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Lung metastases from colorectal cancer: surgical resection and prognostic factors

Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal

Received 8 July 2008; received in revised form 23 October 2008; accepted 28 October 2008.

^_* Corresponding author. Tel.: +351 239400418; fax: +351 239829674. (Email: antunes.cct.huc{at}sapo.pt).

Objective: To analyse our experience with excision of lung metastases from colorectal carcinoma (CRC), and to evaluate clinically relevant prognostic factors, identifying the cluster of patients who would benefit from this procedure. Methods: Sixty-one patients, 42 men (69%), with primary CRC who underwent 94 curative resections of pulmonary metastases were retrospectively reviewed. Age was 30–80 years (mean 61.2 ± 15). Population was analysed for age, sex, disease-free interval (DFI), prethoracotomy carcinoembryonic antigen (CEA) level, location and histology of primary tumour, number of lung lesions (and size of largest resected metastasis), type of lung resection, nodal involvement (hilar/mediastinal), use of adjuvant treatment, morbid-mortality and immediate and follow-up survival. Results: Mean DFI was 29 ± 22 months (range 5–132 months). There was no hospital mortality and significant morbidity occurred in five patients (8.2%). Mean follow-up was 39 ± 4 months (range 4–173 months). Mean overall survival and disease-free survival were 67 ± 16 months and 52 ± 6 months, respectively. Three-, 5- and 10-year survival rates from date of primary colorectal resection were 83%, 71% and 43%, respectively. Three-, 5- and 10-year survival rates from date of lung resection were 61%, 48% and 11%, respectively. Five-year survival was 57% in patients with normal prethoracotomy CEA levels and 18% for those with high levels (>5 ng/ml) (p = 0.039). Conclusions: Pulmonary metastasectomy has potential survival benefit for patients with metastatic colorectal carcinoma. Low morbidity and mortality rates, contrasting with lack of any other effective therapy, justify aggressive surgical management. Single deposits, DFI >36 months and normal prethoracotomy serum CEA were significant independent prognostic factors.

Key Words: Lung metastases • Colorectal cancer • Metastasectomy