Objective: To investigate the efficacy and related prognostic factors in one-stage resection of colorectal cancer and lung metastases by combined laparoscopic and thoracoscopic (biscopic) approach. Methods: The clinical data of 35 patients with colorectal cancer and pulmonary metastases were retrospectively analyzed. Of the patients, 17 cases underwent biscopic one-stage resection followed by systemic chemotherapy (biscopic surgery group), and 18 cases received systemic chemotherapy only (non-surgery group). The treatment efficacy of the two groups was compared and prognostic factors for patients undergoing biscopic surgery were analyzed. Results: Both the primary tumor and pulmonary metastases achieved R0 resection in biscopic surgery group. The 1- and 2-year survival rate was 82.3% and 52.3% in biscopic surgery group, and 44.4% and 22.2% in non-surgery group respectively (P=0.028; P=0.001). Univariate analysis showed that the number of lung metastases (P=0.002) and positive mediastinal lymph nodes (P<0.001) were associated with the postoperative survival of the patients, while gender, age, the location of the primary tumor, pathological type, T stage, lung metastasis size and type of resection, preoperative CEA level and chemotherapy regimens were irrelevant to their postoperative survival (all P>0.05). Multivariate analysis indicated that the number of metastases (P=0.005) and mediastinal lymph node involvement (P=0.006) were independent influential factors for postoperative prognosis of the patients. Conclusion: Biscopic one-stage resection for colorectal cancer and lung metastases can improve the overall survival of the patients, and number of metastases and mediastinal lymph node involvement are the independent influential factors for postoperative prognosis.