Role of Pulmonary Metastasectomy in Colorectal Cancer — Does it Improve Survival?

Colorectal cancer (CRC) still is and remains one of the most common chronic malignancies globally and a major conferrer to cancer-related deaths. Among patients with colorectal cancer, distant spread of metastasis is a common source of treatment breakdown, failure and eventually death, with the lungs being the second most common, frequent site after the liver. Pulmonary metastases happen in an estimated 10–20% of CRC patients, with it occurring at the initial diagnosis or during follow-up [1]. For decades, surgical resection of isolated lung metastases, also called as pulmonary metastasectomy has been practiced and executed vastly and widely, based on the belief and understanding that getting rid of metastatic deposits can prolong survival rates in carefully selected patients. However, despite its extensive widespread use, the true survival advantage of pulmonary metastasectomy remains a topic of ongoing discussion and debate. The absence of randomized controlled trials and being dependent on retrospective series have massively contributed to this dispute. This narrative review aims to investigate and explore the present, current evidence circulating around the role of pulmonary metastasectomy in colorectal cancer, Further Talking about its history, rationale, patient selection guidelines, results, and disadvantages. A literature search was undertaken using PubMed, Google Scholar, and other online databases to be able to identify pertinent studies, reviews, and professional expert opinions. Available data generally help support a survival benefit for patients who go through complete resection of isolated pulmonary metastases, with reported 5-year survival rates ranging from 30% to 50% in selected series, [2] Beneficial prognostic factors include a long disease-free interval, solitary metastasis, normal carcinoembryonic antigen (CEA) levels, and no signs, So an absence of an extrapulmonary disease, [1]. Progression in minimally invasive surgery and improved perioperative awareness and care have further enhanced the safety of pulmonary metastasectomy. But contrary to this, There are major significant limitations to current information, which includes patient selection biases and the absence of advanced high-level randomized numbers. Some experts debate that the perceived advantage may partially reflect the biology of indolent disease rather than the effect of surgery itself. As systemic therapies improve outcomes, the role of surgery must be assessed and re-evaluated within multidisciplinary settings. Modern oncology practice progressively highlights the personalized treatment methods that combine surgery, systemic therapy, and observation tailored to single individual patient profiles [1]. Future directions into this very interesting topic includes ongoing research into molecular and genetic markers that could clarify patient selection, prospective trials that label and address unanswered questions, and improved enhanced alliance between surgeons and oncologists. Until more conclusive evidence becomes accessible, pulmonary metastasectomy should still remain an option for selected CRC patients after careful multidisciplinary examinations. This review ends and concludes that while pulmonary metastasectomy is unlikely to benefit all patients equally and uniformly, it can still offer meaningful survival benefits and even possible cure in a subset of patients with limited lung metastases. Ongoing straining of indications and further research will be key to maximizing the results in this complex and ever developing field.