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. 2009 Nov;22(4):233-41.
doi: 10.1055/s-0029-1242463.

Surgical management of colorectal lung metastasis

P James Villeneuve  1 , R Sudhir Sundaresan
Affiliations

Surgical management of colorectal lung metastasis

P James Villeneuve et al. Clin Colon Rectal Surg. 2009 Nov.

Abstract

Colon cancer is a systemic disease in 19% of patients and metastasizes most frequently to the liver and the lung. Survival is enhanced with complete surgical resection of pulmonary metastases. Comprehensive restaging and verification of preoperative fitness must precede resection. The operative approach is dictated by the anatomic location of the metastases, whereas the extent of resection remains a balance between complete removal of metastatic deposits while preserving as much lung parenchyma as possible. The presence of metastatic involvement of hilar and mediastinal lymph nodes is ominous. Multidisciplinary care is highly recommended. An evidence-based algorithm for the identification assessment and treatment of patients with pulmonary metastases is proposed.

Keywords: Pulmonary metastases; colorectal cancer; outcomes; surgical management.

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Figures

Figure 1
Figure 1
Computed tomographic (CT) and positron emission tomography (PET) images from a 62-year-old man who underwent resection of a T3N0 sigmoid colon carcinoma 2½ years prior. (A) CT image showing the typical peripheral location of a pulmonary metastatic lesion in the posterior basal segment of the right lower lobe (arrowhead). (B) Whole body PET scan shows a solitary focus of uptake in this nodule, confirming the presence of a solitary pulmonary metastasis (arrowhead) without hilar or mediastinal lymph node involvement. The patient underwent successful right video-assisted thoracoscopy procedure with wedge resection of this metastasis.
Figure 2
Figure 2
Computed tomographic (CT) images of a 56-year-old woman who underwent left colon resection of a T4N1 colon carcinoma one year prior. (A) Lung windows show a peripheral metastatic deposit in the left lower lobe (arrowhead). (B) Abdominal CT image showing a metastatic deposit in the left lobe of the liver (arrowhead). The patient underwent successful surgery for synchronous resection of these metastases, through a left video-assisted thoracoscopy approach followed by laparotomy.
Figure 3
Figure 3
An approach to the patient with suspected pulmonary metastases.
See this image and copyright information in PMC

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