Pulmonary Metastasectomy in Colorectal Cancer

Pulmonary metastasectomy has become an established component of multidisciplinary care for selected patients with colorectal cancer that has spread to the lungs. The procedure involves surgical removal of one or more pulmonary nodules that originate from a colorectal primary. Advances in imaging, patient selection and minimally invasive techniques have broadened the cohort of candidates, aiming to achieve local control and extend survival. Key prognostic factors include the number and size of metastases, disease-free interval following primary colorectal resection, and the presence of extrathoracic disease. Modern approaches favour parenchyma-sparing resections to preserve lung function, often utilising video-assisted thoracic surgery. Alongside surgery, perioperative chemotherapy and targeted systemic therapies contribute to an integrated care pathway. Repeat metastasectomy in the event of recurrent pulmonary lesions offers comparable long-term survival to the first resection, albeit with a higher risk of postoperative complications. Overall, pulmonary metastasectomy exemplifies the balance between curative intent and functional preservation, with patient selection guided by oncological criteria and physiological reserves.

Research from Nature Portfolio

Recent studies have introduced laser-assisted pulmonary metastasectomy as a novel technique for resecting multiple small nodules while maintaining healthy lung tissue. Use of a diode-pumped Nd:YAG laser to achieve consistent 5 mm safety margins resulted in a local recurrence rate below 4 per cent over a median follow-up of nearly four years. Outcomes demonstrated that complete resection and smaller nodule size predict durable local control, with three- and five-year survival rates of 84 per cent and 49 per cent respectively. This innovation highlights the potential of precision energy devices to optimise margins and preserve parenchyma in patients with bilateral or multifocal disease.

Pulmonary Metastasectomy in Colorectal Cancer publication trend

The graph below shows the total number of articles in pulmonary metastasectomy in colorectal cancer across all publications each year (not limited to Nature Index journals).

Technical terms

Pulmonary metastasectomy: Surgical excision of lung metastases originating from a primary colorectal cancer.

Parenchyma-sparing resection: Surgical technique that removes tumour tissue while preserving as much healthy lung as possible.

Uniportal VATS: Minimally invasive lung surgery performed through a single small incision using a thoracoscope.

Nd:YAG laser: Neodymium:yttrium–aluminium–garnet device emitting infrared laser energy to ablate tissue with precision.

Safety margin: Peripheral zone of healthy tissue removed around a tumour to reduce the risk of residual disease.

Disease-free interval (DFI): Time between primary colorectal cancer treatment and the appearance of lung metastases.

References

1. New Prognostic Score (Essen Score) to Predict Postoperative Morbidity after Resection of Lung Metastases. Cancers (2023).
2. Laser assisted pulmonary metastasectomy promises a low local recurrence rate. Scientific Reports (2024).
3. Pulmonary metastasectomy and repeat metastasectomy for colorectal pulmonary metastases: outcomes from the Dutch Lung Cancer Audit for Surgery. BJS Open (2023).
4. Oncologic Outcome after Pulmonary Metastasectomy as Part of Multidisciplinary Treatment in a Tertiary Oncological Center. Diagnostics (2023).