Expert consensus on multidisciplinary therapy of colorectal cancer with lung metastases (2019 edition)

Table 5 Treatment strategy for lung metastases with two and above extrapulmonary metastasis sites

Clinical situation		Alternative strategies
Lung metastases	Extrapulmonary metastases	Alternative strategies
Curable	Curable	Mainly systemic therapy¹. This suitable patients for surgical resection of lung metastases and other metastatic lesions should be carefully selected²
Curable	Incurable	Systemic therapy¹
Incurable	Curable	Systemic therapy¹
Incurable	Incurable	Systemic therapy¹

¹It is necessary to consider the patient’s physical status, location of primary tumor, molecular biology characteristics, and prognostic status before determining the systemic therapy regimen
²In addition to liver metastases, extrapulmonary metastases may be peritoneal metastases, pelvic implantation metastases, ovarian metastases, abdominal lymph node and superficial lymph node metastases, brain metastases, and bone metastases. Currently, there is still a debate on whether resection of the aforementioned extrapulmonary metastases can result in survival benefits for patients. Only a small number of studies found that R0 resection of some organ metastases (such as peritoneal metastases, ovarian metastases, and abdominal metastases) may improve patient survival. Therefore, caution must be exercised when selecting patients for local treatment of lung metastases and other metastatic lesions. It is recommended that systematic therapy be conducted first [44]

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