Skip to main content
SpringerLink
Log in

How Uncommon are Isolated Lung Metastases in Colorectal Cancer? A Review from Database of 754 Patients Over 4 Years

  • original article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

It is commonly thought that colon cancer metastases to the lungs without involvement of the liver are rare.

Methods

We performed a retrospective review of all patients with colorectal cancer diagnosed between December 2003 and August 2007 in Singapore. Isolated lung metastases were determined as (1) Definite if there was confirmed histology or cytology of the lung lesion(s) in the absence of liver lesions on CT scan, and (2) Probable if there were only radiological evidence suggestive of lung metastases rather than lung primary also in the absence of liver lesions on CT scan.

Results

There were 196 patients with rectal and 558 patients with colon cancer (369 left-sided and 189 right-sided). There were 13 definite isolated lung metastases, and the remaining 43 were probable. Twenty-three (12%) patients with rectal cancer and 33 (6%) patients with colon cancer had isolated lung metastases (OR 2.11, 95% CI 1.21–3.70). Patients with ≥pT3 lesions (OR 1.92, 95% CI 0.75–4.93) and ≥pN1 (OR 1.56, 95% CI 0.86– 2.83) were more likely to have isolated lung metastases.

Conclusion

The true incidence of isolated lung without liver metastases in colorectal cancer is likely to lie between 1.7% and 7.2%. While the incidence of isolated lung metastases is twice as common in patients with rectal cancer, it is still significant in patients with colon cancer. The absence of liver involvement should not preclude a search for lung metastases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Eisenberg B, Decosse JJ, Harford F, Michalek J. Carcinoma of the colon and rectum: the natural history reviewed in 1704 patients. Cancer 1982;49(6):1131–1134. doi:10.1002/1097-0142(19820315)49:6<1131::AID-CNCR2820490611>3.0.CO;2-T.

    Article  PubMed  Google Scholar 

  2. Galandiuk S, Wieand HS, Moertel CG, Cha SS, Fitzgibbons RJ Jr, Pemberton JH, Wolff BG. Patterns of recurrence after curative resection of carcinoma of the colon and rectum. Surg Gynecol Obstet 1992;174(1):27–32.

    PubMed  Google Scholar 

  3. Pihl E, Hughes ES, McDermott FT, Johnson WR, Katrivessis H. Lung recurrence after curative surgery for colorectal cancer. Dis Colon Rectum 1987;30:417–419. doi:10.1007/BF02556487.

    Article  PubMed  Google Scholar 

  4. McCormack PM, Attiyeh FF. Resected pulmonary metastases from colorectal cancer. Dis Colon Rectum 1979;22:553–556. doi:10.1007/BF02587003.

    Article  PubMed  Google Scholar 

  5. Hanna WC, Ponsky TA, Trachiotis GD, Knoll SM. Colon cancer metastatic to the lung and the thyroid gland. Arch Surg 2006;141(1):93–96. doi:10.1001/archsurg.141.1.93.

    Article  PubMed  Google Scholar 

  6. Phillips JS, Lishman S, Jani P. Colonic carcinoma metastasis to the thyroid: a case of skip metastasis. J Laryngol Otol 2005;119(10):834–836. doi:10.1258/002221505774481273.

    Article  PubMed  Google Scholar 

  7. Scheele J, Altendorf-Hofmann A, Stangl R, Gall FP. Pulmonary resection for metastatic colon and upper rectum cancer. Is it useful? Dis Colon Rectum 1990;33(9):745–752. doi:10.1007/BF02052319.

    Article  PubMed  Google Scholar 

  8. Goya T, Miyazawa N, Kondo H, Tsuchiya R, Naruke T, Suemasu K. Surgical resection of pulmonary metastases from colorectal cancer. 10-year follow-up. Cancer 1989;64(7):1418–1421. doi:10.1002/1097-0142(19891001)64:7<1418::AID-CNCR2820640709>3.0.CO;2-N.

    Article  PubMed  Google Scholar 

  9. Wilkins EW Jr, Head JM, Burke JF. Pulmonary resection for metastatic neoplasms in the lung: experience at the Massachusetts Hospital. Am J Surg 1978;135:480–483. doi:10.1016/0002-9610(78)90023-5.

    Article  PubMed  Google Scholar 

  10. Akasu T, Yamaguchi T, Fujimoto Y, Ishiguro S, Yamamoto S, Fujita S, Moriya Y. Abdominal sacral resection for posterior pelvic recurrence of rectal carcinoma: analyses of prognostic factors and recurrence patterns. Ann Surg Oncol 2007;14(1):74–83. doi:10.1245/s10434-006-9082-0.

    Article  PubMed  Google Scholar 

  11. Welter S, Jacobs J, Krbek T, Krebs B, Stamatis G. Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg 2007;84(1):203–210. doi:10.1016/j.athoracsur.2007.03.028.

    Article  PubMed  Google Scholar 

  12. Ishikawa K, Hashiguchi Y, Mochizuki H, Ozeki Y, Ueno H. 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 2003;46(5):629–636. doi:10.1007/s10350-004-6623-0.

    Article  PubMed  Google Scholar 

  13. Merrie AE, Phillips LV, Yun K, McCall JL. Skip metastases in colon cancer: assessment by lymph node mapping using molecular detection. Surgery 2001;129(6):684–691. doi:10.1067/msy.2001.113887.

    Article  PubMed  Google Scholar 

  14. Herrera-Ornelas L, Justiniano J, Castillo N, Petrelli NJ, Stulc JP, Mittelman A et al. Metastases in small lymph nodes from colon cancer. Arch Surg 1987;122:1253–1256.

    PubMed  Google Scholar 

  15. Tang R, Wang JY, Chen JS et al. Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum. J Am Coll Surg 1995;180:705–712.

    PubMed  Google Scholar 

  16. Read TE, Mutch MG, Chang BW, McNevin MS, Fleshman JW, Birnbaum EH, Fry RD, Caushaj PF, Kodner IJ. Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 2002;195(1):33–40. doi:10.1016/S1072-7515(02)01224-3.

    Article  PubMed  Google Scholar 

  17. Radespiel-Tröger M, Hohenberger W, Reingruber B. Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratification. Cancer 2004;100(5):958–967. doi:10.1002/cncr.20065.

    Article  PubMed  Google Scholar 

  18. Zlobec I, Baker K, Minoo P, Jass JR, Terracciano L, Lugli A. Node-negative colorectal cancer at high risk of distant metastasis identified by combined analysis of lymph node status, vascular invasion, and Raf-1 kinase inhibitor protein expression. Clin Cancer Res 2008;14(1):143–148. doi:10.1158/1078-0432.CCR-07-1380.

    Article  PubMed  Google Scholar 

  19. Park YJ, Park KJ, Park JG, Lee KU, Choe KJ, Kim JP. Prognostic factors in 2230 Korean colorectal cancer patients: analysis of consecutively operated cases. World J Surg 1999;23(7):721–726. doi:10.1007/PL00012376.

    Article  PubMed  Google Scholar 

  20. Hine KR, Leonard JC, Booth SN, Dykes PW. Carcinoembryonic antigen concentrations in undiagnosed patients. Lancet 1978;2:1337–1340. doi:10.1016/S0140-6736(78)91975-X.

    Article  PubMed  Google Scholar 

  21. Devesa JM, Morales V, Enriquez JM et al. Colorectal cancer. The bases for a comprehensive follow-up. Dis Colon Rectum 1988;31:636–652. doi:10.1007/BF02556803.

    Article  PubMed  Google Scholar 

  22. Beart RW, Metzger PP, O’Connell MJ, Schutt AJ. Postoperative screening of patients with carcinoma of the colon. Dis Colon Rectum 1981;24:585–589. doi:10.1007/BF02605750.

    Article  PubMed  Google Scholar 

  23. Rocklin MS, Senagore AJ, Talbott TM. Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma. Dis Colon Rectum 1991;34:794–797. doi:10.1007/BF02051073.

    Article  PubMed  Google Scholar 

  24. Barillari P, Bolognese A, Chirletti P, Cardi M, Sammartino P, Stipa V. Role of CEA, TPA, and Ca 19-9 in the early detection of localized and diffuse recurrent rectal cancer. Dis Colon Rectum 1992;35(5):471–476. doi:10.1007/BF02049405.

    Article  PubMed  Google Scholar 

  25. Hine FR, Dyke PW. Serum CEA testing in the postoperative surveillance of colorectal carcinoma. Br J Cancer 1984;49:689–693.

    PubMed  Google Scholar 

  26. McCall JL, Black RB, Rich CA, Harvey JR, Baker RA, Watts JM, Toouli J. The value of serum carcinoembryonic antigen in predicting recurrent disease following curative resection of colorectal cancer. Dis Colon Rectum 1994;37(9):875–881. doi:10.1007/BF02052591.

    Article  PubMed  Google Scholar 

  27. Desch CE, Benson AB 3rd, Somerfield MR, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Pfister DG, Virgo KS, Petrelli NJ, American Society of Clinical Oncology. Colorectal cancer surveillance: 2005 update of an American Society of Clinical Oncology practice guideline. J Clin Oncol 2005;23(33):8512–8519. doi:10.1200/JCO.2005.04.0063.

    Article  PubMed  Google Scholar 

  28. Chau I, Allen MJ, Cunningham D, Norman AR, Brown G, Ford HE, Tebbutt N, Tait D, Hill M, Ross PJ, Oates J. The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer. J Clin Oncol 2004;22(8):1420–1429. doi:10.1200/JCO.2004.05.041.

    Article  PubMed  Google Scholar 

  29. Staib L, Schirrmeister H, Reske SN, Beger HG. Is (18)F-fluorodeoxyglucose positron emission tomography in recurrent colorectal cancer a contribution to surgical decision making? Am J Surg 2000;180(1):1–5. doi:10.1016/S0002-9610(00)00406-2.

    Article  PubMed  Google Scholar 

  30. Sarikaya I, Bloomston M, Povoski SP, Zhang J, Hall NC, Knopp MV, Martin EW Jr. FDG-PET scan in patients with clinically and/or radiologically suspicious colorectal cancer recurrence but normal CEA. World J Surg Oncol 2007;5:64. doi:10.1186/1477-7819-5-64.

    Article  PubMed  Google Scholar 

  31. Warwick R, Page R. Resection of pulmonary metastases from colorectal carcinoma. Eur J Surg Oncol 2007. 33(Suppl 2):S59–S63. doi:10.1016/j.ejso.2007.09.018.

    PubMed  Google Scholar 

  32. Zink S, Kayser G, Gabius HJ, Kayser K. Survival, disease-free interval, and associated tumor features in patients with colon/rectal carcinomas and their resected intra-pulmonary metastases. Eur J Cardiothorac Surg 2001;19(6):908–913. doi:10.1016/S1010-7940(01)00724-2.

    Article  PubMed  Google Scholar 

  33. Joosten J, Bertholet J, Keemers-Gels M, Barendregt W, Ruers T. Pulmonary resection of colorectal metastases in patients with or without a history of hepatic metastases. Eur J Surg Oncol 2008;34(8):895–899. doi:10.1016/j.ejso.2008.01.009.

    PubMed  Google Scholar 

  34. Labow DM, Buell JE, Yoshida A, Rosen S, Posner MC. Isolated pulmonary recurrence after resection of colorectal hepatic metastases–is resection indicated? Cancer J 2002;8(4):342–347. doi:10.1097/00130404-200207000-00011.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Ker Kan Tan & Richard Sim

  2. Johns Hopkins Singapore International Medical Centre, Singapore, and Johns Hopkins University, Baltimore, MD, USA

    Gilberto de Lima Lopes Jr.

Authors
  1. Ker Kan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gilberto de Lima Lopes Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Sim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ker Kan Tan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, K.K., Lopes Jr., G.d.L. & Sim, R. How Uncommon are Isolated Lung Metastases in Colorectal Cancer? A Review from Database of 754 Patients Over 4 Years. J Gastrointest Surg 13, 642–648 (2009). https://doi.org/10.1007/s11605-008-0757-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0757-7

Keywords

Search

Navigation