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Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study

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The aim of this retrospective study was to establish the prognostic factors for overall survival after pulmonary resection for lung metastases of colorectal carcinoma (CRC).


The baseline characteristics and outcomes of 266 CRC patients undergoing complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group. We used the Cox proportional hazard regression to identify independent prognostic factors for OS.


The 5-year overall survival rate of patients undergoing complete resection of isolated pulmonary metastases was 56.5 %. The independent unfavorable prognostic factors after pulmonary resection included stage T4 (p = 0.0004) and N2 (p = 0.0082) as primary cancer-related factors, and more than three metastases (p = 0.0342), bilateral distribution (p = 0.0450), metastatic disease-free interval (DFI) of less than 2 years (p = 0.0257), and a preoperative carcinoembryonic antigen (CEA) level greater than 5.0 ng/mL (p = 0.0209) as pulmonary metastases-related factors.


This retrospective analysis suggested that the indications for pulmonary resection of CRC metastases should be decided not only by the status of lung metastases, but also by pulmonary-related factors such as the T and N stage of the primary lesion, preoperative CEA level, and the DFI.

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  1. Gatta G, Faivre J, Capocaccia R, de Leon PM, EUROCARE Working Group. Survival of colorectal cancer patients in Europe during the period 1978–1989. Eur J Cancer. 1998;34:2176–83.

    Article  PubMed  CAS  Google Scholar 

  2. Zink S, Kayser G, Gabius HJ, Kaiser K. Survival, disease-free interval, and associated tumour features in patients with colorectal carcinomas and their resected intra-pulmonary metastases. Eur J Cardiothorac Surg. 2001;19:908–13.

    Article  PubMed  CAS  Google Scholar 

  3. Levi F, Lucchini F, Negri E, La Vecchia C. Worldwide patterns of cancer mortality 1990–94. Eur J Cancer Prev. 1999;8:381–400.

    Article  PubMed  CAS  Google Scholar 

  4. Inoue M, Ohta M, Iuchi K, Matsumura A, Ideguchi K, Yasumitsu T, et al. Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma. Ann Thorac Surg. 2004;78:238–44.

    Article  PubMed  Google Scholar 

  5. Lucena JR. Resección de metastases pulmonares en cancer colorectal. Cir Esp. 2005;78:362–5.

    Article  PubMed  Google Scholar 

  6. Iwasaki A, Shirakusa T, Yamashita Y, Noritoni T, Maekawa T, Hamada T. Characteristic differences between patients who have undergone surgical treatment for lung metastases or hepatic metastases from colorectal cancer. Thorac Cardiovasc Surg. 2005;53:358–64.

    Article  PubMed  CAS  Google Scholar 

  7. Blalock A. Recent advances in surgery. N Engl J Med. 1944;231:261–7.

    Article  Google Scholar 

  8. Thomford NR, Woolner LB, Clagett OT. The surgical treatment of metastatic tumors in the lungs. J Thorac Cardiovasc Surg. 1965;49:357–63.

    PubMed  CAS  Google Scholar 

  9. Rena O, Casadio C, Viano F, Cristofori R, Ruffini E, Filosso PL, et al. Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience. Eur J Cardiothorac Surg. 2002;21:906–12.

    Article  PubMed  Google Scholar 

  10. Melloni G, Doglioni C, Bandiera A. Prognostic factors and analysis of microsatellite instability in resected pulmonary metastases from colorectal carcinoma. Ann Thorac Surg. 2006;81:2008–13.

    Article  PubMed  Google Scholar 

  11. Takahashi S, Nagai K, Saito N. Multiple resections for hepatic and pulmonary metastases of colorectal carcinoma. Jpn J Clin Oncol. 2007;37:186–92.

    Article  PubMed  Google Scholar 

  12. Onaitis MW, Petersen RP, Haney JC. Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases. Ann Thorac Surg. 2009;87:1684–8.

    Article  PubMed  Google Scholar 

  13. Miller G, Biernacki P, Kemeny NE. Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases. J Am Coll Surg. 2007;205:231–8.

    Article  PubMed  Google Scholar 

  14. Ike H, Shimada H, Ohki S, Togo S, Yamaguchi S, Ichikawa Y. Results of aggressive resection of lung metastases from colorectal carcinoma detected by intensive follow-up. Dis Colon Rectum. 2002;45:468–75.

    Article  PubMed  Google Scholar 

  15. Lin BR, Chang TC, Lee YC. Pulmonary resection for colorectal cancer metastases: duration between cancer onset and lung metastasis as an important prognostic factor. Ann Surg Oncol. 2009;16:1026–32.

    Article  PubMed  Google Scholar 

  16. Welter S, Jacobs J, Krbek T. Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg. 2007;84:203–10.

    Article  PubMed  Google Scholar 

  17. Chen F, Hanaoka N, Sato K. Prognostic factors of pulmonary metastasectomy for colorectal carcinomas. World J Surg. 2009;33:505–11.

    Article  PubMed  CAS  Google Scholar 

  18. Saito Y, Omiya H, Kohno K. Pulmonary metastasectomy for 165 patients with colorectal carcinoma: a prognostic assessment. J Thorac Cardiovasc Surg. 2002;124:1007–13.

    Article  PubMed  Google Scholar 

  19. Shiono S, Ishii G, Nagai K. Histopathologic prognostic factors in resected colorectal lung metastases. Ann Thorac Surg. 2005;79:278–282 (discussion 83).

    Google Scholar 

  20. Watanabe K, Nagai K, Kobayashi A, Sugito M, Saito N. Factors influencing survival after curative resection of pulmonary metastases from colorectal cancer. Br J Surg. 2009;96:1058–65.

    Article  PubMed  CAS  Google Scholar 

  21. Lee WS, Yun HR, Yun SH. Treatment outcomes of hepatic and pulmonary metastases from colorectal carcinoma. J Gastroenterol Hepatol. 2008;23:e367–72.

    Article  PubMed  Google Scholar 

  22. The Japanese Society for Cancer of the Colon and Rectum. The Japanese classification of colorectal carcinoma. 2nd English Edn. Tokyo: Kanehara Co., Ltd; 2009.

  23. The Japanese Society for Cancer of the Colon and Rectum. Treatment guideline for colon cancer for physicians, 2005. Tokyo: Kanehara Co., Ltd.; 2005.

    Google Scholar 

  24. Jass JR, Sobin LH (eds). World Health Orgamization International histological classification of tumors. Berlin: Springer; 1989.

  25. Pfannschmidt J, Dienemann H, Hoffmann H. Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series. Ann Thorac Surg. 2007;84:324–38.

    Article  PubMed  Google Scholar 

  26. Pfannschmidt J, Hoffmann H, Dienemann H. Reported outcome factors for pulmonary resection in metastatic colorectal cancer. J Thorac Oncol. 2010;5(Suppl 2):172–8.

    Article  Google Scholar 

  27. Fiorentino F, Hunt I, Teoh K, Treasure T, Utley M. Pulmonary metastasectomy in colorectal cancer: a systematic review and quantitative synthesis. J R Soc Med. 2010;103:60–6.

    Article  PubMed  Google Scholar 

  28. Suemitsu R, Takeo S, Kusumoto E, Hamatake M, Ikejiri K, Saitsu H. Results of a pulmonary metastasectomy in patients with colorectal cancer. Surg Today. 2011;41(1):54–9.

    Google Scholar 

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We thank all the physicians at the institutions participating in the Pulmonary Metastases from Colon Cancer Project for contributing to this case series. Takashi Hirai, M.D., Ph.D. (Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan), Masahiko Watanabe, M.D., Ph.D. (Department of Surgery, Kitasato University, Kanagawa, Japan), Tadahiko Masaki, M.D., Ph.D. (Department of General Gastrointestinal Surgery, Kyorin University, Tokyo, Japan), Kazuo Shirouzu, M.D., Ph.D. (Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan), Hirotoshi Hasegawa, M.D., Ph.D. (Department of Surgery, Keio University, Tokyo, Japan), Yukio Saito, M.D., Ph.D. (Department of Surgery, International Medical Center of Japan, Tokyo, Japan), Koichi Hirata, M.D., Ph.D. (Department of Surgery, Sapporo Medical University, Sapporo, Japan), Toshiaki Watanabe, M.D., Ph.D. (Department of Surgery II, Teikyo University, Tokyo, Japan), Tatsuya Aoki, M.D., Ph.D. (Department of Surgery, Tokyo Medical University, Tokyo, Japan), Kimihiko Funahashi, M.D., Ph.D. (Department of Surgery, Omori Medical Center, Toho University, Tokyo, Japan), Kenjiro Kotake, M.D., Ph.D. (Department of Surgery, Tochigi Cancer Center, Tochigi, Japan), Kenichi Takahashi, M.D., Ph.D. (Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan), Tsuneo Iiai, M.D., Ph.D. (First Department of Surgery, Niigata University, Niigata, Japan), Kotaro Maeda, M.D., Ph.D. (Department of Surgery, Fujita Health University, Aichi, Japan), Naohiro Tomita, M.D., Ph.D. (Department of Surgery, Hyogo College of Medicine, Hyogo, Japan), Kazuo Hase, M.D., Ph.D. (Department of Surgery, National Defense Medical College, Saitama, Japan), Masato Kusunoki, M.D., Ph.D. (Department of Surgery, Mie University, Mie, Japan), Shimpei Ogawa, M.D., Ph.D. (Department of Surgery II, Tokyo Women’s Medical University), and Yoichiro Homma, M.D. (Department of Surgery II, Tokyo Women’s Medical University).

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Correspondence to Tomoichiro Hirosawa or Michio Itabashi.

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Hirosawa, T., Itabashi, M., Ohnuki, T. et al. Prognostic factors in patients undergoing complete resection of pulmonary metastases of colorectal cancer: a multi-institutional cumulative follow-up study. Surg Today 43, 494–499 (2013).

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