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 with pulmonary resection. OUTCOME MEASURES Survival of patients with various preoperative and post operative clinical variables. RESULTS The perioperative 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 (discase-free interval) was 36 months. The 7 patients who also under went resection of extrapulmonary metastases had a 5-year survival rate of 52%. Significant preoperative variables that carried a poor prognosis included the following: more than one pulmonary lesion, a disease-free interval of less than 2 years, and moderately or poorly differentiated 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 resection for metastatic colorectal cancer is both effective and safe. Resectable extrapulmonary metastases and pulmonary recurrence should not preclude lung resection. Postoperative chemotherapy has no survival benefit. Preoperative variables should guide the clinician when considering surgical intervention.