• Eur J Cardiothorac Surg · Mar 2017

    Multicenter Study

    Outcomes of segmentectomy and wedge resection for pulmonary metastases from colorectal cancer.

    • Satoshi Shiono, Takehiro Okumura, Narikazu Boku, Tomoyuki Hishida, Yasuhisa Ohde, Yukinori Sakao, Katsuo Yoshiya, Ichinosuke Hyodo, Keita Mori, and Haruhiko Kondo.
    • Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
    • Eur J Cardiothorac Surg. 2017 Mar 1; 51 (3): 504-510.

    ObjectivesAlthough wedge resection is the most common surgical procedure for pulmonary metastases from colorectal cancer, there are few reports about segmentectomy for colorectal metastasectomy.MethodsThis was a subset analysis of a Japanese nationwide retrospective study of resected pulmonary metastases from colorectal cancer. The study included 553 patients who underwent segmentectomies ( n  = 98) or wedge resections ( n  = 455) without preoperative chemotherapy between January 2004 and December 2008. Recurrence patterns, recurrence-free survival and overall survival were analysed for each procedure.ResultsAs for the patients' background factors, only the median size of resected metastases was different between patients with segmentectomies (median 18 mm, range 5-50 mm) and wedge resections (14 mm, 5-51 mm) ( P  < 0.001). Prolonged air leak developed more frequently in those undergoing segmentectomy compared with wedge resection (5.1% vs 1.8%) ( P  = 0.048). The resection-margin recurrence rate was higher in patients who underwent wedge resection compared with segmentectomy (7.3% vs 2.0%; P  = 0.035). The 5-year recurrence-free survival was 48.8% in patients with segmentectomy and 36.0% in patients with wedge resections. The 5-year overall survival was 80.1% in patients with segmentectomy and 68.5% in patients with wedge resection. Multivariable analysis revealed that the surgical procedure, segmentectomy, was a significant favourable factor for recurrence (hazard ratio: 0.63, 95% confidence interval: 0.44-0.87, P  = 0.005), but not for overall survival (hazard ratio: 0.65, 95% confidence interval: 0.38-1.05, P  = 0.080).ConclusionsSegmentectomy demonstrated a good efficacy with less resection-margin recurrence in patients with resectable pulmonary-limited metastasis from colorectal cancer.© The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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