gms | German Medical Science

Background: Resection of pulmonary metastases in patients with surgically treated colorectal cancer is believed to provide a long term survival benefit. There is however little current evidence to support the notion that the subgroup of patients who undergo hepatic resection of metachronous liver metastases prior to pulmonary metastatectomy also derive a survival benefit from this surgery.

Methods: A retrospective analysis of 42 patients undergoing resection of pulmonary metastases of colorectal cancer with previously resected metachronous liver metastasis between May 1998 and November 2006 was performed. Multiple parameters were investigated for their effect on patient outcome by the use of a Log-Rank test and multivariate Cox regression analysis.

Results: The median overall survival of the group was 114 months without any 30 day mortality. Factors found to have negative influence on survival, based on their Log-Rank scores were: the total number of metastases (p=0.0026), time interval from hepatic to pulmonary metastatectomy (p=0.0046), time from colonic resection to pulmonary metastatectomy (p=0.0169) and presence of lymphangio (p=0,029) or venous (p=0.0107) invasion found in the primary colorectal tumour. In the subsequent Cox regression analysis, only the time interval from the primary colonic resection to pulmonary metastatectomy (p=0.023; HR 0,967) as well as the presence of lymphangio invasion (p=0.026; HR: 3.7) in the primary colorectal tumour, were found to have a negative influence on survival.

Conclusions: Despite the selection bias the overall survival seems to justify the resection of single or multiple pulmonary metastases in these circumstances. The status of the lymphangio invasion of the primary tumour has a major impact in long term survival in our series.

Disclosure: No significant relationships.