The prognosis of pulmonary metastasectomy depends on the location of the primary colorectal cancer

Jong Ho Cho, Masatsugu Hamaji, Mark S. Allen, Stephen D. Cassivi, Francis C. Nichols, Dennis A. Wigle, K. Robert Shen, Claude Deschamps

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background. Rectal cancer has a higher risk of developing lung metastasis compared with colon cancer. It is unclear whether the prognosis after pulmonary metastasectomy for these distinct tumors is different..

Methods. Patients who underwent pulmonary metastasectomy for colorectal carcinoma were analyzed for survival and patterns of recurrence depending on the location of the primary colorectal cancer. Multivariate regression analysis was performed to identify clinical variables predictive of survival after pulmonary metastasectomy.

Results. Between 1985 and 2012, 698 patients underwent pulmonary metastasectomy for metastatic colorectal cancer. Complete information was available in 626 patients. These patients were divided into groups based on whether the primary tumor was colon or rectal in origin.m Median follow-up was 45.5 months (range, 23 to 287 months). There were no statistical differences between the two groups in terms of number of lung metastases, tumor size, or lymph node involvement. There was no difference in overall survival (p [ 0.545). Five-year disease-free survival for colon cancer patients was 67.2% compared with 60.1% for rectal cancer (p [ 0.004). The most common sites of recurrence after pulmonary metastasectomy were liver in colon cancer and lung in rectal cancer. Multivariate Cox proportional hazards analysis indicated that rectal cancer (hazard ratio, 1.39; 95% confidence interval, 1.07 to 1.83; p [ 0.015) and multiple metastases (>3; hazard ratio, 1.41; 95% confidence interval, 1.04 to 1.89; p [ 0.027) were independent adverse risk factors affecting disease-free survival after pulmonary metastasectomy.

Conclusions. Disease-free survival and site of recurrence after pulmonary metastasectomy for colorectal carcinoma are dependent on the site of the primary tumor. Lung metastases from rectal cancer have a worse diseasefree survival compared with colon cancer. This may influence treatment and follow-up strategies.

Original languageEnglish (US)
Pages (from-to)1231-1237
Number of pages7
JournalAnnals of Thoracic Surgery
Issue number4
StatePublished - Oct 1 2014

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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