ReviewSurgical Resection of Pulmonary Metastases From Colorectal Cancer: A Systematic Review of Published Series
Section snippets
Criteria for Selecting Studies
No randomized trials comparing surgical resection versus no surgery have ever been conducted; therefore we have attempted to identify all relevant prospective and retrospective studies reporting the outcome of surgical resection with curative intent of colorectal pulmonary metastases. Patients undergoing repeat pulmonary resection and hepatic and pulmonary metastases resection were also included. To ensure that the reviewed surgical series reflected the outcomes for patients treated with modern
Results
Twenty published series were eligible and met all the inclusion criteria without multiple publications presenting updated information or data on different aspects of the same patient population. A total of 1,684 patients were reported in 17 different studies [13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29] demonstrating improved survival after resection of colorectal metastases to the lung; reports on 186 patients in three different studies [30, 31, 32] specifically
Prognostic Factors
Most consistently there were 14 different factors in the categories tested for prognostic relevance in the different studies: patient demographics (ie, age and gender), primary tumor characteristics (ie, TNM, stage, histology, origin), lung metastases (ie, number, size, laterality, type of resection, thoracic lymph node involvement), timing of metastases (ie, disease-free interval), pre-thoracotomy carcinoembryonic antigen (CEA) value, and different histologic patterns of the primary and lung
Stage of the Primary Colorectal Cancer
The reporting of Union Internationale Contre le Cancer (UICC) stage of the primary colorectal cancer and Duke’s system was variable (Table 3, Table 4); eleven studies did not report the stage of the disease at all. In four studies [19, 26, 28, 31], patients were staged according to the UICC system (ie, 51 patients had stage I, 107 patients had stage II, 154 had stage III, and 71 had stage IV disease). Of the patients being staged by Duke’s classification [13, 20, 27, 28, 30], 14 patients had
Surgical Approach
Information on the surgical approach was reported in a minority of studies. Seven studies [20, 21, 22, 23, 26, 27, 32] reported on bilateral thoracotomies that were performed simultaneously (ie, sternotomy or clamshell). Only in the studies by Pfannschmidt and colleagues [21] and Saito and colleagues [23] were there a significant number of surgical procedures performed bilateral and simultaneously (ie, n = 61 and n = 18, respectively). No significant difference of survival in multivariate
Comment
Resection for pulmonary metastases was first performed in late 1882 by Weinlechner [39] for metastatic rib sarcoma, in which successful resection of the lung and the associated chest wall was performed. The first case series consisted of 24 patients and was published in 1947 by Alexander and Haight [40]. Ten of the patients underwent a pneumonectomy and 12 a lobectomy. From this time to the mid-1960s, resection of lung metastases was performed infrequently and only in highly selected patients.
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