Study objectives: The reported 5-year survival rate
after pulmonary metastasectomy from colorectal carcinoma, usually
accomplished through thoracotomy or median sternotomy, ranges from 9 to
47%. Video-assisted thoracoscopy (VAT) is employed routinely for many
thoracic surgical procedures, but the main concern about this approach
for resection of lung metastases is that VAT does not allow complete
lung palpation to identify and remove metastases not detected by
preoperative radiologic examinations.
Design: In this
study, we reviewed our experience with thoracoscopic resection of
single peripheral lung metastases from colorectal carcinoma with
potentially curative intent.
interventions: From July 1992 to September 1998, 24 patients (15
male, 9 female) with a mean age of 56 years, who previously had
undergone resection for colorectal carcinoma and had a single limited
and peripheral lung lesion identified by high-resolution CT, underwent
thoracoscopic wedge resection of the lesions.
No intraoperative complications developed. Three patients had minor
postoperative complications successfully treated. In one case, we found
a benign lesion, and this patient was excluded from the analysis. In
the remaining cases, metastases from colorectal cancer were confirmed.
The median follow-up was 29 months, ranging from 3 to 67 months.
Thirteen patients (56.5%) developed recurrence of the disease, and 5
of them (21.7%) had local recurrence. Cumulative 5-year survival
estimated by Kaplan-Meier method was 49.5%, not really different from
the data reported in the literature.
Thoracoscopic resection of single peripheral lung metastases from
colorectal cancer with potentially curative intent seems effective and
justified since the ultimate outcome of this highly selected group of
patients seems to be not different from that obtained after a more
VAT = video-assisted thoracoscopy