Lung Chemoperfusion Improves Relapse-Free Survival after Metastasectomy for Colorectal Cancer

Metastasectomy is a recommended and widely used operation for pulmonary metastases from colorectal cancer (CRC). The main disadvantage of pulmonary metastasectomy is the high rate of metastasis recurrence, which occurs in almost half of patients. To suppress residual pulmonary microfoci, isolated lung chemoperfusion (ILuP) is used, but its effectiveness has not been studied.The results of pulmonary metastasectomy were studied in 160 patients. In 65 patients of the main group, open metastasectomy with isolated chemoperfusion of the lungs was performed; in 95 patients of the control group, standard open or thoracoscopic metastasectomy was performed. The study design included 1:1 pseudorandomization using the nearest neighbor method. For 17 patients who underwent standard metastasectomy and then metastasectomy with ILuP for recurrent pulmonary metastases, these patients themselves were used as the nearest neighbor. For the remaining patients, the matching pairs were selected by the Propensity Score Matching method. After balancing the sample, the main and control groups comprised 41 pairs of observations, which were subjected to further analysis with assessment of relapse-free pulmonary survival according to Kaplan-Meier. Factors influencing survival were studied in the Cox's model.The median recurrence-free survival in patients of the main group who underwent metastasectomy with ILuP was 22.3 months versus 9.1 months in the control group. One-year recurrence-free survival in the main group was 77.5 ±  6.6% versus 38.1 ± 9.1% in the control group.Isolated lung chemoperfusion increases median recurrence-free survival after pulmonary metastasectomy by more than one year for colorectal cancer.