Resection of non-hepatic colorectal cancer metastasis.

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Colorectal cancer (CRC) continues to be one of the leading causes of significant health problems and cancer-related death in the world. Each year about one million people are diagnosed with CRC worldwide with an estimated 140,000 individuals being diagnosed in the United States (1). About one-half of patients will either present with colorectal liver metastasis (CLM) or develop them during the course of their disease (2,3). While roughly 20% of all patients will present with synchronous liver metastasis, another 25-30% will present with metachronous disease (4-7). Common sites of extra-hepatic metastatic disease include the lung, hilar/peri-hepatic lymph nodes, as well as the peritoneum (8-12). While systemic chemotherapy remains the cornerstone of therapy for patients with stage IV colorectal disease, some patients are optimally managed with the addition of surgical therapy (13-17). Previous data on patients with extrahepatic disease (EHD) and CLM have suggested that these patients have a poor prognosis (18-20). As such, in most instances, EHD was traditionally considered a strong relative or absolute contraindication to surgical resection. However, more recently our group, as well as others, have reported long-term survival after resection of EHD (9-12,21-25). As a consequence, resection of EHD from a colorectal primary has increasingly become accepted over the last decade. We herein review the management of patients with EHD metastatic disease from a colorectal primary tumor. Specifically, we highlight the data on the surgical management of patients with metastatic disease at the most common EHD sites (e.g. lung, hilar/peri-hepatic lymph nodes, peritoneum), as well as define general oncological principles for treating this challenging cohort of patients.