases to lung. Chest Surg Clin North Am 8:119–126
Pfannschmidt J, Muley T, Hoffmann H, Dienemann H (2003) Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. J Thorac Cardiovasc Surg 126:732–739
Regnard JF, Grunenwald D, Spaggiari L, Girard P, Elias D, Ducreux M, Baldeyrou P, Levasseur P (1998) Surgical treatment of hepatic and pulmonary metastases from colorectal cancers. Ann Thorac Surg 66:214–218; discussion 218–219
Gutman M, Fidler IJ (1995) Biology of human colon cancer metastasis. World J Surg 19:226–234
Rena O, Casadio C, Viano F, Cristofori R, Ruffini E, Filosso PL, Maggi G (2002) Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience. Eur J Cardio-thorac Surg 21:906–912
Okumura S, Kondo H, Tsuboi M, Nakayama H, Asamura H, Tsuchiya R, Naruke T (1996) Pulmonary resection for metastatic colorectal cancer: experiences with 159 patients. J Thorac Cardiovasc Surg 112:867–874
Saito Y, Omiya H, Kohno K, Kobayashi T, Itoi K, Teramachi M, Sasaki M, Suzuki H, Takao H, Nakade M (2002) Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg 124:1007–1013
Yano T, Fukuyama Y, Yokoyama H, Tanaka Y, Miyagi J, Kuninaka S, Asoh H, Ichinose Y (1997) Failure in resection of multiple pulmonary metastases from colorectal cancer. J Am Coll Surg 185:120–122
Inoue M, Ohta M, Iuchi K, Matsumura A, Ideguchi K, Yasumitsu T, Nakagawa K, Fukuhara K, Maeda H, Takeda S, Minami M, Ohno Y, Matsuda H (2004) Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg 78:238–244
Ishikawa K, Hashiguchi Y, Mochizuki H, Ozeki Y, Ueno H (2003) Extranodal cancer deposit at the primary tumor site and the number of pulmonary lesions are useful prognostic factors after surgery for colorectal lung metastases. Dis Colon Rectum 46:629–636
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Lee, WS., Yun, S.H., Chun, HK. et al. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis 22, 699–704 (2007). https://doi.org/10.1007/s00384-006-0218-2
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DOI: https://doi.org/10.1007/s00384-006-0218-2