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Eur J Cardiothorac Surg 2000;18:671-677
© 2000 Elsevier Science NL
a Division of Thoracic Surgery, Lung Center, 02 Level, South Tower, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212-4772, USA
b Department of Surgery, University of Rome, Rome, Italy
c Department of Cardio-thoracic Surgery, Humana Hospital, Dallas, TX, USA
d Division of Cardio-thoracic Surgery, University of Southern Illinois, Springfield, IL, USA
e Section of Thoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
f Division of Thoracic Surgery, Chinese University of Hong Kong, Hong Kong, People's Republic of China
Received 8 September 1999; received in revised form 15 August 2000; accepted 19 September 2000.
Corresponding author. Tel.: +1-412-359-6412; fax: +1-412-359-3277
e-mail: rlandren{at}wpahs.org
Objective: Careful patient selection is vital when video-assisted thoracoscopic surgical (VATS) therapeutic pulmonary metastasectomy of colorectal carcinoma is considered. Complete resection of all metastatic disease remains a vital concept. We reviewed our VATS experience for therapeutic metastasectomy of peripheral colorectal pulmonary metastases. Methods: Over 90 months, therapeutic VATS metastasectomy was accomplished upon 80 patients with colorectal metastases. Thin cut computed tomography (CT) was central in identifying lesions. The mean interval from primary carcinoma to VATS resection was 41 months (1–156 months; median, 33). A solitary lesion was resected in 60 patients and multiple (2–7) lesions resected in 20 patients. Statistics were obtained using the Student's t-test. Results: No operative mortality or major postoperative complications occurred. The hospital stay was 4.5±2.2 days (range, 1–13). All lesions were resected by VATS, with four conversions to thoracotomy to improve the margins. The mean survival of patients with one lesion was 34.8 months compared with 26.5 months for patients with multiple lesions (P=0.37). The mean survival was 20.5 months when metastases occurred <3 years vs. 28.1 months for >3 years from primary carcinoma resection (P=0.20). Twenty-five (31%) patients are disease free; with a mean interval of 38.7 (3–84; median, 35) months. Sixty-nine percent (55/80) of patients developed a recurrence: 6/80 (8%) local; 19/80 (24%) regional (same hemithorax away from resection); and 30/80 (38%) distant. The overall survival at 1 year was 81.2%, 48.4% at 3 years and 30.8% at 5 years. Conclusions: Therapeutic VATS resection of colorectal metastases appears efficacious. Preoperative CT can identify peripheral colorectal metastases amenable to VATS. Conversion to thoracotomy is indicated when none of the lesions identified by CT are found or when clear surgical margins are jeopardized.
Key Words: Pulmonary metastases • Colorectal carcinoma • Lung resection
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