title: Surgical treatment of synchronous colorectal liver and lung metastases: the usefulness of thoracophrenolaparotomy for single stage resection.
abstract: When suitable, surgery still remains the therapeutic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, simultaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients (median age of 53 years) carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolaparotomy. The median number of liver metastases removed was 5 (range 2-30) and of lung metastases removed was 2 (range 1-3). Lung metastases were located in the upper lobe in 1 patient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity: one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases: in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.
authors.affiliation: Department of Hepatobiliary Surgery, Humanitas Research Hospital, University of Milan School of Medicine, Rozzano, Milan, Italy. guido.torzilli@humanitas.it.
authors.forename: Daniele
authors.initials: D
authors.lastname: Del Fabbro
authors.forename: Marco
authors.initials: M
authors.lastname: Alloisio
authors.forename: Fabio
authors.initials: F
authors.lastname: Procopio
authors.forename: Matteo
authors.initials: M
authors.lastname: Cimino
authors.forename: Matteo
authors.initials: M
authors.lastname: Donadon
authors.forename: Angela
authors.initials: A
authors.lastname: Palmisano
authors.forename: Luca
authors.initials: L
authors.lastname: Vigano
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology; D013906:Thoracoscopy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome