THORACOTOMY FOR COLON AND RECTAL-CANCER METASTASES

Between 1978 and 1990, 23 patients underwent 35 thoracotomies for meta static colorectal cancer. The pulmonary disease was diagnosed within a n interval of 0 to 105 (average, 33.4) months after colon resection. F ifteen patients underwent a single thoracotomy; 12 patients had solita ry lesions, and three patients had multiple nodules. Eight patients un derwent multiple thoracotomies. The median survival following thoracot omy was 28 months; three-year survival was 45 percent, and five-year s urvival was 16 percent. Factors that had no significant bearing on sur vival included origin and stage of the primary tumor and patient age a nd sex. An interval before thoracotomy of three years had an impact on survival approaching statistical significance (P = 0.17). Patients wh o underwent multiple thoracotomies had a significantly prolonged survi val (P = 0.04). Patients who underwent a single thoracotomy for a soli tary lesion had a significantly prolonged survival compared with patie nts who had a single thoracotomy for multiple metastases. After thorac otomy, 14 patients eventually developed recurrent disease, which was c onfined to the lung in only four patients. Of these 14 patients, 11 su bsequently died of cancer. We conclude that thoracotomy for metastatic disease should be considered when the primary tumor is controlled, th e lungs are the only site of metastatic disease, and there is adequate lung reserve to withstand surgery. Survival following thoracotomy may be influenced by the interval before diagnosis, the number of pulmona ry nodules, and the number of thoracotomies performed.