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(Chest. 2001;119:1069-1072.)
© 2001 American College of Chest Physicians

Pulmonary Resection for Metastases From Colorectal Cancer*

Toshihiko Sakamoto, MD; Noriaki Tsubota, MD; Koichiro Iwanaga, MD; Tsuyoshi Yuki, MD; Hidehito Matsuoka, MD and Masahiro Yoshimura, MD

* From the Department of General Thoracic Surgery, Hyogo Medical Center for Adults, Akashi, Japan.

Correspondence to: Toshihiko Sakamoto, MD, Department of General Thoracic Surgery, Hyogo Medical Center for Adults, 13–70 Kitaoujicho, Akashi, Hyogo, 673-0022 Japan; e-mail: saka-tos{at}remus.dti.ne.jp

Background: We reviewed our experience in the surgical treatment of 47 patients with colorectal pulmonary metastases and investigated factors affecting their survival.

Method: 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 resection.

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.

Key Words: carcinoembryonic antigen • colorectal cancer • lung metastases • prognosis • surgical resection




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