The Annals of thoracic surgery 2018 03 29() pii S0003-4975(18)30405-3
Lung metastases occur in 10-20% of patients with colorectal cancer (CRC). Lung metastatic pathways of CRC is poorly known and the optimal management for recurrent lung metastases remains uncertain.
Long-term oncological outcomes of 203 patients with CRC lung metastases who underwent metastasectomy were investigated in this multicentre retrospective study. Ninety-two (45.3%) patients with tumour relapse underwent repeated metastasectomy and 11 (5.4%) received a third metastasectomy for a second relapse. Demographic and clinical data including histological grade of primary tumour, presence of CRC liver metastases, type of primary tumour resection, number, size, location and resection type of pulmonary metastases were evaluated. Overall survival (OS) and disease-free survival (DFS) were analyzed. Cox regression model was performed to identify variables influencing OS.
One hundred-seventy-three (85.2%) patients received a wedge resection, 21 (10.3%) underwent pulmonary lobectomy and 9 (4.4%) other procedures (pneumonectomy, bilobectomy). The mean follow-up was 39 months (range 7-154). One-, three-, five-year global OS from CRC diagnosis was respectively 99-80-60% and respectively 97-60-34% from the first metastasectomy. Log Rank test between OS (one vs repeated metastasectomy) did not show significant differences (p=0.659). Cox regression model showed that nodal status (HR 17.7, p=0.008) and administration of adjuvant chemotherapy (HR 0.33, p=0.026) are risk and protective factors, respectively, for OS.
Repeated pulmonary metastasectomy should be offered to patients with metastatic CRC since there are no differences in terms of OS between those undergoing single and repeated metastasectomy. Adjuvant chemotherapy should be suggested in case of metastatic CRC.