Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases.


Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Onaitis, MW; Petersen, RP; Haney, JC; Saltz, L; Park, B; Flores, R; Rizk, N; Bains, MS; Dycoco, J; D'Amico, TA; Harpole, DH; Kemeny, N; Rusch, VW; Downey, R

Published Date

  • June 2009

Published In

Volume / Issue

  • 87 / 6

Start / End Page

  • 1684 - 1688

PubMed ID

  • 19463577

Pubmed Central ID

  • 19463577

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2009.03.034


  • eng

Conference Location

  • Netherlands