title: Long-term results and prognostic factors after resection of hepatic and pulmonary metastases of colorectal cancer.
abstract: BACKGROUND
  Resection of colorectal liver or lung metastases is an established therapeutical concept at present. However, an affection of both these organs is frequently still regarded as incurable.
  
  
  METHODS
  All cancer patients are documented in our prospective cancer registry since 1995. Data of patients who underwent liver and lung resection for colorectal metastases were extracted and analysed.
  
  
  RESULTS
  Sixty-five patients underwent surgery for liver and lung metastases. In 33 cases, the first distant metastasis was diagnosed synchronously to the primary tumour. For the remaining patients, median time interval between primary tumour and first distant metastasis was 18 months (5-69 months). Complete resection was achieved in 51 patients (79 %) and was less likely in patients with synchronous disease (p = 0.017). Negative margins (p = 0.002), the absence of pulmonary involvement in synchronous metastases (p = 0.0003) and single metastases in both organs (p = 0.036) were associated with a better prognosis. Five- and 10-year survival rates for all patients are 57 and 15 % from diagnosis of the primary tumour, 37 and 14 % from resection of the first metastasis and 20 and 15 % from resection of the second metastasis. After complete resection, 5- and 10-year survival rates increased to 61 and 18 %, 43 and 17 % as well as 25 and 19 %, respectively. Long-term survivors (≥10 years) were seen only after complete resection of both metastases.
  
  
  CONCLUSIONS
  Patients with resectable liver and lung metastases of the colorectal primary should be considered for surgery after multidisciplinary evaluation regardless of the number or size of the metastases or the disease-free intervals. Clear resection margins are the strongest prognostic parameter.
authors.affiliation: Department of General, Visceral and Vascular Surgery, University of Jena, Erlanger Allee 101, 07747 Jena, Germany. silke.schuele@med.uni-jena.de
authors.forename: Silke
authors.initials: S
authors.lastname: Schüle
authors.forename: Yves
authors.initials: Y
authors.lastname: Dittmar
authors.forename: Thomas
authors.initials: T
authors.lastname: Knösel
authors.forename: Peter
authors.initials: P
authors.lastname: Krieg
authors.forename: Roland
authors.initials: R
authors.lastname: Albrecht
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
authors.forename: Annelore
authors.initials: A
authors.lastname: Altendorf-Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen