Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients?

BACKGROUND: There is an increasing risk of cervical lymph node metastases as tumour thickness increases in patients with anterior tongue squamous cell carcinoma (SCC). The role of elective neck treatment in early anterior tongue cancer in unclear. METHODS: Patients diagnosed with anterior tongue cancer and treated with glossectomy +/- neck dissection were identified. The aim was to document the incidence of pathological lymph node metastases and outcome with increasing tumour thickness. The Cox proportional hazards model was used to identify prognostic factors. Survival curves were calculated using the Kaplan-Meier method. RESULTS: Between 1980 and 2002 99 patients (63 male and 36 female) with anterior tongue SCC were treated at Westmead Hospital, Sydney, and had a documented tumour thickness. Median age at diagnosis was 63 years (23-89 years). Median follow up was 37 months (6-205 months). Sixty-three patients underwent partial glossectomy and neck dissection. Thirty-six underwent partial glossectomy only. At the time of presentation 45/63 (71%) were clinically node negative. Using tumour thickness < or = 5 mm versus > 5 mm the incidence of nodal metastases was 8% versus 51% (P = 0.007). On multivariate analysis pathological nodal involvement and advanced stage both significantly predicted survival. The 2-year disease-free survival difference based on tumour thickness (< or = 5 mm vs > 5 mm) was 76% versus 65% (P = 0.47). CONCLUSIONS: Elective treatment to the ipsilateral neck is not indicated in all patients with anterior tongue cancer. However, for patients with a tumour thickness > 5 mm it is recommended that they undergo treatment to the ipsilateral neck in the form of a supraomohyoid neck dissection.     

Metastatic cancer to the floor of mouth: the lingual lymph nodes

BACKGROUND: The upper level of a cervical lymphadenectomy is anatomically defined at its anterior extent by the lower border of the mandible and, in surgical practice, by the lingual nerve. A neck dissection completed below this level is generally considered adequate for removal of lymph nodes at risk for metastases from oral cavity cancer. Traditional discontinuous neck dissections do not provide for removal of floor of mouth tissue along with the primary and neck specimens. METHODS: A case report presenting biopsies from a T2N2bM0 squamous cell carcinoma of the mobile tongue and adjacent floor of the mouth in a 73-year-old man. RESULTS: Deep biopsy of a ventral tongue and floor of mouth squamous cell carcinoma revealed occult metastatic cancer to lymph nodes located in the superficial floor of mouth associated with the sublingual gland above the lingual nerve. This report identifies floor of mouth lymph nodes that can be involved with cancer and missed through the standard practice of discontinuous neck dissection.Conclusions. This finding offers evidence that, in certain cases, a traditional discontinuous neck dissection may not address all lymph nodes at risk in the treatment of oral cavity cancer. Further investigation into lymph node distribution within the oral cavity is warranted to reappraise the upper limits of cervical lymphadenectomy.     

Cervical lymph node metastases in squamous cell carcinoma of tongue and floor of mouth

Oral squamous cell carcinoma has high chances of cervical lymph node metastasis. This case series describes the distribution of cervical lymph nodes in 50 cases of squamous cell carcinoma of tongue and floor of mouth. The mean age was 47.28±10.5 years. Thirty positive metastatic lymph nodes were found; 90% occurring at level I-II mostly in T4 size but also in T1 and T2 cases. The distribution of involved lymph nodes in oral cancer affects the neck dissection extent and is, therefore, an important pre-operative feature.     

Perineural Invasion as a Major Determinant for the Aggressiveness Associated with Increased Tumor Thickness in T1–2 Oral Tongue and Buccal Squamous Cell Carcinoma

Background

Neck management for cN0 neck remains controversial for T1–2 oral tongue and buccal squamous cell carcinoma (SCC). Increased tumor thickness and perineural invasion (PNI) are two pathologic features that correlated with cervical lymph node (LN) metastasis and poor survival. However, the relationships between these two features remain unclear.

Methods

Detailed histologic reevaluation under hematoxylin and eosin staining was performed in tumors of 212 consecutive patients with T1–2, cN0 oral tongue and buccal SCC. The interrelationships between the impacts of tumor thickness and PNI on cervical LN metastasis and disease-specific survival (DSS) were analyzed.

Results

Increased tumor thickness (>6 mm) correlated with higher LN metastasis and poor 5-year DSS rates in univariate analysis. However, only PNI independently predicted both in multivariate analysis (P = 0.004 and P = 0.039, respectively). When stratified by PNI status, increased tumor thickness did not correlate with higher LN metastasis rate in either PNI-negative or PNI-positive groups (P = 0.337 and P = 0.730). Compared to patients with thin tumors (≤6 mm), patient with thick tumors revealed significantly higher LN metastasis rate (41.9 vs. 16.4 %, P = 0.001) and lower 5-year DSS rate (77.5 vs. 93.7 %, P = 0.006) only at the presence of PNI.

Conclusions

PNI can be a major determinant for higher LN metastasis and poor 5-year DSS rates associated with increased tumor thickness in T1–2 oral tongue and buccal SCC. Careful evaluation of PNI should be mandatory in routine pathologic examination, aside from the measurement of tumor thickness.     

Risk factors for late cervical lymph node metastases in patients with stage I or II carcinoma of the tongue

BACKGROUND: Many histopathologic parameters in squamous cell carcinoma of the tongue have been identified as predictive factors for cervical lymph metastasis. However, predictive factors for occult cervical lymph node metastases and the criterion for elective therapy remain inconclusive. This study analyzed the clinicopathologic factors associated with late cervical lymph node metastases in patients with carcinoma of the tongue. METHODS: The clinicopathologic features of 50 consecutive patients seen between January 1985-December 1996 with previously untreated stage I or II squamous cell carcinoma of the tongue were reviewed. All patients were treated with partial glossectomy without elective neck dissection. Their mean age was 54.5 y (range, 23-90 y) and the male-female ratio was 1.2:1 (27 men and 23 women); 30 cases were stage I, and 20 cases were stage II. Clinicopathologic factors were analyzed to determine factors predicting late cervical lymph node metastasis. RESULTS: The overall cervical lymph node metastasis rate was 14.0% (7 of 50). Clinicopathologic factors significantly associated with the development of cervical lymph node metastasis were tumor size (> or =30 mm), tumor depth (> or =4 mm), differentiation, mode of invasion, microvascular invasion, and histologic grade of malignancy. In a multivariate logistic regression analysis, moderately differentiated squamous cell carcinoma of the tongue with tumor depth > or =4 mm had predictive value for late cervical lymph node metastasis and diminished overall survival (odds ratio, 10.0; p =.02; hazards ratio, 7.0; p =.039). CONCLUSIONS: The findings of this study demonstrate tumor depth > or =4 mm moderately differentiated squamous cell carcinoma of the tongue have a substantially higher rate of late cervical metastases. In the basis of these data, it is our recommendation that this be used in the decision to electively treat the neck.     

The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: Treatment rationale

One hundred thirty-six surgical cases of squamous cell carcinoma of the oral tongue and floor of the mouth at the Emory University Hospitals were reviewed for the incidence of occult metastases. Thirty-five percent of the T1 T2 lesions of the anterior tongue had occult metastases. The figure was 31.5% for similarly staged lesions of the floor of the mouth. The presence of regional metastases resulted in a 2-year determinate survival rate of 37% and 32% for patients with oral tongue and floor of the mouth lesions, respectively. The poor prognosis in the study for delayed cervical metastases and the high incidence of occult cervical metastases have led the authors to propose a more aggressive therapy for the clinically negative necks in these two sites of squamous cell carcinoma of the oral cavity.     

Tumour regression does not increase the risk of sentinel node involvement in thin melanomas

Few studies have analysed the relationship between tumour regression and risk of nodal metastasis in patients with thin melanomas (Breslow thickness < or = 1 mm), and the conclusions reported have been conflicting. The aim of this study was to evaluate the role of histological regression as a predictor of lymph node metasta- sis in a selected group of patients with thin melanomas, submitted to lymphatic mapping and sentinel lymph node biopsy. From November 1999 to November 2006, 59 patients with thin melanomas (28 females and 31 males; mean age: 58.7 years) underwent lymphatic mapping and sentinel lymph node biopsy. The mean Breslow thickness was 0.60 mm (range: 0.24-1 mm). Tumour ulceration was present in 2 patients (3.4%) and histological regression in 45 (76.3%). Sentinel lymph node metastases were detected in 2 of 59 patients (3.4%), but only one patient with a positive sentinel lymph node exhibited histological regression of his tumour. Therefore, the sentinel lymph node positivity rate in thin regressing melanomas was 2.2%. Literature data and our experience suggest that tumour regression is not a predictor of sentinel lymph node metastasis in patients with thin melanomas, and therefore does not justify the routine use of lymphatic mapping and sentinel lymph node biopsy in this melanoma setting.     

Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip.

Tumor thickness is a relatively new prognostic factor that has been investigated for lower lip cancer. This study was performed in 27 patients, 13 of whom had histopathologically confirmed cervical metastasis, to investigate whether tumor thickness could be used as a predictor of cervical lymph node metastasis. The mean tumor thickness of those cases with neck metastasis was 5.60 mm (SD = 2.24), and the mean thickness of cases without neck metastasis was 3. 79 mm (SD = 1.68). The difference between tumor thicknesses of both groups was found to be statistically significant (P < 0.05). The tumor thickness of 5 mm was determined as a cutoff point, above which the cervical lymph node metastasis rate was significantly increased. As a conclusion, tumor thickness is an objective histopathologic factor that is easily reproducible; it significantly influences cervical lymph node metastasis in lower lip cancer, and it may be used in the assessment of prognosis.     

Strong Immunohistochemical Expression of Vascular Endothelial Growth Factor Predicts Overall Survival in Head and Neck Squamous Cell Carcinoma

Background Head and neck squamous cell carcinoma (HNSCC) has high morbidity and mortality, and its relationship with tumor angiogenesis as measured by mircovessel density (MVD) or vascular endothelial growth factor (VEGF) expression has shown mixed results, with some, but not others, reporting correlation with outcome. Methods A retrospective study of 186 patients with HNSCC was performed. Patients were evaluated for MVD and VEGF and to correlate the levels with clinical parameters, including age at diagnosis, sex, site of tumor, stage, survival (disease free and overall), pathological tumor grade, and the presence of lymph node metastases. Results The 186 cancers included the following sites: oral tongue (n = 69), palate (n = 9), maxillary sinus (n = 8), floor of mouth (n = 13), oropharynx (n = 27), hypopharynx (n = 26) and larynx (n = 34). Over three-quarters of patients had advanced tumor (stage III/IV) and 58.6% had lymph node metastases. MVD and VEGF were assessed in 166 and 164 cases, respectively, but these were not correlated with site and grade. The 3-year overall and disease-free survival rates were 55.4% and 53.2%, respectively. Both univariate and multivariate survival analysis showed that advanced T stage, nodal metastasis, and strong VEGF intensity were independent adverse predictors for overall and disease-free survival. In stage IV disease, strong VEGF immunoreactivity was found to be the single adverse factor affecting the overall survival and a contributory factor for disease-free survival. Conclusions VEGF immunoreactivity is a strong predictor of adverse outcome, particularly in locoregionally advanced disease.     

Tumor thickness influences prognosis of T1 and T2 oral cavity cancer—but what thickness?

BACKGROUND: Previous studies have demonstrated that tumor thickness might influence prognosis in oral cancer, but the significant point at which outcome changes has varied from 1.5 mm to 6 mm. The clinical relevance of thickness remains unclear, and a reproducible prognostic "breakpoint" needs to be defined. METHODS: Tumor thickness was measured in 145 oral cavity squamous cancers, clinically staged T1 (n = 62) or T2 (n = 83). Clinical and pathologic data were collected prospectively between 1988 and 2000, but thickness was measured on paraffin sections for this study. Minimum follow-up was 2 years, and thickness was correlated with local control, cervical node involvement, and survival. Patients with clinically positive nodes (n = 21) were not excluded. Overall, 55 patients had pathologic node involvement at some time in their disease. RESULTS: Median tumor thickness was 6.2 mm, and there was little variation between sites: tongue, 6.4 mm; floor of mouth, 6.6 mm; and other sites, 5.7 mm. Median thickness for T1 tumors was 4.3 mm, significantly less than the T2 group, 8 mm (p <.01). Median thickness also varied significantly for tumors with associated nodal disease (8.5 mm) and without nodal disease (5.8 mm) (p <.01). Prognosis changed significantly at a cutoff of 4 mm with local control, nodal disease, and survival rates of 91%, 8%, and 100%, respectively, for tumors <4 mm compared with 84%, 48%, and 74% for those 4 mm or more thick (p <.01). Subgrouping greater than and less than 3 mm and 5 mm also showed a difference but with poorer discrimination. Thickness and pathologic nodal involvement were highly significant independent prognostic factors. CONCLUSIONS: Tumor thickness is a highly significant, objectively measurable prognostic factor in early stage oral cancers. There is a need to standardize techniques of measurement to allow a multi-institutional study to be carried out. This will facilitate the development of strategies aimed at improving the outcome of higher risk patients.     

Maspin expression in stage I and II oral tongue squamous cell carcinoma.

BACKGROUND: A relatively high failure rate in the therapy of patients with early oral tongue squamous cell carcinomas (SCCs) is evidenced by untreated clinically negative neck lymph node metastasis. It is important to predict the malignant potential of oral tongue SCC in stage I and II patients, because the development of lymph node metastasis directly affects the prognosis of the patients. METHODS: We evaluated maspin expression immunohistochemically in patients with stage I and II oral tongue SCCs and determined whether the expression level may be a useful factor in predicting metastatic potential and prognosis of these SCCs. RESULTS: Clinical follow-up data showed a longer disease-free interval and overall survival periods for tumors immunohistochemically positive for maspin than for tumors negative for maspin, with the difference in disease-free interval being statistically significant (p =.01). The absence of maspin expression was found more frequently in cases of subsequent cervical lymph node metastasis than in cases without metastasis (p =.03). CONCLUSIONS: Decreased maspin expression may be a significant factor associated with the metastatic potential of stage I and II oral tongue SCCs.     

Predictive value of laminin-5 and membrane type 1-matrix metalloproteinase expression for cervical lymph node metastasis in T1 and T2 squamous cell carcinomas of the tongue and floor of the mouth

BACKGROUND: Laminin-5 (Ln-5) cleaved by membrane type 1-matrix metalloproteinase (MT1-MMP) enhances the migration of tumor cells. The purpose of this study was to determine whether or not enhanced expression of both Ln-5 and MT1-MMP was associated with lymph node metastasis in patients with T1 and T2 squamous cell carcinoma (SCC) of the tongue and floor of the mouth. METHODS: By use of biopsy specimens of primary tumors from 57 patients, intratumoral expression of Ln-5 and MT1-MMP was evaluated immunohistochemically and its association with node metastasis analyzed. RESULTS: The tumors were categorized into three groups: Ln-5 focal type/MT1-MMP (-) (group I, n = 14), Ln-5 focal type/ MT1-MMP (+) and Ln-5 diffuse type/MT1-MMP (-) (group II, n = 16), and Ln-5 diffuse type/MT1-MMP (+) (group III, n = 27). The incidence of node metastasis (initial and latent metastases) was two of 14 (14.3%), five of 16 (31.3%), and 15 of 27 (55.6%) in groups I, II, and III, respectively. Multivariate analysis identified tumor thickness (odds ratio, 4.751; p = .0152) and Ln-5/ MT1-MMP expression (odds ratio, 3.795, p = .0304) as independent factors of node metastasis. Moreover, in 35 patients with N0 disease, Ln-5/MT1-MMP expression was the only parameter associated with latent node metastasis (odds ratio, 12.800, p = .0247). CONCLUSION: These results suggest that immunohistochemical evaluation of Ln-5 and MT1-MMP expression is useful for identifying patients with T1 and T2 SCC of the tongue and floor of the mouth who should be treated with elective neck dissection.     

Supraomohyoid neck dissection in the management of cervical lymph node metastases of squamous cell carcinoma of the lower lip

BACKGROUND: Supraomohyoid neck dissection (SOHND) is generally considered an adequate staging procedure in selected patients with squamous cell carcinoma (SCC) of the lip and oral cavity, with clinically negative nodes in the neck that are at increased risk for occult metastatic disease. The potential role of SOHND as a therapeutic surgical procedure for cervical metastasis limited to level I is controversial. METHODS: A series of 44 patients with clinical cervical lymph node metastases at level I from SCC of the lower lip is reported to evaluate the results of a treatment protocol consisting of therapeutic SOHND on indication followed by radiotherapy. RESULTS: Regional recurrences were observed in four (9%) patients. All recurrences developed within the SOHND dissected area only. CONCLUSIONS: A therapeutic SOHND, on indication followed by radiotherapy, can be an oncologically sound and effective procedure in the management of regional lymph node metastases at level I from SCC of the lower lip.     

甲状腺微小癌颈淋巴结转移危险因素分析及手术范围的探讨

目的:探讨影响甲状腺微小癌(TMC)颈淋巴结转移的危险因素以及颈淋巴结清扫的范围。方法:回顾性分析2009年1月—2013年6月收治的269例TMC患者资料,患者均在原发灶根治的同时行中央区淋巴结清扫,27例患者行颈侧区淋巴结清扫,分析患者各临床病理因素与颈淋巴结转移的关系。结果:269例患者中107例(39.8%)发生颈淋巴结转移,其中中央区淋巴结转移103例(96.3%),颈侧区淋巴结转移25例(23.4%)。单因素分析显示,男性、肿瘤直径5.0 mm、包膜侵犯与TMC颈淋巴结转移有关(均P0.05);多因素分析显示,肿瘤直径5.0 mm(OR=3.358,P0.05)、包膜侵犯(OR=5.230,P0.05)是颈淋巴结转移的独立危险因素。结论:对于肿瘤直径5.0 mm或有包膜侵犯的TMC患者,中央区淋巴结转移的几率增加,行中央区淋巴结清扫是必要的。     

The pattern and prevalence of lymphatic spread in thoracic oesophageal squamous cell carcinoma

Background: Oesophageal squamous cell carcinoma (SCC) is a common type of cancer in China. The knowledge of its pattern of lymphatic metastasis would be of clinical value for surgical and radiation oncologists to treat this disease. Material and methods: A large series of 1850 thoracic oesophageal SCC was retrospectively analysed after extended oesophagectomy with three-field lymphadenectomy (3FL). Specimens were assessed for pattern of lymphatic spread. Result: Of the 1850 patients, 1081 (58.4%) developed mediastinal, cervical and/or abdominal node metastases. The lymphatic metastasis rates were 35.6%, 22.2%, 26.5%, 6.1% and 26.5%, respectively, for the cervical, upper, middle, lower mediastinal nodes and abdominal nodes. The adjacent mediastinal node metastasis alone occurred in 5.5% of patients, and the multiple level or skip node spread accounted for 20.9% and 73.6% of patients with node metastases. Upward lymphatic spread developed in 46.4% of patients, both up- and downward in 33.2%, and the downward, 20.5%. For the upper oesophageal SCC, the most common node metastasis was in the cervical (49.5%) and followed by the upper mediastinal (28.7%), middle mediastinal (11.4%), abdominal (8.0%) and lower mediastinal (1.4%) nodes. For the middle oesophageal SCC, the highest incidence of node spread was also in the cervical (35.0%) and similar rates in the middle mediastinal (29.8%), abdominal (27.2%) and upper mediastinal (22.4%) nodes, but the least in the lower mediastinal (6.0%) node. For the lower oesophageal SCC, more node metastasis occurred in the abdominal (51.7%), and followed by the middle mediastinal (25.6%), cervical (17.2%), lower mediastinal (13.9%) and upper mediastinal (10.0%). However, the lymphatic metastasis rates of the upper, middle and lower thoracic oesophageal SCC were similar. The unfavourable factors for lymphatic metastasis were long oesophageal lesion (p < 0.000), late T stage (p < 0.000) and poor differentiation of tumour cells (p < 0.000). Conclusion: The prevalence was: (1) lymphatic spread prone to the upward in the upper oesophageal SCC, downward in the lower one and both up- and downward in the middle one with in favour of the upward and (2) multiple level and skip node metastases were very often seen. The unfavourable factors for node spread were long oesophageal lesion, late T stage and poor differentiation of tumour cells.     

Predictive value of p53 and PCNA expression for occult neck metastases in patients with clinically node-negative oral tongue cancer

OBJECTIVE: In an attempt to identify molecular markers predictive of occult neck metastases, we investigated whether positive p53 or proliferating cell nuclear antigen (PCNA) immunoreactivities on deparaffinized sections of the primary tumor are correlated to the presence of occult neck node metastases in oral tongue cancer patients with clinically negative cervical nodes (N0). STUDY DESIGN AND SETTING: Between 1986 and 1997, 37 clinically N0 patients who underwent neck dissection (25 male, 12 female; mean age 54 years) were selected for p53 and PCNA staining. RESULTS: p53 and PCNA immunoreactivities were detected in 68% and 32%, respectively. There was no correlation between p53 or PCNA and other clinicopathological factors, such as tumor differentiation, tumor type, tumor size, and T-stage. Although tumor differentiation (P=0.03) and tumor size (P=0.03) were significantly correlated with occult neck metastases of oral tongue cancer by univariate analysis, no correlation was found between p53 or PCNA and the presence of occult neck metastasis. CONCLUSION: p53 and/or PCNA expression are unsuitable as biological markers predictive of lymph node metastases of oral tongue cancer. SIGNIFICANCE: p53- or PCNA-positive status are not a reliable parameter for selection of elective neck dissection in the management of N0 oral tongue cancer patients.     

中央区淋巴结转移强度对甲状腺乳头状癌颈侧区淋巴结转移的临床意义

目的:应用中央区淋巴结转移（central lymph node metastasis,CLNM）强度概念,探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈侧区淋巴结转移（lymph node metastasis,LNM）危险因素及对其影响。方法:回顾性分析内蒙古医科大学附属医院...     

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目的探讨甲状腺微小癌(TMC)颈淋巴结转移规律,指导TMC颈淋巴结的恰当处理。方法回顾性分析济南军区总医院1999年1月至2010年5月行颈淋巴结清扫的117例TMC病人颈淋巴结转移情况,分析TMC局部淋巴结转移的特点、影响因素、诊断方法及处理意见。结果淋巴结转移发生率53.8%(63/117)。常见颈部淋巴结转移部位依次为Ⅵ区(47.9%)、Ⅲ区(20.9%)、Ⅳ区(16.5%)、Ⅱ区(6.1%)。随Ⅵ区淋巴结转移个数增多,侧方淋巴结转移递增。肿瘤数目、大小不同淋巴结转移发生率差异有统计学意义(P=0.000,P=0.014)。超声检查判断淋巴结有无转移的敏感性、特异性和准确性分别为19.0%、98.1%和55.5%。术中淋巴结快速病理检查有13.8%假阴性。全组无复发、转移和死亡。结论 TMC区域淋巴结转移发生率较高,应重视术前评估和术中快速活检,掌握TMC淋巴结转移特点,有助采取恰当手术方式,有选择的预防性区域性颈淋巴清扫可为可使病人获益。     

Noninvasive quantitative assessment of oral tongue cancer by intraoral ultrasonography

BACKGROUND: To assess tissue characterization of oral tongue cancer and prediction of subclinical cervical lymph node metastasis, we investigated whether intraoral ultrasonography could be used in conjunction with a computer-aided diagnosis (CAD) system. METHODS: The study population comprised 109 patients with presurgical, clinical T1N0 or T2N0 oral tongue squamous cell carcinoma who underwent partial glossectomy. All the patients were examined by preoperative intraoral and postoperative ex vivo ultrasonography. To evaluate the ultrasonic images quantitatively, ultrasonographic parameters from tumor contour features were computed by using the proposed CAD system. The imaging results were correlated with histopathologic findings. RESULTS: Oral tongue cancer was clearly identified in all patients by intraoral ultrasonography. Ultrasonic images of oral tongue cancer reflected the histopathologic structures. Subclinical cervical lymph node metastasis was predicted by intraoral ultrasonography. In a logistic regression analysis using the proposed CAD system, the diagnostic sensitivity, specificity, and accuracy for prediction of subclinical lymph node metastasis were 87.2%, 84.3%, and 85.3%, respectively. CONCLUSIONS: Intraoral ultrasonography in conjunction with the proposed CAD system allows tissue characterization and prediction of subclinical cervical lymph node metastasis.     

Prognostic factors in resection of pulmonary metastasis from colorectal cancer

BACKGROUND: The aim of this retrospective study was to evaluate characteristics of primary colorectal cancer and pulmonary metastases in order to identify prognostic factors for overall survival and risk factors for further intrapulmonary recurrence after resection of pulmonary metastases from colorectal cancer. METHODS: Forty-nine patients who underwent resection of pulmonary metastases from colorectal cancer were reviewed. The factors assessed were age, sex, pathological findings of the original colorectal cancer (depth, lymphatic invasion, venous invasion, lymph node metastasis, differentiation, Dukes' stage) and pulmonary metastasis (maximum tumour size, number of tumours, completeness of resection), serum carcinoembryonic antigen level, previous hepatectomy for liver metastases, and surgical procedure for resection of pulmonary metastasis. Overall survival and intrapulmonary recurrence were also reviewed. RESULTS: Survival rates after resection of pulmonary metastases were 78 per cent at 3 years and 56 per cent at 5 years. Solitary pulmonary metastases were significantly correlated with survival (P = 0.049). The pathological features of the primary colorectal cancer had no impact on survival. Histologically incomplete resection of pulmonary metastasis significantly correlated with pulmonary re-recurrence (P = 0.034). CONCLUSION: Long-term survival can be expected after complete resection of pulmonary metastases arising from colorectal cancer, especially in patients with a solitary pulmonary metastasis.