Surgical treatment of pulmonary metastases from colorectal cancers. Eight years survival and principal prognostic factors

Objective. In order to achieve a better definition of the indications for s urgical excision of pulmonary metasteses in color rectal cancer (CCR), a re trospective study of the eight year survival of patients who had been opera ted on was carried out with reference to the principal prognostic factors. Methods and results. Between May 1986 and December 1997 38 patients had an excision for pulmonary metastases for CCR. The mean delay between diagnosis of the metastases and surgical treatment of the CCR was 39+/-24 months (0- 98). Thirthy two patients (84%) had a single pulmonary metastasis. The mean diameter of the metastasis was 38+/-22 nm. Twenty metastases had a diamete r <30 mm. Five patients had a locoregional recurrence of their CCR before p ulmonary surgery. Fourteen patients had an abnormally elevated level of car cinoembrionic antigen (ACE-CEA) before the pulmonary excision. Five pneumon ectomies, 23 lobectomies, 1 bilobectomy and 11 atypical resections were car ried out. A lymph node clearance was performed in 25 cases. Six patients (1 6%) had an associated excision of an hepatic metastasis. The in-hospital mo rtality was 2.6%. Chemotherapy was associated with a pulmonary excision in 17 patients (46%). The mean survival was 2.7 years (0.13-8.7 years). The su rvival at one year was 89+/-5.2% and at five years 35.2+/-10.1% and at eigh t years 18.8%+/-10.3%. Age, sex, histological stage of the primary tumor, t he size and the delay in appearance in the pulmonary metastases, the number of metastases, the preoperative CEA, the operative technique and the perio perative chemotherapy did not influence the levels of survival at Jive year s. At the same lime associated excision of an hepatic metastsis did not wor sen the prognosis at five years. Conclusion. Complete excision of pulmonary metastases in a colorectal cance r allows for significantly longer survival. This study associated with a li terature review may help in advancing towards better selection of surgical candidates.