title: Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma.
abstract: BACKGROUND
  Patients with hepatic and pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. We examined the longterm outcomes of patients who underwent both lung and liver resections for colorectal metastases over a 10-year period.
  
  
  METHODS
  Four hundred twenty-three hepatectomies were performed for metastatic CRC between 1992 and 2002 at two university-affiliated hospitals. Patients who underwent both lung and liver resections for metastatic CRC were studied. Demographic, perioperative, and survival data were evaluated by retrospective chart review. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis and survival curves were compared using the log-rank test.
  
  
  RESULTS
  Thirty-nine patients underwent both lung and liver resections for metastatic CRC. Eleven patients (28%) underwent staged liver and lung metastasectomy from synchronously identified metastases. Twenty-eight patients (72%) underwent sequential metastasectomy because of recurrent disease. The median disease-free and overall survivals after initial metastasectomy were 19.8 and 87 months, respectively. Serial metastasectomy was common in this patient population. The mean number of metastasectomies performed was 2.6 per patient (range 1 to 4). There was no difference in overall survival for patients with synchronous versus metachronous presentation of liver and lung metastases (p=0.45). The site of first recurrence after initial metastasectomy was, most commonly, the lung (n=19, 49%), followed by the liver (n=8, 21%). Nineteen patients (49%) underwent subsequent resections for recurrences. Seven patients (18%) underwent 2 or more liver resections for recurrent disease, and 12 (31%) underwent multiple lung resections.
  
  
  CONCLUSIONS
  An aggressive multidisciplinary surgical approach should be undertaken for recurrent CRC metastases. In selected patients, serial metastasectomy for recurrent metastatic disease is safe and results in excellent longterm survival after CRC resection.
authors.affiliation: Department of Surgery, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.forename: Riad
authors.initials: R
authors.lastname: Haddad
authors.forename: Wigdan
authors.initials: W
authors.lastname: Al-Sukhni
authors.forename: Robin D
authors.initials: RD
authors.lastname: Kim
authors.forename: Paul D
authors.initials: PD
authors.lastname: Greig
authors.forename: David R
authors.initials: DR
authors.lastname: Grant
authors.forename: Bryce R
authors.initials: BR
authors.lastname: Taylor
authors.forename: Bernard
authors.initials: B
authors.lastname: Langer
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D011013:Pneumonectomy; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome