Factors influencing survival after complete resection of pulmonary metastases from colorectal cancer.

BACKGROUND: The aim of this retrospective study was to determine the efficacy of complete (R0) resection for pulmonary metastases of colorectal carcinoma, and to clarify prognostic factors for survival that could be used to identify patients likely to benefit most from pulmonary resection.

METHODS: Data on 113 patients who underwent R0 resection of pulmonary metastases from colorectal cancer were reviewed. Overall median follow-up was 49 (range 1-140) months. Clinical and pathological factors were reviewed, and prognostic factors influencing survival were identified.

RESULTS: The overall 5-year survival rate was 67.8 per cent. Multivariable Cox hazard regression analysis revealed that the prethoracotomy serum carcinoembryonic antigen (CEA) level and lymphatic invasion by pulmonary tumour correlated significantly with survival. The 5- and 7-year survival rates of patients with a prethoracotomy CEA level below 5 ng/ml and no lymphatic invasion by pulmonary tumour were 94 and 79 per cent respectively. Pathological features of the primary colorectal cancer, previous hepatectomy for liver metastasis and repeated thoracotomy had no impact on survival.

CONCLUSION: Long-term survival can be expected after R0 resection of pulmonary metastases from colorectal cancer, particularly in patients with a prethoracotomy CEA level below 5 ng/ml and no lymphatic invasion by pulmonary tumour.