Do Repeated Operations for Recurrent Colorectal Lung Metastases Result in Improved Survival?

Cecilia Menna, Giammauro Berardi, Simone Maria Tierno, Claudio Andreetti, Giulio Maurizi, Anna Maria Ciccone, Antonio D'Andrilli, Francesco Cassiano, Camilla Poggi, Daniele Diso, Federico Venuta, Erino Angelo Rendina, Mohsen Ibrahim
Annals of Thoracic Surgery 2018, 106 (2): 421-427

BACKGROUND: Lung metastases occur in 10% to 20% of patients with colorectal cancer (CRC). Lung metastatic pathways of CRC are poorly known, and the optimal management for recurrent lung metastases remains uncertain.

METHODS: Long-term oncologic outcomes of 203 patients with CRC lung metastases who underwent metastasectomy were investigated in this multicenter retrospective study. Ninety-two patients (45.3%) with tumor relapse underwent repeated metastasectomy and 11 (5.4%) received a third metastasectomy for a second relapse. Demographic and clinical data, including histologic grade of primary tumor, presence of CRC liver metastases, type of primary tumor resection, number, size, location, and resection type of pulmonary metastases, were evaluated. Overall survival (OS) and disease-free survival were analyzed. Cox regression model was performed to identify variables that influenced OS.

RESULTS: One hundred seventy-three patients (85.2%) received a wedge resection, 21 (10.3%) underwent pulmonary lobectomy, and 9 (4.4%) underwent other procedures (pneumonectomy, bilobectomy). The mean follow-up was 39 months (range: 7 to 154 months). One-, 3-, and 5-year global OS from CRC diagnosis was 99%, 80%, and 60%, respectively, and 97%, 60%, and 34% from the first metastasectomy, respectively. Log-rank test between OS (one versus repeated metastasectomy) did not show significant differences (p = 0.659). Cox regression model showed that nodal status (hazard ratio [HR] 17.7, p = 0.008) and administration of adjuvant chemotherapy (HR 0.33, p = 0.026) are risk and protective factors, respectively, for OS.

CONCLUSIONS: Repeated pulmonary metastasectomy should be offered to patients with metastatic CRC because there are no differences in terms of OS between patients undergoing single and repeated metastasectomy. Adjuvant chemotherapy should be suggested in case of metastatic CRC.

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