Factors influencing long-term survival and surgical indications for pulmonary metastasectomy for metastases from colorectal cancer

Abstract

Background: This study examined the prognostic factors and surgical indications for pulmonary metastasectomy for metastases from colorectal cancer. Methods: We retrospectively reviewed 142 patients treated between 1985 and 2005 who had undergone complete resections of pulmonary metastases from colorectal cancer. Results: Overall 5-year and 10-year survival rates were 42.4% and 32.0%, respectively. The 5-year survival rate for patients with a solitary metastasis was 55.1%, compared with 24.0% for patients with multiple metastases (P= 0.013). The 5-year survival rate for patients with a disease-free interval (DFI) ≥ 1000 days was 55.1%, compared with 31.6% for patients with a DFI < 1000 days (P= 0.008). No significant differences in survival rate according to the location of the primary lesion, maximum tumor size, preoperative serum carcinoembryonic antigen level, or surgical procedure were observed. Prior resection for liver metastases and repeated resection for recurrent pulmonary metastases did not influence the survival rate. A multivariate analysis demonstrated that the number of metastases was an independent, significant prognostic factor for survival. The survival rate of patients with three or more metastases was significantly lower than that of patients with two or fewer metastases. Conclusions: The number of metastases is an independent prognostic factor after pulmonary metastasectomy for metastases from colorectal cancer. Patients with a solitary pulmonary metastasis benefit the most from pulmonary metastasectomy. The pulmonary resection of three or more metastases is associated with a reduced survival rate. Pulmonary metastasectomy is recommended even for patients with a prior hepatic metastasectomy or patients with recurrent pulmonary metastases. © Tianjin Lung Cancer Institute and Blackwell Publishing Asia Pty. Ltd.