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Thoracoscopic Resection of Solitary Lung Metastases From Colorectal Cancer Is a Viable Therapeutic Option^*

^* From the University of Rome "La Sapienza," Department of Thoracic Surgery, Rome, Italy.

Correspondence to: Tiziano De Giacomo, MD, University of Rome "La Sapienza," Department of Thoracic Surgery, Policlinico Umberto I, V.le Policlinico 155, 00161, Rome, Italy; e-mail: tdegiac{at}tin.it

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.

Patients and 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.

Results: 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.

Conclusions: 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 invasive approach.

Abbreviation: VAT = video-assisted thoracoscopy

Key Words: colorectal carcinoma • lung metastasis • thoracoscopy

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