title: Outcome of strict patient selection for surgical treatment of hepatic and pulmonary metastases from colorectal cancer.
abstract: BACKGROUND
  Surgery is currently the only potentially curative treatment for hepatic or pulmonary metastases from colorectal cancer. However, the benefit of surgery and the criteria for the inclusion of patients developing hepatic and pulmonary metastases are not well defined.
  
  
  OBJECTIVE
  The aim of this study was to describe the outcome for patients who undergo surgery for both hepatic and pulmonary metastases from colorectal cancer, to present a set of preoperative criteria for use in patient selection, and to analyze potential prognostic factors related to survival.
  
  
  METHODS
  This was an observational study with retrospective analysis of data collected with a prospective protocol.
  
  
  METHODS
  This investigation was conducted at a tertiary centre.
  
  
  METHODS
  Between January 1996 and January 2010, of 319 patients who underwent surgery for hepatic metastases from colorectal cancer, 44 also had resection of pulmonary metastases. A set of strict selection criteria established by a panel of liver surgeons, chest surgeons, oncologists, and radiologists was used.
  
  
  METHODS
  Survival was estimated with the Kaplan-Meier method, and univariate analyses were performed to evaluate potential prognostic factors for survival, including variables related to patient, primary tumour, hepatic, and pulmonary metastases and chemotherapy.
  
  
  RESULTS
  The 44 patients received a total of 53 pulmonary resections: 36 patients had 1, 7 patients had 2, and 1 patient had 3 resections. There was no postoperative mortality and the morbidity rate after pulmonary resection was 1.8%. No patient was lost to follow-up. Overall survival was 93% at 1 year, 81% at 3 years, and 64% at 5 years. Factors related to poor prognosis in the univariate analysis were presence of more than 1 pulmonary metastasis (p = 0.04), invasion of the surgical margin (p = 0.006), and administration of neoadjuvant chemotherapy (p = 0.01 for hepatic metastases and p = 0.02 for pulmonary metastases).
  
  
  CONCLUSIONS
  The study was limited by its observational nature and the relatively small number of patients.
  
  
  CONCLUSIONS
  In patients with hepatic and pulmonary metastases from colorectal cancer selected according to strict inclusion criteria, surgical treatment performed in a specialized center is a safe option that offers prolonged survival.
authors.affiliation: Liver Surgery and Liver Transplant Unit, Virgen de la Arrixaca University Hospital, University of Murcia, Murcia, Spain. cariki@ono.com
authors.forename: Caridad
authors.initials: C
authors.lastname: Marín
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles
authors.forename: Asuncion
authors.initials: A
authors.lastname: López Conesa
authors.forename: Juan
authors.initials: J
authors.lastname: Torres
authors.forename: Domingo Perez
authors.initials: DP
authors.lastname: Flores
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010348:Patient Care Team; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D020379:Risk Adjustment; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology