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Resection of Pulmonary Metastases from Colon and Rectal Cancer: Factors to Predict Survival Differ Regarding to the Origin of the Primary Tumor

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The purpose of the present study was to determine differences in prognostic factors for survival of patients with pulmonary metastases resected in curative intent from colon or rectum cancer.

Methods

Between 1980 and 2006, prognostic factors after resection of pulmonary metastases in 171 patients with primary rectum or colon tumor were evaluated. Survival of patients after surgical metastasectomy was compared with that of patients receiving standard chemotherapy by matched-pair analysis.

Results

Median survival after pulmonary resection was 35.2 months (confidence interval 27.3–43.2). One-, 3-, and 5-year survival for patients following R0 resection was 88.8, 52.1, and 32.9 % respectively. Complete metastasectomy (R0), UICC stage of the primary tumor, pleural infiltration, and hilar or mediastinal lymph node metastases are independent prognostic factors for survival. Matched-pair analysis confirmed that pulmonary metastasectomy significantly improved survival. Although no difference in survival for patients with pulmonary metastases from lower rectal compared to upper rectal or colon cancer was observed, factors to predict survival are different for patients with lower and middle rectal cancer (R0, mediastinal and/or hilar lymph nodes, gender, UICC stage) compared with patients with upper rectal or colon cancer (R0, number of metastases).

Conclusions

Our results indicate that distinct prognostic factors exist for patients with pulmonary metastases from lower rectal compared with upper rectal or colon cancer. This supports the notion that colorectal cancer should not be considered as a single-tumor entity. Metastasectomy, especially after complete resection resulted in a dramatic improvement of survival compared with patients treated with chemotherapy alone.

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Acknowledgment

This work was supported by a grant from the Chiles Foundation, Portland, Oregon. The Chiles Foundation is a not for profit research institution supporting biomedical research. The Chiles Foundation had no influence on the design or conduct of the study, the collection, management, analysis, and interpretation of the data, or the preparation, review, or approval of the manuscript.

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All authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. Department of General, Visceral, Transplantation, Vascular, Trauma, Hand and Plastic Surgery, University of Munich - Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany

    G. Meimarakis, F. Spelsberg, M. Angele, G. Preissler, J. Fertmann, N. Kalaitzis, M. Stemmler, R. Hatz & H. Winter

  2. Department of Medical Informatics, Biometry, and Epidemiology, University of Munich, Munich, Germany

    A. Crispin

  3. Institute of Pathology, University of Munich, Munich, Germany

    S. Reu

  4. Department of Hematology and Oncology, University of Munich - Grosshadern, Munich, Germany

    C. Giessen, V. Heinemann & S. Stintzing

  5. Department of Thoracic Surgery, ASKLEPIOS Fachkliniken Munich-Gauting, Gauting, Germany

    R. Hatz & H. Winter

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  1. G. Meimarakis
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Correspondence to H. Winter.

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G. Meimarakis and F. Spelsberg have contributed equally to this manuscript.

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Meimarakis, G., Spelsberg, F., Angele, M. et al. Resection of Pulmonary Metastases from Colon and Rectal Cancer: Factors to Predict Survival Differ Regarding to the Origin of the Primary Tumor. Ann Surg Oncol 21, 2563–2572 (2014). https://doi.org/10.1245/s10434-014-3646-1

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