Pulmonary metastases from colorectal cancer: 25 years of experience

Objective: To examine the experience of pulmonary resections for colorectal metastases at the McGill University Health Centre. Design: A chart review. Patients: Forty-nine patients treated surgically between 1975 and 1998 for pulmonary metastases from colorectal cancer. Intervention: Thoracotomy wit h pulmonary resection. Outcome measures: Survival of patients with various preoperative and postoperative clinical variables. Results: The perioperati ve death rate was 4%. Overall 5- and 10-year survival rates were 55% and 40 % respectively. The mean interval between the initial colonic resection and resection of pulmonary metastases (disease-free interval) was 36 months. T he 7 patients who also underwent resection of extrapulmonary metastases had a 5-year survival rate of 52%. Significant preoperative variables that car ried a poor prognosis included the following: more than one pulmonary lesio n, a disease-free interval of less than 2 years, and moderately or poorly d ifferentiated colorectal cancer. The 16 patients who received chemotherapy after their thoracotomy had a 5-year survival rate of 51% compared with 54% for the 33 patients who did not receive chemotherapy. Recurrent resections of pulmonary lesions did not reduce survival. Conclusions: Pulmonary resec tion for metastatic colorectal cancer is both effective and safe. Resectabl e extrapulmonary metastases and pulmonary recurrence should not preclude lu ng resection. Postoperative chemotherapy has no survival benefit. Preoperat ive variables should guide the clinician when considering surgical interven tion.