Optimal timing of two-stage pulmonary metastasectomy for synchronous bilateral colorectal pulmonary metastases: A time-dependent survival analysis.
Second-stage lung metastasis surgery within 3 months linked to tripled death risk
Optimal timing of two-stage pulmonary metastasectomy for synchronous bilateral colorectal pulmonary metastases: A time-dependent survival analysis.
Synchronous bilateral colorectal pulmonary metastases (colorectal pulmonary metastases) present a surgically complex scenario in which two-stage video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery) is increasingly practised.
We aimed to characterize the continuous, non-linear relationship between the inter-video-assisted thoracoscopic surgery interval and overall survival (OS) using three complementary bias-corrected statistical approaches.
From a single-center retrospective cohort of 385 colorectal pulmonary metastases patients (January 2009 - December 2023), 152 with synchronous bilateral disease were analyzed.
early second surgery roughly tripled the risk of death
After inverse probability of treatment weighting adjustment, a second video-assisted thoracoscopic surgery was associated with a non-significant directional survival benefit (HR = 0.67, 95% CI: 0.39-1.12, p = 0.124), consistent with an effect contingent on appropriate patient selection rather than universal benefit.
Among patients with two video-assisted thoracoscopic surgery procedures, the restricted cubic spline model demonstrated a statistically significant non-linear dose-response between the inter-video-assisted thoracoscopic surgery interval and mortality hazard (model likelihood-ratio p = 0.006).
A two-stage pulmonary metastasectomy interval of 5-8 months is associated with optimal survival in patients with synchronous bilateral colorectal pulmonary metastases.
Sequential surgery within 3 months significantly worsens prognosis and should be avoided unless mandated by clinical urgency.
Selective two-stage metastasectomy - guided by multidisciplinary team consensus and timed at 5-8 months - minimizes surgical morbidity while preserving the survival benefit of repeat resection.