title: Outcome after liver resection in patients presenting with simultaneous hepatopulmonary colorectal metastases.
abstract: BACKGROUND
  The most common sites of metastasis from colorectal cancer (CRC) are hepatic and pulmonary; they can present simultaneously (hepatic and pulmonary metastases) or sequentially (hepatic then pulmonary metastases, or vice versa). Simultaneous disease may be aggressive, and thus may be approached with caution by the clinician. The aim of this study was to determine the outcomes following hepatic and pulmonary resection for simultaneously presenting metastatic CRC.
  
  
  METHODS
  A retrospective review was undertaken of a prospectively maintained database to identify patients presenting with simultaneous hepatopulmonary disease who underwent hepatic resection. Patients' electronic records were used to identify clinicopathological variables. The log rank test was used to determine survival, and χ(2) analysis to determine predictors of failure of intended treatment.
  
  
  RESULTS
  Fifty-nine patients were identified and underwent hepatic resection; median survival was 45·4 months and the 5-year survival rate 38 per cent. Twenty-two patients (37 per cent) did not have the intended pulmonary intervention owing to progression or recurrence of disease. Thirty-seven patients who progressed to hepatopulmonary resection had a median survival of 54·2 months (5-year survival rate 43 per cent). Those who had hepatic resection alone had a median survival of 24·0 months (5-year survival rate 30 per cent). Failure to progress to pulmonary resection was predicted by heavy nodal burden of primary colorectal disease and bilobar hepatic metastases. Redo pulmonary surgery following pulmonary recurrence did not confer a survival benefit.
  
  
  CONCLUSIONS
  Selected patients with simultaneous hepatopulmonary CRC metastases should be considered for attempted curative resection, but some patients may not receive the intended treatment owing to progression of pulmonary disease after hepatic resection.
authors.affiliation: Departments of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK.
authors.forename: R V
authors.initials: RV
authors.lastname: Dave
authors.forename: S
authors.initials: S
authors.lastname: Pathak
authors.forename: A D
authors.initials: AD
authors.lastname: White
authors.forename: E
authors.initials: E
authors.lastname: Hidalgo
authors.forename: K R
authors.initials: KR
authors.lastname: Prasad
authors.forename: J P A
authors.initials: JP
authors.lastname: Lodge
authors.forename: R
authors.initials: R
authors.lastname: Milton
authors.forename: G J
authors.initials: GJ
authors.lastname: Toogood
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000401:mortality; D015179:Colorectal Neoplasms; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D008297:Male; D059146:Metastasectomy / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome