Published online May 28, 2014. doi: 10.3748/wjg.v20.i20.6133
Revised: November 1, 2013
Accepted: March 4, 2014
Published online: May 28, 2014
Colorectal cancer (CRC) is one of the most common cancers worldwide, with 5%-15% of CRC patients eventually developing lung metastasis (LM). Despite doubts about the role of locoregional therapy in the management of systemic disease, many surgeons have performed pulmonary metastasectomy (PM) for CRC in properly selected patients. However, the use of pulmonary metastasectomy remains controversial due to the lack of randomized controlled studies. This article reviews the results of surgical treatment of pulmonary metastases for CRC, focusing on (1) current treatment guidelines and surgical techniques of PM in patients with LM from CRC; (2) outcomes of PM and its prognostic factors; and (3) controversial issues in PM, focusing on repeated metastasectomy, bilateral multiple metastases, and combined liver and lung metastasectomy.
Core tip: Pulmonary metastasectomy is now the accepted treatment of choice in the multimodal management of metastatic colorectal cancer. There is no absolute contraindication for pulmonary metastasectomy as long as complete resection can be achieved. However, there are still many questions regarding the proper indication of pulmonary metastasectomy, for example: How many times can pulmonary metastasectomy be performed for recurrent pulmonary metastases? How many nodules can be resected safely and effectively in patients with recurrent and multiple metastatic nodules? This article reviews the different therapeutic strategies for patients with pulmonary metastases of colorectal cancer, with a particular focus on these questions.