Abstract
BackgroundThe aim was to assess the likelihood of patients with simultaneously diagnosed liver and lung metastases (SLLM) from colorectal cancer (CRC) to receive the curative treatment decided upon multidisciplinary team meeting (MDT) and to elaborate on the reasons for treatment intention failure and survival outcomes depending on final treatment strategy. MethodThe study included a retrospective review of all patients discussed at the MDT at a single centre between 2010 and 2018 to identify all patients presenting with SLLM from CRC. Treatment intention, actual treatment outcome and reasons for treatment failure was documented. Descriptive and survival statistics were applied. ResultsOf the 160 patients who had SLLM, resection of all metastatic sites was deemed possible in 107 patients (67%) of whom 39 patients (36%) finalized the curative treatment plan. The most common reason for noncompliance with management recommendations was disease progression or recurrence. Complete resection resulted in longer survival compared to patients who did not undergo resection of all metastatic sites with median survival of 63 and 27 months, respectively (p < 0.001). ConclusionA low proportion of patients completed the initially intended curative resections. Simultaneous resection of liver/lung metastases and primary tumour might increase the proportion of fulfilled hepatopulmonary resections.
Highlights
Surgical management of patients with colorectal cancer (CRC) and simultaneously detected liver and lung metastases (SLLM) has been a subject of debate with a consensus agreement on resecting the tumours when all lesions are resectable [1]
Over the 9-year inclusion period, 421 patients were identified as having liver metastases from CRC and a notification of either verified lung metastases, suspected lung metastases or indeterminate lung nodules requiring further review of medical records (Fig. 1)
One hundred and nine patients (68%) presented with stage IV CRC having synchronous liver and lung metastases of whom ten patients had undergone colorectal resection prior to the MDT due to colonic obstruction (n 1⁄4 6) or preference of the colorectal surgeon (n 1⁄4 4)
Summary
Surgical management of patients with colorectal cancer (CRC) and simultaneously detected liver and lung metastases (SLLM) has been a subject of debate with a consensus agreement on resecting the tumours when all lesions are resectable [1]. The few studies on SLLM, where the initially intended hepatopulmonary resections were completed, report a 5-year survival of 43e72% [8e10] and demonstrate that patients with SLLM undergoing complete metastasectomy have similar survival to patients undergoing resection of isolated liver metastases [9,10]. Decisions about selection for surgical resection are normally managed in the setting of a multidisciplinary team meeting (MDT). The aim was to assess the likelihood of patients with simultaneously diagnosed liver and lung metastases (SLLM) from colorectal cancer (CRC) to receive the curative treatment decided upon multidisciplinary team meeting (MDT) and to elaborate on the reasons for treatment intention failure and survival outcomes depending on final treatment strategy. Simultaneous resection of liver/lung metastases and primary tumour might increase the proportion of fulfilled hepatopulmonary resections
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