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Original Articles: General Thoracic

Prognostic Factors for Recurrence After Pulmonary Resection of Colorectal Cancer Metastases

^a Department of Surgery, Duke University Medical Center, Durham, North Carolina
^b Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
^c Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

Accepted for publication March 12, 2009.

^_* Address correspondence to Dr Onaitis, Duke University Medical Center, Box 3305, Durham, NC 27710 (Email: mark.onaitis{at}duke.edu).

Background: This study was undertaken to review a large series of resections of colorectal pulmonary metastases in the era of modern chemotherapy.

Methods: A retrospective chart review of prospectively maintained thoracic surgery databases identified 378 patients who underwent pulmonary resection for colorectal cancer metastases with curative intent from 1998 to 2007.

Results: The primary site of disease was rectum (52%), left colon (26%), right colon (16%), and unknown (6%). Before thoracic recurrence, 166 patients (44%) had previously undergone resection of extrathoracic metastases. Median disease-free interval (DFI) was 24 months from the time of the primary operation. The number of metastatic deposits resected was one in 60%, two in 20%, three in 10%, and four or more in 10%. Chemotherapy was administered to 87 patients (23%) before resection and to 169 patients (45%) after resection. Three-year recurrence-free survival was 28%, and 3-year overall survival was 78%. Multivariable analysis revealed age younger than 65 years, female sex, DFI less than 1 year, and number of metastases greater than three as independent predictors of recurrence. Of 44 patients with three or more lesions and less than 1 year DFI, none was cured by operation. By contrast, recurrence-free survival was 49% at 3 years for those with one lesion and DFI greater than 1 year.

Conclusions: Age younger than 65 years, female sex, DFI less than 1 year, and number of metastases greater than three predict recurrence. Medical management alone should be considered standard for patients who have both three or more pulmonary metastases and less than 1 year DFI.

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Joachim Pfannschmidt
Ann. Thorac. Surg. 2009 87: 1688-1689. [Extract] [Full Text] [PDF]

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				J. Pfannschmidt Invited Commentary. Ann. Thorac. Surg., June 1, 2009; 87(6): 1688 - 1689. [Full Text] [PDF]