Lung invasion: what are the outcomes of colorectal cancer patients who have undergone lung surgery?

This study examined cancer relapse rates and treatment options for patients with colorectal lung metastases (colorectal cancer that has spread to the lungs) after curative lung surgery.

Roughly 20% of patients with colorectal cancer will have cancer in a distant organ by the time they are diagnosed. The cancer will relapse in a distant organ for another 19 to 28% of patients after diagnosis. The lung is the second most common organ for colorectal cancer to spread to, after the liver.

Surgery is the best treatment option for patients with lung metastases. However, roughly 70% of patients who undergo surgery will relapse. The most common site for the cancer to relapse is back to the lungs. It is unclear how best to treat patients who have relapsed after surgery for lung metastases.

The authors analyzed medical records for 112 colorectal cancer patients who had undergone curative surgery for lung metastases. The number of patients who relapsed after lung surgery was investigated. Overall survival time (survival time after the patient relapsed) was also assessed over the 3 year follow-up.

67.97% of patients relapsed after the curative lung surgery. The cancer relapsed in the lung for 49% of patients, in the liver for 16% of patients, in a site other than the lung or liver for 14% of patients, and in more than one organ for 21% of patients.

The most common treatments for relapse included further surgery (46.1%), chemotherapy (48.7%), or palliative care (relief from symptoms, 5.3%). Of the 35 patients who underwent surgery, 22 had lung surgery, 11 had liver surgery and 2 had surgery to other organs.  84.1% of patients were still alive 3 years after undergoing the second surgery and 38.9% of patients were still alive 3 years after receiving chemotherapy. None of the patients who underwent palliative care were still alive.

The authors concluded that the most common relapse site after lung surgery in colorectal cancer patients was the lung. Although the relapse rate was high, surgery for single relapse sites was a promising treatment option.