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Eur J Cardiothorac Surg 2002;21:906-912
© 2002 Elsevier Science NL
a Department of General Thoracic Surgery, University of Torino, Ospedale San Giovanni Battista, v. Genova 3, 10126, Turin, Italy
b Unit of Thoracic Surgery, University of Eastern Piedmont, Ospedale Maggiore della Carità, Novara, Italy
Received 7 November 2001; received in revised form 22 January 2002; accepted 1 February 2002.
* Corresponding author
e-mail: ottavio.rena{at}tiscalinet.it
Objective: We reviewed our experience in the surgical management of 80 patients with colorectal pulmonary metastases and investigated factors affecting survival. Material and methods: From January 1980 to December 2000, 80 patients, 43 women and 37 men with median age 63 years (range 38–79 years) underwent 98 open surgical procedure (96 muscle-sparing thoracotomy, one clamshell and one median sternotomy) for pulmonary metastases from colorectal cancer (three pneumonectomy, 17 lobectomy, seven lobectomy plus wedge resection, six segmentectomy, three segmentectomy plus wedge resection and 62 wedge resection). Pulmonary metastases were identified at a median interval of 37.5 months (range 0–167) from primary colorectal resection. Second and third resections for recurrent metastases were done in seven and in four patients, respectively. Results: Operative mortality rate was 2%. Overall, 5-year survival was 41.1%. Five-year survival was 43.6% for patients submitted to single metastasectomy and 34% for those submitted to multiple ones. Five-year survival was 55% for patients with disease-free interval (DFI) of 36 months or more, 38% for those with DFI of 0–11 months and 22.6% for those with DFI of 12–35 months (P=0.04). Five-year survival was 58.2% for patients with normal preoperative carcino-embryonic antigen (CEA) levels and 0% for those with pathologic ones (P=0.0001). Patients submitted to second-stage operation for recurrent local disease had 5-year survival rate of 50 vs. 41.1% of those submitted to single resection (P=0.326). Conclusions: Pulmonary resection for metastases from colorectal cancer may help survival in selected patients. Single metastasis, DFI>36 months, normal preoperative CEA levels are important prognostic factors. When feasible, re-operation is a safe procedure with satisfactory long-term results.
Key Words: Pulmonary metastases • Colorectal carcinoma • Lung resection • Carcinoembryonic antigen
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