Risk factors for survival and recurrence after lung metastasectomy
Résumé
Background: Colorectal cancer (CRC) is the third most diagnosed cancer ă worldwide, with up to 25% of patients who will develop metastases. ă Pulmonary metastases (PMs) resection for CRC might improve long-term ă survival, but the selection criteria for patients who would benefit ă remain unclear. The aim of this study was to identify preoperative ă predictive factors in patients eligible for this surgical strategy. ă Materials and methods: We retrospectively reviewed data of patients from ă five thoracic surgery departments who underwent PM resection for CRC ă with intent to cure between 2005 and 2010. Univariate and multivariate ă analyses were performed to identify predictive factors influencing ă long-term survival and recurrence after pulmonary resection. ă Results: Three hundred fifty-four patients were eligible. Forty-eight ă patients had pulmonary recurrence (13.5%). Thirty-day postoperative ă mortality was 0.3% (n = 1). Five-and 8-y overall survival (OS) were ă 64.3 +/- 3.99% and 60.72 +/- 4.5%, respectively. In univariate ă analysis, 5-y OS was significantly associated with an American Society ă of Anesthesiologists score of 1 (P = 0.02), a low number of PM (P = ă 0.001), and single wedge resection (P = 0.00001). In multivariate ă analysis, an American Society of Anesthesiologists score of 3 or higher ă (P = 0.05), two or more PMs (P = 0.034) and pneumonectomy (P = 0.021) ă were significant predictors of a poor outcome. In univariate analysis, ă 5-y cumulative recurrence was significantly associated with the absence ă of mediastinal lymph node dissection (P = 0.01). ă Conclusions: Given its high 5-y OS with low postoperative morbidity, ă thus allowing repeat surgical management, resection of PM could be ă performed. Resection of PM could improve long-term survival. (C) 2016 ă Elsevier Inc. All rights reserved.