Ann Surg Treat Res.  2017 Feb;92(2):82-89. 10.4174/astr.2017.92.2.82.

Surgical resection of synchronous and metachronous lung and liver metastases of colorectal cancers

• Jeong S
• Heo JS
• Park JY
• Choi DW
• Choi SH

• KMID: 2367920
• DOI: http://doi.org/10.4174/astr.2017.92.2.82

Abstract

PURPOSE
Surgical resection of isolated hepatic or pulmonary metastases of colorectal cancer is an established procedure, with a 5-year survival rate of about 50%. However, the role of surgical resections in patients with both hepatic and pulmonary metastases is not well established. We aimed to analyze overall survival of these patients and associated factors.
METHODS
Data retrospectively collected from 66 patients who underwent both hepatic and pulmonary metastasectomy after colorectal cancer surgery from August 2002 through August 2013 were analyzed. In univariate analysis, the log-rank test compared patient survival between groups. P < 0.1 was considered indicative of significance. Multivariate analysis of the significance data using a Cox proportional hazard model identified factors associated with overall survival. The synchronous group (n = 57) was defined as patients who had metastasectomy within 3 months from primary colorectal cancer surgery. The remaining nine patients constituted the metachronous group.
RESULTS
Median follow-up was 126 months from the primary colorectal cancer surgery. The 5-year survival was 73.4%. There was no difference in overall survival between the synchronous and metachronous groups, consistent with previous studies. Distribution (involving one hemiliver or both, P = 0.010 in multivariate analysis) of liver metastases and multiplicity of the pulmonary metastasis (P = 0.039) were predictors of poor prognosis.
CONCLUSION
Sequential or simultaneous resection of both hepatic and pulmonary metastasis of colorectal cancer resulted in good long-term survival in selected patients. Thus, an aggressive surgical approach and multidisciplinary decision making with surgeons seems to be justified.

Keyword

Colorectal cancer; Liver metastasis; Lung metastasis; Synchronous metastasis

MeSH Terms

Colorectal Neoplasms*
Decision Making
Follow-Up Studies
Humans
Liver*
Lung*
Metastasectomy
Multivariate Analysis
Neoplasm Metastasis*
Prognosis
Proportional Hazards Models
Retrospective Studies
Surgeons
Survival Rate

Figure

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  Fig. 1 Patient grouping according to initial presentation and sequence of metastasis site.

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  Fig. 2 Survival results. (A) Synchronous versus metachronous survival analysis, by log-rank test (P = 0.327, by log-rank) (1, metachronous; 2, synchronous). (B) Survival from first metastatetomy by log-rank test (P = 0.813, by log-rank). (C) Comparison between liver metastases involving single lobe or both lobe in survival from first site metastasectomy (P = 0.031, by log-rank). (D) Comparison between single and multiple lung metastasis in survival from first site metastasectomy (P = 0.784, by log-rank).

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