Background: We reviewed our experience in the surgical
treatment of 47 patients with colorectal pulmonary metastases and
investigated factors affecting their survival.
From September 1986 to December 1999, 47 patients underwent 59
thoracotomies for pulmonary metastases from colorectal cancer.
Results: The median interval between colorectal resection
and lung resection (disease-free interval [DFI]) was 33 months.
Overall, 5-year survival was 48%. Five-year survival was 51% for
patients with solitary metastasis (n = 30), 47% for patients with
ipsilateral multiple metastases (n = 11), and 50% for patients with
bilateral metastases (n = 6), and there were no significant
differences. Five-year survival was 80.8% for 14 patients with DFI of< 2 years and 39.7% for 30 patients with a DFI of > 2 years
(p = 0.22). Five-year survival for 11 patients with normal
prethoracotomy carcinoembryonic antigen (CEA) levels was 70%, and that
for 26 patients with elevated prethoracotomy CEA levels (> 5 ng/mL)
was 36% (p < 0.05). Eight patients had extrathoracic disease. The
median survival time after pulmonary resection was 18.5 months, and the
5-year survival was 60%. A second resection for recurrent metastases
was performed in five patients, and a third resection was done in one
patient. All six patients are alive. The median survival of five
patients who underwent a second thoracotomy was 22 months (range, 2 to
68 months), and one patient is alive 39 months after the third
Conclusion: Pulmonary resection for
metastases from colorectal cancer may help prolong survival in selected
patients, even with bilateral lesions, recurrent metastasectomy, or
extrathoracic disease. Prethoracotomy CEA level was found to be a
significant prognostic factor.