Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review

: Surgical resection of the primary and metastatic tumour is increasingly recommendedin suitable patients with metastatic colorectal cancer (CRC). While the role of metastasectomy is wellstudied 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.Methods: Three databases were systematically searched, to identify studies that compared survivaloutcomes of LUM, and factors that affected decision for LUM.Results: From a total of 5,477 records, 6 studies were eventually identified. Two papers reportedfindings from one randomised controlled trial and 4 were retrospective reviews. There was no clear survivalbenefit in patients who underwent LUM compared to those who did not. When compared against patientswho underwent liver metastasectomy, there was also no clear survival benefit. Patients who underwentLUM were also more likely to have a single pulmonary tumour, and metachronous disease.Conclusion: The evidence suggests a role for LUM, but is limited by inherent selection bias in retrospectivereviews, and the single randomised clinical trial performed was not completed. More prospective studiesare required to understand the true effect of LUM on outcomes in metastatic CRC.Keywords: Colorectal cancer, pulmonary metastasectomy, pulmonary metastases, survival