|
Patients
with hepatic and pulmonary metastases from colorectal cancer may
benefit from aggressive surgical therapy
Patients with hepatic and pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. Our multi-disciplinary approach to metastatic CRC has been aggressive resection and serial metastasectomies in selected patients when possible. We reviewed our institutional experience with this select group of patients over a ten-year period to determine the efficacy of surgical resection of both hepatic and pulmonary metastases from CRC. Four hundred and twenty three hepatectomies were performed for metastatic CRC between 1992 and 2002 at two university-affiliated hospitals. Patients who underwent both lung and liver resections for metastatic CRC were studied. Demographic, perioperative and survival data were evaluated by retrospective chart review. Disease-free survival (DFS) and overall survival (OS) were evaluated by Kaplan-Meier analysis and survival curves were compared using the log-rank test. Thirty-nine patients underwent both lung and liver resections for metastatic CRC. Eleven patients (28%) underwent staged liver and lung metastasectomy due to synchronously identified metastases. Twenty-eight (72%) patients underwent sequential metastasectomy due to recurrent disease. The median DFS and OS after initial metastasectomy were 19.8 (Figure 1) and 87 months (Figure 2), respectively. Serial metastasectomy was common in this patient population. The mean number of metastasectomies performed was 2.6 per patient (range 1-4). There was no difference in OS for patients with synchronous vs. metachronous presentation of liver and lung metastases (p=0.45). The site of first recurrence after initial metastasectomy was most commonly the lung (n = 19, 49%), followed by the liver (n=8, 21%). Nineteen patients (49%) underwent subsequent resections for recurrences. Seven (18%) patients underwent two or more liver resections for recurrent disease while 12 (31%) underwent multiple lung resections. The results of our study demonstrate that lung and liver resections can be performed safely with good long-term outcome in selected patients with metastatic CRC. In this large single institution series, 39 patients over a 10-year period underwent resection of both hepatic and pulmonary CRC metastases. An aggressive surgical approach resulted in improved OS in this study. Median OS after the last metastasectomy performed, whether it was in the liver or lung, was 42.2 months. Impressively, the median OS from the initial diagnosis of colon cancer is 117 (IQR: 74-120) months. The 5-year OS for patients who underwent multiple metastasectomies was 74% compared to 42% for patients who underwent a single metastasectectomy (i.e. the index liver resection). Multiple metastasectomies with repeated lung and liver resections for recurrences can result in excellent long-term survival in selected patients.
Bibliographical reference:
Shimul A. Shah, Steven Gallinger, Alice C. Wei Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
|