Pulmonary metastasectomy of colorectal cancer origin: Evaluating process and outcomes

Background: This study was undertaken to evaluate the effect of change in policy of computed tomography (CT) scan of the thorax in staging and follow-up of colorectal cancer (CRC). Another objective was to review the outcomes following pulmonary metastasectomies (Pmets) and to determine the prognostic factors affecting outcomes. Methods: This is a retrospective analysis from a prospective cohort database of patients, who underwent Pmet for CRC origin from August 2004 to February 2016. The outcome measures were number of Pmets per year, overall survival (OS), disease-free survival (DFS), and prognostic factors affecting survival. Results: Of 71 patients, 38% (n = 27) underwent Pmet before 2013 and 62% (n = 44) had surgery after 2013. The 2-year DFS after Pmet was 49.3% and estimated 5-year OS was 51.4% at a median follow-up of 28 months. There was a significant increase in number of Pmets/year (P = 0.0015), increased detection of synchronous pulmonary metastasis (PM) (P = 0.005), increased diagnosis of extra-pulmonary metastases (EPM) (P = 0.005), and improved OS (P = 0.026) after introduction of CT scan as staging tool. Site of primary tumor (colon) (P = 0.045), primary nodal stage (P = 0.009), and the presence of EPM (P = 0.01) were independent important prognostic factors affecting survival. Conclusion: The CT scan of thorax as a baseline tool for staging and follow-up in CRC increases referral for pulmonary metastasectomy. Surgery achieves excellent prognosis and long-term survival outcomes in CRC with isolated PM and carefully selected patients with solitary liver metastasis.