Original article: general thoracic
Surgical treatment of hepatic and pulmonary metastases from colon cancer

Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
https://doi.org/10.1016/S0003-4975(00)02522-4Get rights and content

Abstract

Background. Surgical resection of isolated hepatic or pulmonary metastases secondary to colorectal cancer has been shown to yield acceptable long-term survival. However, results are inconclusive for surgical resection of both hepatic and pulmonary metastases.

Methods. We reviewed the records of all patients who underwent surgical resection of both hepatic and pulmonary metastases from colorectal cancer between 1980 and 1998.

Results. A total of 58 patients underwent resection of both hepatic and pulmonary metastases secondary to colorectal cancer. All patients had local control of their primary cancer before metastasectomy. There were no operative deaths. Morbidity occurred in 12% of patients. Follow-up was complete in all patients, with a median duration of 62 months (range, 6 to 201 months). The 5- and 10-year survivals were 30% and 16%, respectively. A premetastasectomy carcinoembryonic antigen level greater than 5 ng/mL increased the risk of early death (p = 0.029). Neither the number of pulmonary lesions nor the time interval between the primary surgery and the metastasectomy had a significant impact on survival (p = 0.67). At 5 years, 55% of patients were free of disease. Four patients had lymph node involvement at the time of pulmonary resection and all 4 patients died within 22 months of their pulmonary metastasectomy.

Conclusions. Resection of both hepatic and pulmonary metastases secondary to colorectal cancer in highly selected patients is safe and results in long-term survival. Thoracic lymph node involvement and elevated carcinoembryonic antigen levels before pulmonary metastasectomy are associated with reduced survival.

Section snippets

Material and methods

We performed a retrospective review of all patients who underwent both hepatic and pulmonary resections for metastatic colorectal cancer between 1980 and 1998. All patients included in the study had local control of their disease and presented with either synchronous or metachronous hepatic and pulmonary metastases. Synchronous lesions were defined as those identified within 3 months of the original colorectal resection. Metachronous lesions were identified as metastatic lesions that presented

Results

During the study period, 264 patients underwent resection for pulmonary metastases and 804 patients had liver resections for metastatic colon cancer; 58 (5.4%) of these patients had resection of both lung and liver metastasis. There were 37 men (64%) and 21 women (36%) with a median age of 59 years (range, 31 to 82 years). At the time of the original colorectal operation, no patients were stage I, 20 (35%) were stage II, 24 (41%) were stage III, and 13 (22%) were stage IV. Only 1 patient (2%)

Comment

Colorectal cancer is the second most common malignancy in the United States. It has been estimated that of all patients presenting with colorectal cancer, 70% are resectable for potential cure [1]. Of the 25% who fail primary resection, 20% may be eligible for resection of local recurrence or hepatic or pulmonary metastases [1]. The failure of systemic chemotherapy to provide long-term survival in patients with metastatic disease has provided the basis for surgical resection in selected

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