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. 2016 Jul;8(7):1764-71.
doi: 10.21037/jtd.2016.05.98.

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Francesco Guerrera  1 , Claudio Mossetti  1 , Manuela Ceccarelli  2 , Maria Cristina Bruna  1 , Giulia Bora  1 , Stefania Olivetti  1 , Paolo Olivo Lausi  1 , Paolo Solidoro  3 , Giovannino Ciccone  2 , Enrico Ruffini  1 , Alberto Oliaro  1 , Pier Luigi Filosso  1
Affiliations

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

Francesco Guerrera et al. J Thorac Dis. 2016 Jul.

Abstract

Background: Surgery is considered an effective therapeutic option for patients with lung metastasis (MTS) of colorectal cancer (CRC). The purpose of the study was to evaluate efficacy and feasibility of lung metastasectomy in CRC patients and to explore factors of prognostic relevance.

Methods: This is a retrospective study of patients operated for lung MTS of CRC from 2004 to 2012 in a single Institution. Overall survival (OS) was the primary endpoint. Secondary endpoints were progression free survival (PFS) in resection status R0 and OS in in patients submitted to re-resections. In order to evaluate prognostic factors, a multivariable Cox proportional hazard model was performed.

Results: One-hundred eighty-eight consecutive patients were included in the final analysis. The median follow-up (FU) was 45 months. The 5-year OS and PFS were 53% (95% CI: 44-60%) and 33% (95% CI: 25-42%), respectively. Two- and 5-year survival after re-resection were 79% (95% CI: 63-89%) and 49% (95% CI: 31-65%), respectively. Multivariate adjusted analysis showed that primary CRC pathological TNM stages (P=0.019), number of resected MTS ≥5 (P=0.009) and lymph nodal involvement (P<0.0001) are independent predictors of poor prognosis.

Conclusions: Patients operated and re-operated for lung MTS from CRC cancers showed encouraging survival rates. Our results indicated that primary CRC stage, number of MTS and lymph nodal involvement are strong predictive factors. Prognosis after surgery remained comforting up to four resected MTS. Adjuvant chemotherapy seems to have a benefit on survival in patients affected by multiple metastases. Finally, according to the high rate of unidentified lymph node involvement in pre-operative setting, lymph node sampling should be advisable for a correct staging.

Keywords: Colorectal cancer (CRC); adjuvant chemotherapy; lung metastases; lymphnode; outcomes; positron emission tomography (PET); surgery.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Survival according to re-intervention.
Figure 2
Figure 2
Survival according to lymph node involvement.
Figure 3
Figure 3
Survival according to adjuvant treatment (in case of multiple metastases).
Figure S1
Figure S1
Overall survival.
Figure S2
Figure S2
Progression free survival (in R0 patients).
Figure S3
Figure S3
Survival according to number of metastases.
See this image and copyright information in PMC

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