Repeat resection for recurrent pulmonary metastasis of colorectal cancer

Stefan Sponholz, Moritz Schirren, Natalie Baldes, Selma Oguzhan, Joachim Schirren
Langenbeck's Archives of Surgery 2017, 402 (1): 77-85

PURPOSE: Resection of recurrent lung metastases from colorectal cancer is not completely investigated. We analyzed overall survival and prognosticators after metastasectomy.

METHODS: We retrospectively reviewed our database of 238 patients with lung metastases of colorectal cancer, undergoing metastasectomy with systematic lymph node dissection from 1999 to 2014. Lymph node metastases were found in 55 patients, and liver metastases were found in 79 patients.

RESULTS: The 5- and 10-year survival rates for all patients were 48 and 32%. Of the 238 patients included in the study, 101 developed recurrent lung metastases (42.4%). Recurrence had no impact on survival (p = 0.474). The 5- and 10-year survival rates from the beginning of recurrence for all patients with recurrence were 40 and 25%. Overall, 52 patients had been reoperated for recurrent lung metastases. 5-year survival for reoperated patients was 75% and significantly prolonged compared with nonreoperated patients (p < 0.001). Also, survival from beginning of recurrence was significantly longer (p < 0.001). Recurrence was more often detected in the case of multiple metastases (p = 0.002) and atypical resections (p = 0.029) at first metastasectomy. Lymph node metastases (p = 0.084) and liver metastases (p = 0.195) had no influence on recurrence. For reoperated patients, lower grading of the primary tumor was the only independent prognosticator for survival in multivariate analyses (p = 0.044).

CONCLUSION: Good long-term survival is achievable for patients with resectable recurrent lung metastases. Multiple metastases and atypical resection at first metastasectomy were associated with recurrent disease. Neither lymph node metastases nor liver metastases were significantly associated with recurrence. Lower grading of the primary tumor was the only independent prognosticator for survival. All in all, the factors that can be influenced by the surgeon are patient selection and R0 resection.

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