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Sequential Resections of Liver- and Pulmonary Metastases of Colorectal Cancers: Results of 45 Patients
Hannes Neeff*1, Frank Makowiec1, Eva Fischer1, Ulrich T. Hopt1, Bernward Passlick2
1Dept. of Surgery, University of Freiburg, Freiburg, Germany; 2Dept. of Thoracic Surgery, University of Freiburg, Freiburg, Germany
Multimodal therapies (especially surgery of metastases and aggressive chemotherapy) in patients with metastases of colorectal cancers (CRC) are increasingly performed and may even provide healing in selected patients with more than one site of metastases. In the current literature there are only few studies with relatively low patient numbers reporting the outcome after resection of both, hepatic and pulmonary metastases of CRC. We, therefore, evaluated survival of patients who underwent sequential resections of hepatic and pulmonary metastases under potentially curative intention.
Methods: From 1989 until 2006 45 patients (31% female, median age 58 years) with (during the course of the disease) hepatic and pulmonary CRC-metastases underwent sequential resections at both metastatic sites. In all patients further tumor locations were excluded preoperatively. Metastases occurred synchronously (regarding primary CRC) in 29 %. In 82% liver resection was performed prior to pulmonary resection. First resection of metastases was performed a median of 16 months after resection of the primary CRC, the median interval to the second resection of metastases was seven months. The primary CRCs were in 53% rectal and in 47% colon carcinomas (62% nodal positive, all with free resection margins). Survival analysis was performed using the Kaplan-Meier-method.
Results: In both, the first and the second resection of metastases, free margins were achieved in 94%. Actuarial five-year survival (5-y SV) was 63% after initial diagnosis of CRC, forty-three percent after the first resection of metastases and 29% after the last resection. Patients with synchronous metastases had a significant poorer survival compared to patients with metachronous metastases (37% 5-y SV after first metastasectomy vs. 72% in patients with metachronous disease; p<0.01). The nodal status and the location of the primary CRC did not influence survival so far.
Conclusions: Within a multimodal management of patients with metastasized CRC a resection of both, hepatic and pulmonary metastases may achieve acceptable survival rates or even healing in selected patients, especially in the presence of biologically less aggressive (= metachronous) disease. Survival rates in these selected patients are comparable to those of patients after isolated hepatic resection reported during the last decade.
