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Lung metastasectomy after colorectal cancer: prognostic impact of resection margin on long term survival, a retrospective cohort study

  • Federico Davini
  • Sara RicciardiEmail author
  • Carmelina C. Zirafa
  • Gaetano Romano
  • Greta Alì
  • Gabriella Fontanini
  • Franca M.A. Melfi
Original Article
  • 27 Downloads

Abstract

Background

Pulmonary metastasectomy is considered a potentially curative treatment for selected patients with metastatic colorectal cancer (CRC). Several prognostic factors have been analysed, but to date, it is still not well defined which is the optimal resection margin during lung metastasectomy (LM). This study analyses the long-term results and prognostic factors after LM in CRC patients with particular attention to the resection margins. Primary endpoint of this study is to assess the correlation between resection margins and long-term outcomes.

Methods

Observational cohort study on all proven cases of CRC lung metastases (2000–2016) resected with curative intent in a single centre.

Results

The series included 210 consecutive patients (M/F 133/77) with a mean age of 65.4 (± 9.96) years, 75% (159/210) of them with a solitary metastasis. Mean size of metastasis was 2.57 cm (± 1.45). One hundred sixty-eight patients underwent wedge resections (80%) and lymphadenectomy was carried out in 90 cases (42.9%). With a mean follow-up of 56 months (range 5–192), we observed a 1-, 3- and 5-year overall survival (OS) of 95%, 74% and 54%, respectively. The patients were divided into three groups according to the resection margin distance from the tumour: (a) ≥ 2 cm (145 cases); (b) < 2, ≥ 1 cm (37 cases); and (c) < 1 cm (12 cases). The OS was significantly different between the three groups (p = 0,020); univariate and multivariate analyses showed that a narrow resection margin was an independent prognostic factor of worse survival (p = 0.006 and HR 3.4 p = 0.009).

Conclusions

Long-term survival of patients after LM is strongly associated with a greater distance between the lesion and the resection margin.

Keywords

Metastasectomy Colorectal cancer Lung metastasis Surgery Outcome 

Notes

Acknowledgements

The authors thank Teresa Hung Key for linguistic accuracy checking.

Compliance with ethical standards

All patients signed an informed consent for the surgery and for the inclusion of their clinical data in the database.

This study is a retrospective analysis of standard surgical procedures, was conducted in accordance with the Declaration of Helsinki and approved by our internal institutional review board (IRB).

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Multispecialty Centre for Surgery, Minimally Invasive and Robotic Thoracic SurgeryUniversity Hospital of PisaPisaItaly
  2. 2.Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, Pathology and Critical CareUniversity Hospital of PisaPisaItaly
  3. 3.Unit of Pathological AnatomyUniversity Hospital of PisaPisaItaly

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