Thoracoscopic resection of solitary lung metastases from colorectal canceris a viable therapeutic option

Study objectives: The reported 5 year survival rate after pulmonary metasta sectomy from colorectal carcinoma, usually accomplished through thoracotomy or median sternotomy, ranges from 9 to 47%. Video-assisted thoracoscopy (V AT) is employed routinely for many thoracic surgical procedures, but the ma in concern about this approach for resection of lung metastases is that VAT does not allow complete lung palpation to identify and remove metastases n ot detected by preoperative radiologic examinations. Design: In this study, we reviewed our experience with thoracoscopic resect ion of single peripheral lung metastases from colorectal carcinoma with pot entially curative intent. Patients and interventions: From July 1992 to September 1998, 24 patients ( 15 male, 9 female) with a mean age of 56 years, who previously had undergon e resection for colorectal carcinoma and had a single limited and periphera l lung lesion identified by high-resolution CT, underwent thoracoscopic wed ge resection of the lesions, Results: No intraoperative complications developed, Three patients had mino r postoperative complications successfully treated. In one case, we found a benign lesion, and this patient was excluded from the analysis. In the rem aining cases, metastases from colorectal cancer were confirmed, The median follow-up was 29 months, ranging from 3 to 67 months. Thirteen patients (56 .5%) developed recurrence of the disease, and 5 of them (21.7%) had local r ecurrence. Cumulative 5-year survival estimated by Kaplan-Meier method was 49.5%, not really different from the data reported in the Literature. Conclusions: Thoracoscopic resection of single peripheral lung metastases f rom colorectal cancer with potentially curative intent seems effective and justified since the ultimate outcome of this highly selected group of patie nts seems to be not different from that obtained after a more invasive appr oach.