Surgical treatment of hepatic and pulmonary metastases from colorectal cancers.
BACKGROUND
Selected patients with double hepatic and pulmonary metastases from colorectal cancer may benefit from operation.


METHODS
From 1970 to 1995, 239 patients underwent operation for resection of pulmonary metastases from colorectal cancer at two French surgical centers. Among these patients, 43 (18%) had previously undergone complete resection of hepatic metastases and constitute the subject of this retrospective study.


RESULTS
The median interval time between hepatic and pulmonary resections was 18 months. Two pneumonectomies, 5 lobectomies, 3 segmentectomies, 6 wedge resections, and 27 metastasectomies were performed. No postoperative mortality was observed. Two patients had major postoperative complications. Seven patients (16%) underwent subsequent pulmonary resection for recurrences. Twenty-one patients were still alive, 14 free of disease. The median survival from pulmonary resection was 19 months and the 5-year probability of survival was 11%. Prethoracotomy carcinoembryonic antigen blood levels and the number of pulmonary resection were found to be significant prognostic factors; the interval time between hepatic and pulmonary resection (> 36 months) was borderline significant (p = 0.06).


CONCLUSIONS
Selected patients with combined hepatic and pulmonary metastases from colorectal cancer should be considered for surgical resection. Patients with normal prethoracotomy carcinoembryonic antigen levels and late metachronous pulmonary metastasis, appear to be the best surgical candidates.
Regnard
J F
JF
Department of Thoracic Surgery, Marie Lannelongue Hospital, Institut Mutualiste Montsouris, Paris, France.
Grunenwald
D
D
Spaggiari
L
L
Girard
P
P
Elias
D
D
Ducreux
M
M
Baldeyrou
P
P
Levasseur
P
P
D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood; D003110:Colonic Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011379:Prognosis; D012004:Rectal Neoplasms / Q000473:pathology*; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy
D002272:Carcinoembryonic Antigen