Management of pulmonary metastases from colorectal cancer

A significant number of patients who undergo complete resection of colorectal carcinoma develop pulmonary metastases. Despite advances in systemic chemotherapy, resection of the metastases localized to lungs remains the only mode of curative treatment. Control of primary disease, ability to resect all gross tumor, and adequate cardiorespiratory reserve are significant factors in selecting patients for resection. Hepatic metastases do not appear to influence long-term survival if completely resected. Patients with solitary metastases experienced the best long-term survival, but patients with as many as three pulmonary metastases, either unilateral or bilateral, could undergo resection with a 40% 5-year survival. The number of nodules does not constitute absolute criteria by which to select patients, and the decision must be individualized, given the set of circumstances. Complete surgical resection is critical to achieving long-term survival and is best achieved by a median sternotomy or "clamshell" incision. Resection of the metastases can be more effectively accomplished in most instances by wedge excision than by lobectomy or pneumonectomy, with minimal operative mortality and morbidity.