Lung Metastasectomy for Colorectal Carcinoma in Patients with a History of Hepatic Metastasis

Background: We reviewed resection of pulmonary metastases preformed by the Department of Thoracic Surgery at Kyoto University Hospital to confirm the clinical significance of this surgery in patients with colorectal carcinoma and a history of hepatic metastasis. Methods: From 1992 to 2006, 19 patients with colorectal carcinoma and a history of hepatic metastasis underwent a pulmonary metastasectomy. Surgical outcomes of these patients were investigated in terms of various perioperative variables. Results: Sixteen of 19 patients showed metachronous presentation of hepatic and pulmonary metastases, while 3 patients showed synchronous presentation. Overall survival rate after the pulmonary resection was 93%, at 1 year; 75%, at 3 years and 60% at 5 years. Three years after the pulmonary resection, none of the patients with synchronous hepatic and pulmonary metastases survived, while patients with metachronous metastases had an overall survival rate of more than 80%. Interestingly enough, the overall survival curve of the patients with colorectal carcinoma and a history of hepatic metastasis, who underwent a pulmonary metastasectomy was almost the same as that of patients who did not have the surgery, during the same period. Conclusion: Aggressive resection of pulmonary metastases in a select group of colorectal cancer patients with a history of liver metastases might result in prolonged survival.