Resection of hepatic and pulmonary metastases from colorectal cancer

doi:10.1016/0960-7404(92)90042-J

Surgical Oncology

Volume 1, Issue 6, December 1992, Pages 399-404

https://doi.org/10.1016/0960-7404(92)90042-J Get rights and content

Abstract

Resection of hepatic metastases of colorectal origin has gained wide acceptance, but when patients have synchronous or metachronous pulmonary metastases, they are often considered incurable and are offered systemic therapy only. We performed a retrospective review of the patients at Memorial Sloan-Kettering Cancer Center who underwent resection of both hepatic and pulmonary metastases of colorectal origin between 1970 and 1990. Ten patients were identified who met the above criteria. Median survival after hepatic and pulmonary resections were 34 and 18 months, respectively. Actuarial 1-, 3- and 5-year survivals are 89%, 78% and 52%, respectively. With a median of 18 months after second operation, three patients have no evidence of disease (NED), four are alive with disease (AWD) and three are dead of disease (DOD). In the absence of effective chemotherapy, selected patients with hepatic and pulmonary metastases of colorectal origin should be considered for resection as it offers the only possibility for long-term survival.

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Cited by (64)

Liver Metastases
2013, Abeloff's Clinical Oncology: Fifth Edition
Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases
2009, European Journal of Surgical Oncology
Citation Excerpt :
Our study adds to the evidence that resection of combined liver and lung metastases can be performed safely with encouraging survival. The observed median survival of 44 months following diagnosis of metastatic -disease compares favourably with other studies 8,12–24. Given that median survival with chemotherapy is only 18–20 months 9,10 we feel that the small number of patients with resectable pulmonary and hepatic colorectal metastases should be offered surgery.
Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy.
Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data.
Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2–10) days for the pulmonary and 7 (1–23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8–87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%.
We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.
Inoperable colorectal liver metastases: A declining entity?
2008, European Journal of Cancer
Citation Excerpt :
Resection of isolated pulmonary metastases from colorectal adenocarcinoma is now accepted treatment with a reported 5-year survival of approximately 40–50%27–30 and post-operative mortality of less than 1%.31,32 Data from patients undergoing resections for metachronous presentations of pulmonary and hepatic disease also display a survival advantage to be gained from aggressive resection or multiple resections in these patients, with median and 5-year survivals comparable to resection of isolated pulmonary metastases.33–35 Reports of resections after synchronous presentation of disease is more sparse, but most studies, with the exception of Nagakuri and colleagues36 suggest that the presence of pulmonary metastases at the same time of presentation with CLM is not a contraindication to resection (Table 1).37–42
Untreated colorectal liver metastases (CLMs) have a dismal prognosis. Surgery remains the gold standard of treatment, but many patients will have inoperable disease at presentation. Until recently, the outlook for such patients was bleak. The purpose of this review was to report on available options in the treatment CLMs, which would be considered unresectable by conventional evaluation.
Inclusion criteria were articles published in English-language journals reporting on either retrospective or prospective cohorts of patients undergoing treatment for conventionally inoperable CLM. Main outcome measures were survival, resectability rates, morbidity and mortality following treatment of the patients’ disease.
Improved chemotherapy regimes and other innovative treatments have opened up new options for such patients and may even render conventionally inoperable disease resectable. The aim of treatment should be down-staging of metastases to achieve resectability, however, other treatments such as ablation may be also be used (either alone or in conjunction with resection).
A nihilistic attitude to the patient with seemingly inoperable liver metastases should be discouraged. Discussion of such patients at multi-disciplinary meetings is essential in order to plan and monitor treatments.
Staging of Advanced Colorectal Cancer
2008, Surgical Oncology Clinics of North America
The management of advanced colorectal cancer has changed dramatically during the last decade. By redefining resectability, and with the use of modern chemotherapy, nearly 10% of unresectable patients are now alive 5 years after diagnosis, and, overall, 20% are alive at 5 years when the combined results of surgery and chemotherapy are considered. These achievements are not reflected in the current staging, which categorizes all disease spread beyond the lymph node basin of the primary tumor as unstratified stage 4. This article discusses the merits of a number of proposals for a new, meaningful staging system for advanced colorectal cancer.
Surgical and Nonsurgical Therapy for Lung Metastasis: Indications and Outcomes
2007, Surgical Oncology Clinics of North America
Citation Excerpt :
Combined surgical resection of isolated hepatic and lung metastases has met with relative success. Several small studies report 5-year survival after combined resections ranging from 11% to 43% [104,106–109]. This is almost within the range of survival rates reported for hepatic resections alone (21%–43%) [103,110–114].
Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma
2006, Journal of the American College of Surgeons
Patients with hepatic and pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. We examined the longterm outcomes of patients who underwent both lung and liver resections for colorectal metastases over a 10-year period.
Four hundred twenty-three hepatectomies were performed for metastatic CRC between 1992 and 2002 at two university-affiliated hospitals. Patients who underwent both lung and liver resections for metastatic CRC were studied. Demographic, perioperative, and survival data were evaluated by retrospective chart review. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis and survival curves were compared using the log-rank test.
Thirty-nine patients underwent both lung and liver resections for metastatic CRC. Eleven patients (28%) underwent staged liver and lung metastasectomy from synchronously identified metastases. Twenty-eight patients (72%) underwent sequential metastasectomy because of recurrent disease. The median disease-free and overall survivals after initial metastasectomy were 19.8 and 87months, respectively. Serial metastasectomy was common in this patient population. The mean number of metastasectomies performed was 2.6 per patient (range 1 to 4). There was no difference in overall survival for patients with synchronous versus metachronous presentation of liver and lung metastases (p = 0.45). The site of first recurrence after initial metastasectomy was, most commonly, the lung (n = 19, 49%), followed by the liver (n = 8, 21%). Nineteen patients (49%) underwent subsequent resections for recurrences. Seven patients (18%) underwent 2 or more liver resections for recurrent disease, and 12 (31%) underwent multiple lung resections.
An aggressive multidisciplinary surgical approach should be undertaken for recurrent CRC metastases. In selected patients, serial metastasectomy for recurrent metastatic disease is safe and results in excellent longterm survival after CRC resection.

View all citing articles on Scopus

^☆: Presented in part at the 45th Annual Meeting of the Society of Surgical Oncology, New York, New York, March 17, 1992.

¹: Present address: James Smith, MD, Department of Surgery, Section of Surgical Oncology, Loma Linda University Medical Center, Loma Linda, California 92354, USA.

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Original articleResection of hepatic and pulmonary metastases from colorectal cancer☆

Abstract

Am J Surg

Beitraege zur Leber-Chirurgie

Bruns Beitr Klin Chir

Report of a case of resection of the liver for the removal of a neoplasm, with a table of seventy six cases of resection of the liver for hepatic tumours

Ann Surg

A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumour Study Group Protocol 6584

J Clin Oncol

Multivariate analysis of a personal series of 247 consecutive patients with liver metastases from colorectal cancer

Ann Surg

Hepatic resection for metastases of the colon and rectum

Surg Gynecol Obstet

Resection of the liver for colorectal carcinoma metastases: a multi-institutional study of long-term survivors

Dis Colon Rectum

Registry of hepatic metastases, resection of theliver for colorectal carcinoma metastases: a multi-institutional study of indications for resection

Surgery

Major hepatic resection for colorectal liver metastases

Br J Surg

Resection of hepatic metastases from colorectal cancer

Ann Surg

Major hepatic resection for metachronous metastases from colon cancer

Ann Surg

Morbidity and mortality of hepatic resection for metastatic colorectal carcinoma

Dis Colon Rectum

Sites of recurrent tumour after ‘curative’ colorectal surgery: implications for adjuvant therapy

Br J Surg

Resected pulmonary metastases from colorectal cancer

Dis Colon Rectum

Original article
Resection of hepatic and pulmonary metastases from colorectal cancer☆