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• W2078335848 abstract "J Thorac Cardiovasc Surg 2003;126:732–9. Pfannschmidt J, Muley T, Hoffman H, Dienemann H. Comments: In this retrospective study, the authors analyze the results and outcomes of surgical resection of pulmonary metastases from colorectal cancer. Over a 5-year period, 167 patients underwent complete resection of metastatic colorectal carcinoma. The patients were selected for surgical treatment if they had 1) technically resectable metastasis, 2) tolerable general and functional risks, 3) primary tumor under control, and 4) no extrathoracic metastasis except hepatic lesions. In total, 215 surgeries were performed in 167 patients. Overall, the median 5-year survival was 40.2 months. The multivariate analysis showed that the independent predictors of poor outcome were >1 metastases, thoracic lymph node involvement, and a preoperative carcinoembryonic antigen (CEA) level of >5 ng/mL. Several other interesting findings were also reported: 1) In 15 of 84 patients with a single metastasis, lymph node involvement was detected by operative lymph node dissection. Preoperative chest computed tomography had shown lymph node enlargement (>1 cm) in only 44% of patients with positive lymph nodes. 2) The choice of surgical procedure such as unilateral thoracotomy, staged bilateral thoracotomy, or median sternotomy had no effect on survival. Also, there was no difference in survival after lobectomy compared with wedge resection. 3) The survival was similar after removal of metastasis from colon and rectal primary cancers. 4) The long-term survival of patients who underwent repeated thoracotomies did not differ from that of patients who had a single operation. 5) The resection of hepatic metastasis in addition to pulmonary metastasis did not affect survival. Overall, the 30-day mortality rate after the operation was 1.8%. The survival of patients after pulmonary metastasectomy in this study was similar to that reported in prior studies (J Thorac Cardiovasc Surg 1996;112:867–77, J Thorac Cardiovasc Surg 2002;124:1007–13). However, the study was retrospective and there was no control group. Also, selection bias cannot be avoided in studies of this nature. Therefore, it is difficult to conclude that the survival of all patients with colorectal cancer with pulmonary metastasis is better after surgery than after other forms of treatment. Only a prospective, randomized, controlled study can establish a better outcome with surgery in these patients. Nevertheless, the authors have shown the long-term outlook is quite favorable in selected patients after resection of pulmonary metastasis. The study also identifies the subgroup of patients with colorectal cancer with pulmonary metastasis who are likely to survive longer after surgical treatment. In this context, it is important to vigorously pursue enlarged thoracic lymph nodes to detect metastatic involvement using a less invasive sampling technique such as transbronchial needle aspiration or mediastinoscopy before considering thoracotomy." @default.
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• W2078335848 date "2004-01-01" @default.
• W2078335848 modified "2023-09-22" @default.
• W2078335848 title "Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experience in 167 patients" @default.
• W2078335848 doi "https://doi.org/10.1097/00128594-200401000-00030" @default.
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