Abstracts
2000 Digestive Disease Week

# 2273 Isolated Pulmonary Recurrence After Resection of Colorectal Hepatic Metastases—Is Resection Indicated?
Daniel M. Labow, Joseph F Buell, Atsushi Yoshida, Ralph Layman, James M. Millis, Mark Ferguson, Mitchell C Posner, Chicago, IL

Resection of colorectal hepatic metastases is an accepted treatment modality. Concurrent or sequential pulmonary metastasectomy continues to be a controversial strategy. We examined the efficacy of these combined interventions in metastatic colorectal cancer. Methods: A retrospective review of 106 patients resected for colorectal hepatic metastases was performed to identify patients with pulmonary metastases. Patient demographics, operative interventions, and overall survival were analyzed. Statistical methods included unpaired student’s t-test, actuarial survival and log-rank analysis. Results: Nineteen patients (18%) had pulmonary metastases posthepatic resection of which 12/19(63%) underwent pulmonary resection. No differences were observed between this group, the 7 patients with unresectable pulmonary metastases and 87 patients without pulmonary metastases with regard to age, sex, race or extent of hepatic metastases. When comparing the resected vs unresected pulmonary recurrences, the disease-free interval from hepatic resection to detection of pulmonary metastases was 21±20 months (range 3-72 months) vs 16±8 months (range 4-25 months, p=NS), respectively. All patients with pulmonary recurrence who underwent pulmonary metastasectomy had unilateral disease. Seven of 12(58%) underwent wedge resections while the remaining 5(42%) required lobectomies to obtain a complete resection. Four patients that underwent pulmonary resection had multiple lung metastases (2-4 lesions) while 8 had isolated metastasis. There were no peri-operative deaths in the pulmonary metastasectomy group. Contraindications to pulmonary resection included extensive pulmonary disease (n=4) and concurrent extrapulmonary disease (n=3). A survival benefit was noted at 3 years for the resected vs unresected group (60% vs 31%, p<0.05). Survival was no different when comparing the resected pulmonary recurrence patients to the resected hepatic metastases only patients (60% vs 54%, p=NS) Conclusions: Pulmonary metastasectomy can be performed safely and effectively in patients with recurrent disease after hepatic resection for colorectal metastases. Prolonged survival can be achieved with resection of isolated pulmonary recurrence post-hepatic resection for colorectal cancer. Further studies that delineate selection criteria for pulmonary resection of colorectal metastases are warranted.