499 A 15-Year Experience of Colorectal Pulmonary Metastasectomy in a High-Volume Tertiary Referral Centre

Abstract

Abstract Aim PulMiCC trial results have challenged the role of pulmonary metastasectomy as part of the management of metastatic colorectal cancer in contemporary practice. We aimed to review short and long-term outcomes for patients undergoing surgical resection of pulmonary colorectal metastases. Method Retrospective analysis of electronic-patient-record data was performed. All patients undergoing lung resection for pathologically confirmed colorectal pulmonary metastatic disease from November-2005 to May-2021 were included. In-hospital, 90-day, 1-year, 2-year, 5-year and 10-year mortality rates were analysed. Cox proportional hazards regression analysis was used to identify factors associated with reduced overall survival. Statistical analysis was undertaken using SPSS version-28. Results 619 patients underwent surgery during the study period. Mean age was 66.0 years (±10.0) and 61.2%(n=379) were male. 68.7%(n=425) underwent open surgery. 151(24.4%) had multiple metastases resected. Median follow-up time was 45(IQR 23–87) months. In-hospital mortality was 0.3%(n=2) and median post-operative length of stay was 4(IQR 3–5) days. 90-day, 1-year, 5-year and 10-year mortality rates were 1.1%(n=7/619), 4.5%(n=26/580), 40.6%(n=165/406) and 74.0%(n=208/281), respectively. After multivariable analysis, advanced age (HR 1.026, 95% CI 1.011–1.043, p<0.001) and resection of more than one metastasis (HR 1.524, 95% CI 1.108–2.097, p=0.010) were independently associated with reduced overall survival. Conclusions Although there is inherent selection bias associated with patients referred for surgical management of colorectal cancer, our results demonstrate extremely low short-term mortality and encouraging longer-term outcomes for these patients. Advanced age and the presence of more than one metastasis at the time of surgery were associated with worse prognosis.