Factors influencing outcome after pulmonary resection for colorectal cancer (CRC) metastases in the current era.
4024 Background: We examined the role for surgery and factors associated with relapse-free and overall survival after pulmonary metastasectomy for CRC. METHODS: A retrospective review of prospective databases at two tertiary-care centers was performed to identify patients who underwent complete resection of all macroscopic disease from 1998 to 2007. RESULTS: 377 study patients were identified. The primary site of disease was rectum (52%), left colon (26%), right colon (16%), and other (6%). Before thoracic recurrence, 156 patients (41%) underwent resection of extrathoracic metastases. Median disease-free interval (DFI) was 24 months from time of primary operation. Resection was a single or multiple wedge resections in 72%, lobectomy in 19%, segmentectomy in 7%, and bilobectomy in 2%. Number of metastatic deposits resected was 1 in 60%, 2 in 20%, 3 in 10%, and 4 or more in 10%. Median size of the largest nodule was 1.5 cm. Pre-resection chemotherapy was administered to 87 patients (23%). Post-resection chemotherapy was delivered to 169 patients (45%). Kaplan-Meier recurrence-free survival was 28% and overall survival was 78% at 3 years. Regarding recurrence-free survival, univariate analysis revealed age <65 years, gender, DFI <1 year, number of metastases ≥3 as significant predictors, and presence of prior extrathoracic disease trended toward signficance. Multivariable analysis revealed age <65 years, female gender, DFI <1 year, and number of metastases ≥3 as independent predictors of recurrence. Of 44 patients with 3 or more lesions and <1 year DFI, none was cured by operaton. By contrast, recurrence-free survival was 49% at 3 years for those with 1 lesion and DFI >1 year. CONCLUSIONS: Age less than 65 years, female gender, DFI <1 year, and number of metastases 3 or greater are independent predictors of recurrence. Non-surgical management should be considered standard for patients who have both 3 or more pulmonary metastases and <1 year DFI. [Table: see text] No significant financial relationships to disclose.
Onaitis, MW; Haney, J; Petersen, R; Saltz, LB; Flores, RM; Rizk, N; Bains, MS; D'Amico, T; Kemeny, NE; Rusch, VW; Downey, RJ
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