Efficacy of Surgical Resection of Both Pulmonary and Liver Metastases from Colorectal Cancer

Abstract

Purpose: Resection is effective for some patients with isolated hepatic or pulmonary metastases of colorectal cancer (CRC). But the role of surgery in the management of patients who have both liver and lung metastases is not well defined. The aim of this study was to evaluate the validity of surgical therapy for isolated hepatic and pulmonary colorectal metastases. Methods: Between 1992 and 2006, 256 patients underwent hepatic resection for the first treatment of CRC metastases. Among these patients, 31 patients underwent both lung and liver resections for metastatic CRC. Demographic, perioperative, survival and variables were evaluated by retrospective chart review. Results: Twenty-nine patients (93.5%) underwent sequential pulmonary resection after hepatectomy because of recurrent disease. Two patients (6.5%) underwent staged liver and lung metastasectomy from synchronously identified metastases. Median interval between heaptic resection and pulmonary resection was 17.7±10.4 month. The features of the first liver metastases: The median number of tumors was 1.59 (range 1 to 20 tumors) and 14 patients had bilateral disease. The median size of the largest tumor was 3.0 cm (range 0.3 to 8 cm). In 11 (35.5%) patients, a hemihepatectomy or more was required to remove all gross disease. The features of the first pulmonary metastases: The median number of nodules was 2.7 (range 1 to 10) and 13 patients (41.9%) had their metastatic disease confined to bilateral lung. The median tumor size was 1.9 cm (range 0.4 to 6 cm). A large majority of patients (83.9%) had a wedge resection; lobectomy was required in only 5 (16.1%) patients. Median survival from resection of the first liver metastasis was 86.5 month, with the 5-, and 10-year over all survival rates of 77.5% and 39.5%, respectively. Median survival from resection of the first pulmonary metastasis was 55.2 month, with the 5-, and 10-year over all survival rates of 44.7% and 38.2%, respectively. By multivariate analysis, number of pulmonary metastases more than 3 (risk ratio= 4.417, 95% confidence interval CI=1.376-14.175, p=0.013) was an independent unfavorable prognostic factor of long-term survival. The overall cumulative survival results in patients with more than 3 pulmonary metastases (5,10-year 16.6 median survival 23.4 months) was markedly worse than in patients less than 3 pulmonary metastases (5-year 60.2%, 10-year 45.1% median survival 97.1 months) (p<0.0071). Conclusion: Surgical resection of both hepatic and pulmonary colorectal metastases is safe and results in excellent long term survival in selected patients. Poor results were obtained in patients who had more than 3 pulmonary metastases.