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Pulmonary Metastasectomy: A Multicenter Comparison of Wedge Resection Versus Anatomic Resection for Single Metastases of Colorectal Cancer
by
, ,
Stefan Welter
1,*
,
Isabelle Moneke
2,
Ramzi Wara
1,
Antonia Uyen-Thao Le
2,
Ahmad Shalabi
3,
Thomas Graeter
3,
Till Ploenes
4,5 and
Daniel Baum
4 1
Department of Thoracic Surgery, Lungenklinik Hemer, 58675 Hemer, Germany
2
Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg im Breisgau, Germany
3
Department of Thoracic Surgery, SLK Lungenklinik Löwenstein, 74245 Löwenstein, Germany
4
Department of Thoracic Surgery, Fachkrankenhaus Coswig, Lung Center, 01640 Coswig, Germany
5
Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, 01069 Dresden, Germany
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(20), 3299; https://doi.org/10.3390/cancers17203299 (registering DOI)
Submission received: 5 September 2025
/
Revised: 29 September 2025
/
Accepted: 3 October 2025
/
Published: 11 October 2025
(This article belongs to the Section Cancer Metastasis)
Simple Summary
Operative treatment of single pulmonary metastasis from colorectal cancer should be focused on the prevention of local margin recurrence. With a retrospective evaluation from 4 German thoracic surgery centers, we could demonstrate that anatomical metastasis resection is associated with larger safety margins, greater number of lymph nodes removed, no incomplete resections and fewer intrapulmonary margin recurrences, compared to non-anatomic resections like wedge or laser enucleation. Overall (OS) and recurrence-free survival (RFS) were excellent, but were not different between the groups. After propensity-score matching in patients with peripheral or intermediate lesions, anatomic resection was associated with a significantly lower rate of local margin recurrence, no significant difference in intrathoracic lymph node recurrence and no difference in OS or RFS was found.
Abstract
Background/Objectives: Patients with single metastases from colorectal cancer constitute a subgroup with an excellent 5-year OS of 55–70% and with a real chance for cure. In this situation, local margin recurrence in the lung may impair the prognosis and thus is the main outcome target of surgery. Methods: A retrospective multicenter analysis of patients with single metastases from colorectal cancers was performed. Four German Thoracic Surgery units contributed data from their prospective metastasectomy databases. Statistical analysis was focused on tumor recurrence and risk factors for local margin recurrence. Results: 166 patients from four centers could be further analyzed. For later comparison, 93 (56%) anatomic resections and 73 (44%) non-anatomic resections were pooled. Tumor recurrence was detected: at any site 87/161 (54%), within the lung 62/161 (38.5%) at intrapulmonary margins 25/145 (17.2%) and in intrathoracic lymph nodes 14/138 (10.1%). Intrapulmonary local margin recurrence was more often found in non-anatomic (25.4%) versus anatomic (11.6%) resections (p = 0.052). After propensity score matching (PSM), local margin recurrence was significantly more frequent after non-anatomic resection of intermediate and peripherally located metastases (p = 0.042). Furthermore, local margin recurrence was associated with small safety margins (p < 0.001), small number of lymph nodes removed (p < 0.001) and with intrathoracic lymph node recurrence (p = 0.001). The 5- and 10-year OS of the whole group was 70% and 47% with a median survival of 9.0 years. The 5- and 10-year RFS of the whole group was 59% and 43% with a median of 7.3 years. Conclusions: This study demonstrates that anatomical resection of single CRC lung metastases is superior to non-anatomic resection with respect to local radicality and local intrapulmonary margin recurrence, but there was no difference in OS and RFS.
