title: Long-term outcome after sequential resections of liver and lung metastases from colorectal carcinoma.
abstract: BACKGROUND
  Surgical resection of colorectal liver metastases (CLM) is an established form of treatment. Limited data exists on the value of sequential hepatic and pulmonary metastasectomy. We analysed patients who underwent sequential liver and lung resections for CLM.
  
  
  METHODS
  A total of 910 patients who underwent liver resection for CLM between January 2000 and December 2007, were analysed to identify patients with resectable pulmonary metastases (n= 43; 4.7%). Patient demographics, overall survival and survival difference between synchronous and metachronous pulmonary metastasectomy groups were compared. In addition, outcomes in the 'liver and lung resection' group were compared with a matched group of 'liver resection only' patients (matched for age, primary disease stage, interval to liver resection and liver disease stage).
  
  
  RESULTS
  Forty-three patients (median age 62, range 43-83 years, 22 males) underwent sequential liver and lung resection. A total of 36 patients underwent major hepatic resections, 18 patients had bilobar disease and the median number of liver lesions resected was 3 (range 1-5 lesions). Ten patients had synchronous liver and lung metastases. The median interval between liver and lung metastasectomy was 25 months (range 2-88 months). A total of two patients underwent major lobectomies, three patients had bilateral disease and the median number of lung lesions resected was one (range 1-3). The 1-, 3- and 5-year overall survival rates after first metastasectomy were 100%, 87.1% and 53.9%, respectively, with a median survival of 42 months.
  
  
  METHODS
  Undergoing metachronous pulmonary metastasectomy had better 1-, 3- and 5-year survival rates than those with synchronous disease (100%, 88.9% and 60.9% vs. 100%, 75% and 0%, respectively; P= 0.02, log rank test). There was no significant survival difference between the 'liver and lung resection' and the 'liver resection only' groups.
  
  
  CONCLUSIONS
  Sequential liver and lung resection for CLM is associated with good long-term survival in selected patients, except in those presenting with synchronous lung and liver metastases.
authors.forename: Ravi
authors.initials: R
authors.lastname: Marudanayagam
authors.forename: Krishnamoorthy
authors.initials: K
authors.lastname: Ramkumar
authors.forename: Vivekanandan
authors.initials: V
authors.lastname: Shanmugam
authors.forename: Gerald
authors.initials: G
authors.lastname: Langman
authors.forename: Pala
authors.initials: P
authors.lastname: Rajesh
authors.forename: Chris
authors.initials: C
authors.lastname: Coldham
authors.forename: Simon R
authors.initials: SR
authors.lastname: Bramhall
authors.forename: David
authors.initials: D
authors.lastname: Mayer
authors.forename: John
authors.initials: J
authors.lastname: Buckels
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza