Pulmonary Resection for Metastasis from Colorectal Cancer

Tomoaki Maruta, Takeyasu Suda, Katsuyoshi Hatakeyama, Masanori Tsuchida^* and Jun-ichi Hayashi^*

Division of Digestive and General Surgery, Niigata University Graduate School of Medicine and Dental Sciences
Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medicine and Dental Sciences^*

Purpose: We clarified the indications for pulmonary resection in pulmonary metastatic tumors from colorectal cancer. Methods: From December 1980 to December 2000, 55 underwent pulmonary resection for pulmonary metastases. We analyzed survival at the original site, gender, age at pulmonary resection, time from surgery for colorectal origin to detection of pulmonary metastasis, number and size of pulmonary metastases, lymph node metastasis, existence of extrapulmonary recurrence lesions before or with pulmonary recurrence, and CEA level at pulmonary recurrence. Results: 5-year survival was 29.0% and 10-year survival was 22.1%. Only 2 factors-how big pulmonary metastatic lesions were, >5cm, and lymph node metastases-were significant in prognosis. The existence of extrapulmonary recurrence lesion (i.e., liver metastases, local recurrence, etc.) before or with pulmonary metastases did not affect the postthoracotomy period. Pulmonary recurrence occurred in 30 cases after primary pulmonary resection. Some 14 had second surgery for pulmonary metastasis. 3-year survival after second pulmonary metastasis was 40.2% in patients with second pulmonary resection and 0% in those without second pulmonary resection. 5-year survival after second surgery was 31.7%. Second surgery significantly prolonged the period after detection of second pulmonary metastasis and demonstrated as good a survival rate as that following primary pulmonary resection. Eleven cases that had second surgery had third pulmonary metastasis. Four had third surgery for pulmonary metastasis, with no significant difference seen between with or without third pulmonary resection on survival after detection of a third pulmonary metastasis and survival after second surgery. Conclusion: For pulmonary metastasis from colorectal cancer, aggressive surgery is recommended. Second surgery should be considered for second pulmonary recurrence.

Key words
colorectal cancer, pulmonary metastasis, pulmonary resection

Reprint requests
Tomoaki Maruta Division of Digestive and General Surgery, Niigata University Graduate School of Medicine and Dental Science 1-757 Asahmachi-, Niigata-City, 951-8510, JAPAN

Accepted
March 27, 2002

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