Cancer Management and Research (Dec 2021)

Anatomical Resection Improves Disease-Free Survival After Lung Metastasectomy of Colorectal Cancer

  • Liu T,
  • Chang W,
  • Wang H,
  • Lin Q,
  • Wei Y,
  • Tang W,
  • Liu Y,
  • Chen Y,
  • Niu Z,
  • Jiang Y,
  • Ren L,
  • Xu J

Journal volume & issue
Vol. Volume 13
pp. 9429 – 9437


Read online

Tianyu Liu,1,* Wenju Chang,1,2,* Hao Wang,3,* Qi Lin,1,2,* Ye Wei,1,2 Wentao Tang,1 Yu Liu,1 Yijiao Chen,1 Zhengchuan Niu,1 Yudong Jiang,1 Li Ren,1,2 Jianmin Xu1,2 1Colorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Engineering Research Center of Colorectal Cancer Minimally Invasive Technology, Shanghai, People’s Republic of China; 3Department of Thoracic Surgery; Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianmin Xu; Li RenColorectal Cancer Center, Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of ChinaTel/Fax +86-21-64041990Email [email protected]; [email protected]: This study aimed to evaluate the role of anatomical resection (AR) in lung metastasectomy (LM) of colorectal cancer (CRC) and to investigate clinically relevant prognostic factors.Patients and Methods: The medical records of 350 consecutive patients who underwent LM of CRC from 2011 to 2019 were reviewed. The patients were designated into AR group (lobectomy and segmentectomy), and non-anatomical resection (NAR) group (wedge resection), respectively. Kaplan–Meier method was used to analyze disease-free survival (DFS), pulmonary-specific disease-free survival (PDFS) and overall survival (OS). Cox proportional hazards regression model was performed to analyze the factors associated with DFS, PDFS and OS.Results: A total of 92 (31.2%) patients were enrolled in AR group and 203 (68.8%) in non-anatomical resection (NAR) group. AR significantly improved the 3-year DFS (64.1% vs 46.8%, HR 0.587, 95% CI 0.397– 0.867, P = 0.007) and PDFS (75.0% vs 60.1%, HR 0.565, 95% CI 0.356– 0.899, P = 0.016) compared with NAR. However, the extent of resection did not significantly impact the 3-year OS (AR 92.4% vs NAR 85.7%, HR 0.511, 95% CI 0.224– 1.165, P = 0.110). In multivariate analysis, AR was identified as a protective factor for DFS (HR 0.576, 95% CI 0.356– 0.934, P = 0.025) and PDFS (HR 0.631, 95% CI 0.409– 0.973, P = 0.037). Preoperative abnormal CA19-9 was identified as the only prognostic factor for OS.Conclusion: AR was superior to NAR for DFS and PDFS after LM from CRC.Keywords: pulmonary metastasis, lobectomy, wedge resection, prognosis