대한대장항문학회

Purpose: Pulmonary metastases from colorectal carcinomas have been reported to occur in 10% of all patients who undergo a curative resection. A number of studies have reported aggressive treatments, including lung resection, for pulmonary metastases that appear to prolong the survival in selected cases. The aim of this study was to assess the clinical characteristics, and the prognostic factors of pulmonary metastases, as well as the outcomes after resection of the pulmonary metastases.<br>Methods: A retrospective study was performed on 104 patients who presented with primary pulmonary metastases without metastases in other organs after a curative resection for a colorectal carcinoma between January 1994 and December 2000 at Asan Medical Center. Pulmonary metastases were diagnosed by using serial changes in the chest X-ray and the CT. Univariate (log-rank) and multivariate (Cox’s model) analyses were employed to identify the prognostic factors.<br>Results: The mean interval between colorectal resection and pulmonary metastases (disease-free interval) was 22 (range: 4~64) months. Fifty-eight of 104 patients had pulmonary metastases originating from rectal cancer. More than half of the patients (55.7%) had bilateral multiple metastases. Fifty-six of 104 patients underwent chemotherapy, 28 conservative therapy, and 20 a pulmonary resection with the extent of the resection varying from a wedge resection of the metastatic nodule to a lobectomy. Prolonged survival was associated with serum CEA levels at the diagnosis of the metastases (P=0.02) and with the type of treatment (P<0.01).<br>Conclusions: The s-CEA level at the diagnosis of the pulmonary metastases appears to be a reliable predictor of survival in patients with pulmonary metastases from colorectal cancer. Resection of the pulmonary metastasis in colorectal cancer may significantly prolong survival. Thus, aggressive therapy, including surgery, should be considered for pulmonary metastatic tumors in selected groups.<br>