Chirurgisches Vorgehen bei kolorektalen Lungenmetastasen

Context

Pulmonary metastasectomy is associated with low morbidity and mortality and might provide a survival advantage for selected patients.

Objective

The aim of this study was an evidence-based systematic review of the current status of the diagnostics and therapy of pulmonary metastases arising from malignant colorectal cancer.

Material and methods

A systematic literature search was performed in PubMed, Medline, current guidelines and by manual searching. Relevant publications from the last 20 years were analyzed and the results are summarized in a structured review.

Results

The indications for metastasectomy should be discussed in an interdisciplinary tumor board. Even in the absence of pre-metastasectomy chemotherapy, an observation period of at least 2 months should be recommended for assessment of the tumor biology. The 5-year survival rate ranges between 40 % and 68 % for patients undergoing pulmonary metastasectomy. Positive prognosticators for survival might be complete resection, low carcinoembryonic antigen (CEA) levels, few metastases, long disease-free interval, localization of the primary tumor in the colon, no lymph node metastases and regression or stable disease after preoperative chemotherapy and/or observation interval. Rectal cancer represents a different tumor entity compared to colon cancer even in metastasectomy patients. Rectal cancer is associated more often with multiple metastases, higher prevalence of thoracic lymph node metastases and shorter disease-free interval. Resectable liver and lung metastases or the prevalence of thoracic lymph node metastases are not a contraindication for surgery.

Conclusion

Pulmonary metastasectomy for colorectal cancer is an established treatment within multimodal treatment concepts. The indications for metastasectomy should be discussed in an interdisciplinary tumor board. Rectal cancer represents a different tumor entity compared to colon cancer even in metastasectomy patients. Resectable liver and lung metastases or the presence of thoracic lymph node metastases are not a contraindication for surgery per se.