Surgery for pulmonary metastases from colorectal cancer: Predictive factors for survival

Introduction - Colorectal cancer is the 3rd commonest cause of death from cancer: 5% of patients will develop lung metastases. The management of oligometastatic disease is based on the objective of optimal local control. State of the art - To date, no results from randomized control trials support the resection of pulmonary metastases in oligometastastic colorectal cancer patients. However, numerous series, mainly retrospective, report long-term survival for highly selected patients, with 5-year survival ranging from 45 to 65% in the most recent series. The consensual predictive factors of a good prognosis are: a disease free-interval >36 months, a number of metastases <= 3, a normal level of carcino-embryonic antigen and the absence of hilar or mediastinal lymph node involvement. Perspectives - Around 20 to 40% of patients will develop recurrence, probably linked to the presence of undetectable micrometastases. Therefore, experimental work is being undertaken to develop new treatment techniques such as isolated lung perfusion, radiofrequency ablation and stereotactic radiation therapy. Conclusion - Highly selected patients suffering from colorectal cancer lung metastases could benefit from resection with improved survival and disease-control. (C) 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.