PURPOSE: The purpose of this study was to analyze our experience with pulmonary resection for metastatic colorectal carcinoma to determine prognostic factors and critically evaluate the potential role of extended metastasectomy.
METHODS: We analyzed the postoperative survival of 120 patients who underwent curative pulmonary surgery at eight institutions in the Kansai Metastatic Lung Tumor Study Group from 2000 to 2003.
RESULTS: Overall 5 survival was 38.2%. Five-year survival was 52.0% for patients without lymph node metastasis, versus 6.4% at 4 years for patients with metastases. Five-year survival of patients with a prethoracotomy carcinoembryonic antigen level less than 10 ng/mL was 41.4%, versus 14.8% at 4 years for patients with a carcinoembryonic antigen level 10 ng/mL or greater. The patients who underwent a second or third thoracotomy for recurrent colorectal carcinoma. Overall 5-year survival from the date of the second thoracotomy was 50.2%. The survival for the patients with hepatic metastasis resected before thoracotomy did not differ significantly from that of patients without hepatic metastases.
CONCLUSION: The status of lymph nodes and prethoracotomy carcinoembryonic antigen level were significant independent prognostic factors. Patients with pulmonary metastases potentially benefit from pulmonary metastasectomy even when there is a history of solitary liver metastasis. Careful follow-up is warranted, because patients with recurrent pulmonary metastases can undergo repeat thoracotomy with acceptable long-term survival.
CLINICAL IMPLICATIONS: Patients with obvious and proven hilar or mediastinal lymph node metastases may be no good candidates for resection.
DISCLOSURE: Yukihito Saito, No Financial Disclosure Information; No Product/Research Disclosure Information