Oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases

Abstract

Background: The oncological benefit of complete metastasectomy for simultaneous colorectal liver and lung metastases (SLLM) and the significance of the time to surgical failure (TSF) in such patients are unknown. Methods: Patients undergoing hepatectomy from 2005 to 2016 as an initial treatment for colorectal liver metastases (CLM) in a single tertiary hospital were divided into three groups: patients with isolated CLM undergoing complete resection (Group 1, n = 317), SLLM undergoing complete metastasectomy (Group 2, n = 33), and SLLM undergoing complete hepatectomy but incomplete lung resection (Group 3, n = 20). Upfront surgery was performed for patients with initially resectable disease. A staged strategy (hepatectomy followed by lung resection) without interval chemotherapy was mainly applied for SLLM as long as the lung metastases were resectable. Clinical characteristics and prognoses were compared among the groups. Results: The 5-year overall survival rate of Group 2 was significantly better than that of Group 3 (70.3% vs. 11.9%, <.001) and similar to that of Group 1 (63.5%, “P” = .859). The 5-year disease-free survival rate was significantly worse in Group 2 than 1 (22.1% vs. 34.6%, =.048), while the 5-year TSF was similar (52.9% vs. 49.9%, =.991). On multivariable analysis, a carcinoembryonic antigen level of >200 ng/ml was the sole predictor of incomplete resection of lung metastases (odds ratio, 13.8; 95% confidence interval, 1.75–298; =.011). Conclusion: The prognosis in patients with SLLM who achieve complete metastasectomy is acceptable and might be improved by a carcinoembryonic antigen level of ≤200 ng/ml, appropriate selection based on operative indications, and aggressive repeat resection.