REVIEW OF THE PLACE OF SURGERY IN THE TRE ATMENT OF LUNG METASTASES OF COLON AND RECTUM CANCERS

The authors analysed the five main series reported in the literature e xclusively devoted to surgical treatment of lung metastases of colon a nd rectum cancers and their own experience. The classical indications, limited to solitary lesions, have been extensively modified, and rese ction of bilateral lesions, recurrent lesions and pulmonary lesions in patients previously operated for other extrathoracic metastases is no w possible. The 5-year survival rates vary between 20 and 44% in the v arious series. The complete nature of the resection is an essential pr erequisite to prolonged survival. The other prognostic factors are dis cussed: presence of lymph node invasion or raised CEA appear to carry a poor prognosis. On the other hand, the type of resection performed, the disease-free interval, the repeated nature of the pulmonary resect ion and the presence of previously operated extrathoracic metastases d o not appear to influence survival. Opinions differ concerning the pro gnostic significance of disseminated pulmonary lesions, particulary wh en complete resection is possible. These results confirm the special p lace of surgery in the treatment of lung metastases of colon and rectu m cancers. The operative indications are still difficult to define, bu t the relatively benign nature of this surgery justifies an extension of the indications.