title: Surgical treatment of combined hepatic and pulmonary colorectal cancer metastases.
abstract: OBJECTIVE
  Surgical resection of combined hepatic and pulmonary metastases remains controversial in light of limited supportive evidence. This study aimed to audit our initial experience with this aggressive surgical strategy.
  
  
  METHODS
  Between 1997 and 2006 we assessed 19 patients with colorectal cancer metastases for combined liver and lung metastasectomy, of whom 16 patients underwent surgery. We retrospectively reviewed perioperative and survival data.
  
  
  RESULTS
  Synchronous liver metastases were present in three out of 16 patients at time of diagnosis of the primary tumour, and one out of 16 patients had synchronous lung and liver metastases with the primary tumour. Of those 12 patients who developed metachronous metastases five patients developed liver metastases first, one patient developed pulmonary metastases first, and six patients developed synchronous liver and lung metastases. Thirty nine operations were performed on 16 patients. The median hospital stay was 5.5 (2-10) days for the pulmonary and 7 (1-23) days for the hepatic resections. There were no in-hospital deaths. Chemotherapy was given to five patients prior to metastasectomy and nine received adjuvant chemotherapy following metastasectomy. Median survival from diagnosis of metastatic disease was 44 months (8-87 months). Estimated 1-year survival from diagnosis of metastatic disease was 94%, estimated 5-year survival was 20%.
  
  
  CONCLUSIONS
  We believe an aggressive but selective surgical approach to combined hepatic and pulmonary colorectal metastases is justified by limited resource requirements and encouraging survival.
authors.affiliation: Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK. adambarlow@doctors.net.uk
authors.forename: A D
authors.initials: AD
authors.lastname: Barlow
authors.forename: A
authors.initials: A
authors.lastname: Nakas
authors.forename: C
authors.initials: C
authors.lastname: Pattenden
authors.forename: A E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.forename: A R
authors.initials: AR
authors.lastname: Dennison
authors.forename: D P
authors.initials: DP
authors.lastname: Berry
authors.forename: D M
authors.initials: DM
authors.lastname: Lloyd
authors.forename: G S
authors.initials: GS
authors.lastname: Robertson
authors.forename: D A
authors.initials: DA
authors.lastname: Waller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011013:Pneumonectomy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome