Open and video-assisted thoracoscopic resection of solitary lung metastases in patients with colorectal cancer: Preliminary results.

Introduction: In patients with colorectal cancer (CRC), the most frequent metastatic site is the liver. In resectable cases liver resection is usually performed, while different treatment modalities including, hepatic arterial infusion chemotherapy, vein embolization, and local destruction with cryotherapy or radiofrequency ablation represent the treatments of choice in unresectable cases. The lung is an uncommon site of metastases from CRC, accounting for 5-10% of cases. In addition, some CRC patients develop pulmonary metastases even when the metastatic sites are considered to be limited to the liver. Unfortunately, untreated stage IV CRC patients have an overall median survival of 6-8 months, and a 5-year survival less than 2-3%. Thus, surgery still remains the sole possible treatment for patients with resectable lung metastases. Pulmonary resection for metastatic CRC has long been reported, although initially this surgical treatment was considered not completely satisfactory. Currently, pulmonary metastasectomy through thoracoscopy appears to be feasible, leading to similar results than that obtained with open surgery, with the advantages of a minimally invasive approach. The aim of this study was to analyze the results of video-assisted thoracoscopic (VATS) pulmonary metastasectomy in patients with CRC. Methods: We retrospectively reviewed the results of surgery in a group of 34 patients (26 men, 8 women, median age 64 years) with stage I-II CRC who developed a solitary and small (< 2 cm) lung metastasis. The primary tumor was a solitary adenocarcinoma in all patients. The interval between colorectal resection and lung metastasis onset was 25.3±5.6 months. According to the surgical approach, two groups of age- and sex-matched patents were obtained: Group A (VATS metastasectomy, 18 patients), and Group B (open thoracotomy, 16 patients). Results: The mean postoperative follow-up was 49 months (range 6-98 months). The overall 1-year and 3-year survival rate was 85.3% and 67.6%, while the disease-free interval (DFI) rate was 58.8% and 35.3% in Groups A and B, respectively. The 1- and 3-year (Group A vs. B) survival rate was 83.3% vs. 87.5% (95% CI 0.71-4.92, p=0.56), and 61.1% vs. 75.0% (95% CI 0.12-2.29, p=031), while the 1- and 3-year DFI rate was 55.6% vs. 62.5% (95% CI 1.19-2.96, p=0.68), and 33.3% vs. 37.5% (95% CI 0.20-3.41, p=0.56), respectively. Conclusion: Better results were obtained in patients who underwent VATS resection, but survival and DFI rates did not differ significantly between Groups. Thus, according to our preliminary reports, in patients with CRC who develop solitary lung metastasis, VATS should be considered the surgical technique of choice.