Anatomical Resection Improves Disease-Free Survival After Lung Metastasectomy of Colorectal Cancer

Purpose: This study aimed to evaluate the role of anatomical resection (AR) in lung metastasectomy (LM) of colorectal cancer (CRC) and to investigate clinically relevant prognostic factors. Patients and Methods: The medical records of 350 consecutive patients who underwent LM of CRC from 2011 to 2019 were reviewed. The patients were designated into AR group (lobectomy and segmentectomy), and non-anatomical resection (NAR) group (wedge resection), respectively. Kaplan-Meier method was used to analyze disease-free survival (DFS), pulmonary-specific disease-free survival (PDFS) and overall survival (OS). Cox proportional hazards regression model was performed to analyze the factors associated with DFS, PDFS and OS. Results: A total of 92 (31.2%) patients were enrolled in AR group and 203 (68.8%) in non anatomical resection (NAR) group. AR significantly improved the 3-year DFS (64.1% vs 46.8%, HR 0.587, 95% CI 0.397-0.867, P = 0.007) and PDFS (75.0% vs 60.1%, HR 0.565, 95% CI 0.356-0.899, P = 0.016) compared with NAR. However, the extent of resection did not significantly impact the 3-year OS (AR 92.4% vs NAR 85.7%, HR 0.511, 95% CI 0.224- 1.165, P = 0.110). In multivariate analysis, AR was identified as a protective factor for DFS (HR 0.576, 95% CI 0.356-0.934, P = 0.025) and PDFS (HR 0.631, 95% CI 0.409-0.973, P = 0.037). Preoperative abnormal CA19-9 was identified as the only prognostic factor for OS. Conclusion: AR was superior to NAR for DFS and PDFS after LM from CRC.