title: Survival Following Resection of Intra- and Extra-Hepatic Metastases from Colorectal Cancer: A Phase II Trial.
abstract: Metastasectomy for intrahepatic metastases (IHM) from colorectal cancer (CRC) provides excellent 5-year overall survival (OS). Presence of extrahepatic metastases (EHM) has been a historic contraindication to surgery. Due to improved safety of hepatectomy, there is growing interest in multisite metastasectomy for IHM and EHM. The objective of this study was to evaluate the results of metastasectomy for patients with IHM and EHM from CRC.
  
  
  
  A phase II study of metastasectomy for both IHM and EHM from CRC. Eligible patients with any number of IHM and up to three EHM foci, resectable with RO intent, were offered metastasectomy. Clinical, survival, and quality of life (QoL) data were analyzed using standard statistical methods.
  
  
  
  Twenty-six patients were enrolled with a median age of 58 (range 32-84) years; 14/26 (54 %) presented with synchronous disease. The lung was the most common EHM site (13/26, 50 %). Protocol surgery was completed in 20/26 (77 %), including 12/26 (46 %) planned sequential resections. Major morbidity and perioperative mortality were 5/26 (19 %) and 1/26 (4 %), respectively. The QoL decline appeared to be transient. All QoL domains returned to baseline by 1-year posttreatment. The median recurrence-free survival (RFS) was 5 months by intent-to-treat analysis. The median OS from the time of CRC diagnosis and metastasectomy were 50 and 38 months (3-year OS 80 and 53 %), respectively.
  
  
  
  Complete metastasectomy of multisite CRC is safe, but disease recurs in the majority of patients. Data suggest that aggressive multisite metastasectomy may provide OS benefit for selected patients.
authors.affiliation: Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada. Alice.Wei@uhn.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca.|Department of Surgery, University of Toronto, Toronto, Canada. Alice.Wei@uhn.ca.
authors.forename: Alice C
authors.initials: AC
authors.lastname: Wei
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.|Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Coburn
authors.affiliation: Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Katharine S
authors.initials: KS
authors.lastname: Devitt
authors.affiliation: Hepatobiliary & Pancreatic Surgical Oncology, Juravinski Hospital and Cancer Centre, Hamilton, Ontario, Canada.|Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Pablo E
authors.initials: PE
authors.lastname: Serrano
authors.affiliation: Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Carol-Anne
authors.initials: CA
authors.lastname: Moulton
authors.affiliation: Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Cleary
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.|Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Canada.
authors.forename: Calvin
authors.initials: C
authors.lastname: Law
authors.affiliation: BC Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Moore
authors.affiliation: Hepato-Pancreato-Biliary Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto General Hospital, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Gallinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D008297:Male; D059146:Metastasectomy / Q000401:mortality*; D008875:Middle Aged; D011013:Pneumonectomy / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate