Incidence of Ipsilateral Side Recurrence After Open or Video-Assisted Thoracic Surgery Resection of Colorectal Lung Metastases

Ann Thorac Surg. 2020 May;109(5):1591-1597. doi: 10.1016/j.athoracsur.2019.11.031. Epub 2020 Jan 15.


Background: There is still controversy whether full lung palpation is required for patients undergoing pulmonary metastasectomy. We aimed to compare pulmonary ipsilateral recurrence (IR) after video-assisted thoracic surgery (VATS) or open surgery.

Methods: A retrospective study of all patients who underwent surgery for colorectal cancer lung metastases between 2003 and 2012 was performed. IR rate was compared between the 2 groups after adjusting for a propensity score matching based on age, sex, disease-free interval, number of metastases, type of resection, presence of a cardiovascular risk factor, presence of a respiratory risk factor, as well as the interaction between the number of metastases and the disease-free interval. The propensity score was used for matched and weighted comparisons of VATS and open patients.

Results: A total of 211 patients underwent surgery for colorectal cancer lung metastases. Of these, 75 (35.5%) were performed via VATS and 136 (64.5%) via open surgery. Before matching, 118 (55.9%) were male and the median age at the time of metastases diagnosis was 61 (range, 49.8-72.2) years. Median disease free-interval was 20 (19.7 ± 28.3) months; 22 (21.6 ± 28.5) months in VATS and 19 (19.0 ± 28.3) months in open surgery. In total, 19 (25.3%) developed IR in VATS, and 39 (28.7%) in open surgery. Five-year overall survival was 53.1% (61.9% VATS; 49.2% open). In the matched sample, IR was 23.6% in VATS vs 26.2% in open surgery (95% confidence interval for risk reduction with VATS: -22.6% to 17.5%; P = .80).

Conclusions: No significant difference was observed in IR rates between VATS and open surgery in the treatment of colorectal cancer lung metastases.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Colorectal Neoplasms / pathology*
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / secondary
  • Lung Neoplasms / surgery*
  • Male
  • Metastasectomy / adverse effects*
  • Metastasectomy / methods
  • Middle Aged
  • Neoplasm Metastasis
  • Neoplasm Recurrence, Local / epidemiology*
  • Ontario / epidemiology
  • Pneumonectomy / adverse effects*
  • Pneumonectomy / methods
  • Retrospective Studies
  • Thoracic Surgery, Video-Assisted / adverse effects*
  • Thoracotomy / adverse effects*