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J Thorac Cardiovasc Surg 1999;117:66-76
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

IS RESECTION OF PULMONARY AND HEPATIC METASTASES WARRANTED IN PATIENTS WITH COLORECTAL CANCER?

From the Departments of Thoracic and Cardiovascular Surgery,^a Colorectal Surgery,^b and Biostatistics and Epidemiology,^c The Cleveland Clinic Foundation, Cleveland, Ohio.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested July 8, 1998. Revisions received Sept 10, 1998. Accepted for publication Sept 14, 1998. Address for reprints: Thomas W. Rice, MD, The Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195.

Background: Conventional management of stage IV colorectal carcinoma is palliative. The value of resecting both liver and lung colorectal metastases that occur in isolation of other sites of metastasis is undetermined.
Objectives: Our objectives were to (1) assess the efficacy of resecting both hepatic and pulmonary metastases, (2) investigate the influence of the sequence and timing of metastases, and (3) identify the profile of patients likely to benefit from both hepatic and pulmonary metastasectomy.
Patients and methods: Of 48 patients identified with resection of colorectal cancer and, at some point in time, both liver and lung metastases, 25 patients underwent metastasectomy (resection group). The remaining 23 patients comprised the nonresection group. Risk factors for death were identified by multivariable analyses.
Results: Median survival was longer after the last metastatic appearance in the resection group (16 months) than in the nonresection group (6 months; P < .001). The pattern of risk also differed; it peaked at 2 years and then declined in the resection group but was constant in the nonresection group. In the resection group, patients with metachronous resections survived longer after colorectal resection (median, 70 months) than patients with synchronous (median, 22 months) or mixed resections (median, 31 months; P < .001). Risk factors for death included older age, multiple liver metastases, and a short disease-free interval.
Conclusions: Younger patients with solitary metachronous metastases to the liver, then the lung, and long disease-free intervals are more likely to benefit from resection of both liver and lung metastases. Patients with risk factors also had better survival with resection than without resection.

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