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Ann Thorac Surg 2004;78:238-244
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Benefits of surgery for patients with pulmonary metastases from colorectal carcinoma

Masayoshi Inoue, MDa*, Mitsunori Ohta, MDb, Keiji Iuchi, MDc, Akihide Matsumura, MDc, Kan Ideguchi, MDc, Tsutomu Yasumitsu, MDd, Katsuhiro Nakagawa, MDd, Kenjiro Fukuhara, MDd, Hajime Maeda, MDa, Shin-ichi Takeda, MDa, Masato Minami, MDb, Yuko Ohno, PhDe, Hikaru Matsuda, MDb,*

a Department of Surgery, Toneyama National Hospital, Toneyama 5-1-1, Toyonaka 560-8552, Osaka, Japan
b Department of General Thoracic Surgery (E1), Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita 565-0871, Osaka, Japan
c Department of Surgery, National Kinki Central Hospital for Chest Diseases, Nagasonecho 1180, Sakai 591-8555, Osaka, Japan
d Department of Surgery, Osaka Prefectural Habikino Hospital, Habikino 3-7-1, Habikino 583-8588, Osaka, Japan
e Department of Mathematical Health Science, Osaka University Graduate School of Medicine, Yamadaoka 1-7, Suita 565-0871, Osaka, Japan

Accepted for publication February 6, 2004.

* Address reprint requests to Dr Inoue, Department of General Thoracic Surgery (E1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
e-mail: masa{at}surg1.med.osaka-u.ac.jp

BACKGROUND: A pulmonary metastasectomy for colorectal carcinoma is a generally accepted procedure, although several prognostic predictors have been reported. The aim of this study is to define the patients who benefit from pulmonary metastasectomy for colorectal carcinoma.

METHODS: Retrospective survival analysis was performed using 128 patients who underwent curative pulmonary resection.

RESULTS: The overall 5-year survival rate was 45.3%. Univariate analysis showed the number of metastases, location (unilateral or bilateral), prethoracotomy carcinoembryonic antigen (CEA) level, hilar or mediastinal lymph-node metastasis, and Dukes' stage to be considerable prognostic factors. Among these, Dukes' A for the primary lesion and unilateral pulmonary metastasis were shown to be independent predictors of longer survival by multivariate analysis (p = 0.0093 and p = 0.0182, respectively). In patients treated with both pulmonary and hepatic metastastasectomies, a better prognosis was observed in those who received metachronous resection. Recurrence after a pulmonary metastasectomy frequently occurred in the thorax and the 3-year survival rate was 44.6% in patients who underwent a repeat thoracotomy.

CONCLUSIONS: Patients with unilateral metastasis and Dukes' A for the primary tumor benefit most from the resection of pulmonary metastasis from colorectal carcinoma. Further, the number of metastases, prethoracotomy CEA level, and hilar or mediastinal lymph-node involvement should be considered to determine the operative indication. Finally, periodic follow-up examinations for thoracic recurrence should be carefully performed as these patients may have a heightened risk of requiring a repeat thoracotomy.




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