• Kai Yin Lee, Jerrald Lau, Bei En Siew, Yong Kang Chua, Yi Xuan Lim, Xin Yi Lim, Choon Seng Chong, and Ker Kan Tan.
• University Surgical Cluster, National University Health System, Singapore.
• Ann Acad Med Singap. 2021 Oct 1; 50 (10): 773-781.

IntroductionSurgical resection of the primary and metastatic tumour is increasingly recommended in suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is well studied and established in colorectal liver metastasis, evidence remains limited in pulmonary metastases. This systematic review was conducted to examine the current evidence on the role of lung metastasectomy (LUM) in CRC.MethodsThree databases were systematically searched, to identify studies that compared survival outcomes of LUM, and factors that affected decision for LUM.ResultsFrom a total of 5,477 records, 6 studies were eventually identified. Two papers reported findings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survival benefit in patients who underwent LUM compared to those who did not. When compared against patients who underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwent LUM were also more likely to have a single pulmonary tumour, and metachronous disease.ConclusionThe evidence suggests a role for LUM, but is limited by inherent selection bias in retrospective reviews, and the single randomised clinical trial performed was not completed. More prospective studies are required to understand the true effect of LUM on outcomes in metastatic CRC.

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