Repeat pulmonary resection for metachronous colorectal carcinoma is beneficial

Initial pulmonary metastatectomy for limited colorectal carcinoma metastases is associated with improved survival. The role of repeat thoracic interventions is less well defined. The purpose of this study is to clarify the role of repeat pulmonary resection for metastatic colorectal carcinoma.

A retrospective study was performed using patients who underwent pulmonary metastatectomy for colorectal carcinoma at a single academic institution between January 1, 1985, and December 31, 2007. Sex, age at colorectal operation, colorectal TNM stage, and operative procedures for pulmonary metastases were recorded. Intervals between the original colorectal operation and thoracic operation and between the first pulmonary metastatectomy and repeat thoracic interventions were calculated. Log-rank comparison of Kaplan-Meier survival curves and covariate analysis were performed.

A total of 69 patients were identified as having undergone at least 1 pulmonary metastatectomy. There were 32 female and 37 male patients with a mean age of 57 +/- 11 years. The median disease-free interval from original colorectal operation to first pulmonary metastatectomy for all the patients was 27 months. A total of 125 pulmonary resections were performed: 64 wedge resections, 27 segmentectomies, 30 lobectomies, and 4 pneumonectomies. Of the 69 patients, 41 underwent a single thoracic metastatectomy, whereas 28 underwent at least 1 second thoracic metastatectomy (2nd, 17 patients; 3rd, 6; 4th, 4; 5th, 1). There were no perioperative mortalities. From the original colorectal resection, the 5-year survival was 59% (median, 52 months). From the initial pulmonary metastatectomy, the 5-year survival for all patients was 25% (median, 36 months). The 5-year survival for patients undergoing only 1 thoracic resection was 23% (median, 24 months), which was not significantly different compared to patients undergoing repeat thoracic resections, 29% (median: 42 months). In the covariate analysis, no parameters significantly impacted survival.

Patients undergoing multiple pulmonary resections have the same survival as patients undergoing a single pulmonary resection for metachronous colorectal carcinoma. These findings indicate pulmonary metastases may be favorably treated with repeat thoracic interventions.