Besides resectability, the prethoracotomy serum CEA level appears the most reliable predictor of survival in patients with isolated PM from colorectal cancer.

Background. Surgical resection of pulmonary metastases (PMs) has been shown to produce approximately 35% 5‐year survival rate, but specific data about late survival are not available in the literature. Methods. A retrospective review and survival analysis of 186 adult patients who underwent surgery for PMs at a single center before June 1984 is presented. Results. Of the 186 patients who had surgery, of whom 34 (18%) had an incomplete resection, the 10‐year survival rate (Kaplan‐Meier) was 23% (95% CI, 16‐30%), and 36 patients, with PMs from nine different primary sites, were still at risk at 10 years. Two patients died of their primary disease more than 10 years after the first thoracotomy, and two are alive with uncontrolled disease. Thirty‐one patients are currently alive and disease free. Comparison between the 36 10‐year survivors and the 150 nonsurvivors revealed that only the percentage of incomplete resections and the mean number of resections per patient were significantly different between the two groups (P <0.001); the histologic type of the primary tumor, the disease‐free interval, and the number of resected PMs at the first thoracotomy were not found to be statistically significant prognostic factors. Conclusions. The 23% 10‐year survival and the high rate of disease free 10‐year survivors in this study constitute support for complete resection as an efficient therapeutic approach in patients with isolated PMs. Relevant criteria to select more precisely those patients who will benefit from resection remain to be developed.

Specific results on the surgical resection of a large number of pulmonary metastases (PM) are currently unavailable, and the risk-benefit ratio of this aggressive approach may appear questionable. A systematic review of the records of 456 adult patients who underwent thoracic surgery for PM between 1979 and 1990 led to the identification of 44 patients who underwent at least one resection of eight or more PM (range eight to 110), of whom 33 (75%) had PM from osteogenic or soft tissue sarcoma. These 44 patients underwent a total of 77 operations, of which 47 (61%) were bilateral and nine (12%) incomplete resections. The 3- and 5-yr probabilities of survival after the first resection of eight or more PM were 36 and 28%, respectively, and were not significantly different from those of the 412 other patients who underwent surgery for PM over the same period. In this small group of patients, only the quality of resection (complete or incomplete) was found to be a highly significant prognostic factor (p < 0.01). A critical analysis of the reported data supports the view that, at least in patients with osteogenic or soft tissue sarcoma, the prognostic value of the number of PM seems to be more dependent on associated resectability than on the number per se and that, after careful preoperative patient selection, PM that can be resected should be resected, whatever their number.