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Is Complete Liver Resection Without Resection of Synchronous Lung Metastases Justified?

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Advances in multidisciplinary care are changing the prognostic impact of colorectal lung metastases. Resection of colorectal liver metastases (CLM) may benefit patients with synchronous lung metastases even when lung metastases are not resected. The aim of this study was to investigate the survival of patients undergoing complete resection of CLM in the setting of unresected lung metastases.

Patients and Methods

We compared survival among 98 patients who underwent resection of CLM with unresected lung metastases, 64 who received only chemotherapy for limited colorectal liver and lung metastases, and 41 who underwent resection of both liver and lung metastases. Prognostic factors were investigated in the patients who underwent resection of CLM only.

Results

The 3-year/5-year overall survival (OS) rates of patients with CLM resection only (42.9 %/13.1 %) were better than those of patients treated with chemotherapy only (14.1 %/1.6 %; p < 0.01) but worse than those of patients with resection of liver and lung metastases (68.9 %/56.9 %; p < 0.01). Multivariate analysis of patients with CLM resection only revealed that KRAS mutation [hazard ratio (HR) 2.10; 95 % confidence interval (CI) 1.21–3.64; p < 0.01] and rectal primary tumor (HR 1.72; 95 % CI 1.02–2.88; p = 0.04) were independent predictors of worse OS. Survival of patients without these risk factors was similar to that of patients with curative metastasectomy.

Conclusions

Complete resection of metastases remains the primary goal of treatment for stage IV colorectal cancer. Resection of CLM without resection of lung metastases is associated with an intermediate survival between that of patients treated with palliative and curative intent and should be considered in selected patients.

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Acknowledgment

This research was supported in part by the National Institutes of Health through MD Anderson’s Cancer Center Support Grant, CA016672.

Disclosure

Yoshihiro Mise, Scott Kopetz, Reza J. Mehran, Thomas A. Aloia, Claudius Conrad, Kristoffer W. Brudvik, Melissa W. Taggart, and Jean-Nicolas Vauthey report no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Yoshihiro Mise MD, Thomas A. Aloia MD, Claudius Conrad MD, Kristoffer W. Brudvik MD & Jean-Nicolas Vauthey MD

  2. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Scott Kopetz MD

  3. Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Reza J. Mehran MD

  4. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Melissa W. Taggart MD

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  1. Yoshihiro Mise MD
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Correspondence to Jean-Nicolas Vauthey MD.

Electronic supplementary material

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Supplementary Figure S1

Selection of patients who underwent hepatectomy only (A) and chemotherapy only (B). CLM, colorectal liver metastases. PS, Eastern Cooperative Oncology Group performance status. (PPTX 506 kb)

Supplementary Figure S2

Overall survival in 84 patients who underwent preoperative chemotherapy before hepatectomy. (TIFF 82 kb)

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Mise, Y., Kopetz, S., Mehran, R.J. et al. Is Complete Liver Resection Without Resection of Synchronous Lung Metastases Justified?. Ann Surg Oncol 22, 1585–1592 (2015). https://doi.org/10.1245/s10434-014-4207-3

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  • DOI: https://doi.org/10.1245/s10434-014-4207-3

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