The Western Thoracic Surgical Association

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What Is The Appropriate Surgical Strategy For Pulmonary Metastasis Of Colorectal Cancer
Hang Li, Sr., Hong Hu, Sr., Yihua Sun, Sr., Haiquan Chen, Sr.
Shanghai Cancer Center Thoracic Surgery, Shanghai, China

Background:
Pulmonary metastasectomy is considered to be a feasible method for selected colorectal cancer (CRC) patients. This study aimed to optimize the individualized surgical strategy of pulmonary metastasectomy, especially in choice of surgery extend and systematic mediastinal lymph nodes dissection.
Methods:
Data of 267 CRC patients who underwent pulmonary metastasectomy were reviewed. Recurrence-free survival (RFS) and overall survival (OS) curve were compared using log-rank test. Pearson Χ2 test or Fisher's exact tests were applied to do bivariate analysis of clinical characteristics.
Results:
A total of 93 (34.8%) patients underwent lobectomy, 162 (60.7%) wedge resection, and 12 (4.5%) segmentectomy. Mediastinal lymph nodes dissection or sampling was performed in 106 (39.7%) patients. The median follow-up phase was 32.5 months (range 7.2-104.7 months). The median RFS and OS were 46.4 months and 76.5 months, respectively. In the patients whose tumor diameter was ≥ 1.5 cm, RFS (5-year; 44.9% vs 29.8%, log-rank P=0.03; hazard ratio, 0.71; 95% CI 0.52-0.89, P=0.026) was better in the lobectomy group; however, no difference was found in OS. Meanwhile, in the patients whose tumor size was <1.5 cm, no difference was observed in RFS, as well as in OS. In the patients with metastatic lesion size ≥1.5cm, a trend towards better RFS was found in patients received lymph nodes dissection, but it didn't reach statistical significance.
Conclusion:
Lobectomy has more curative significance for CRC patients with single pulmonary metastatic lesion ≥1.5 cm. Systematic mediastinal lymph nodes dissection did not improve clinical outcome for CRC patients occurred pulmonary metastasis.


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