Is resection of pulmonary and hepatic metastases warranted in patients with colorectal cancer?

Background: Conventional management of stage IV colorectal carcinoma is pal liative, The value of resecting both liver and lung colorectal metastases t hat occur in isolation of other sites of metastasis is undetermined, Object ives: Our objectives were to (1) assess the efficacy of resecting both hepa tic and pulmonary metastases, (2) investigate the influence of the sequence and timing of metastases, and (3) identify the profile of patients likely to benefit from both hepatic and pulmonary metastasectomy, Patients and met hods: Of 48 patients identified with resection of colorectal cancer and, at some point in time, both liver and lung metastases, 25 patients underwent metastasectomy (resection group). The remaining 23 patients comprised the n onresection group. Risk factors far death were identified by multivariable analyses. Results: Median survival was longer after the last metastatic app earance in the resection group (16 months) than in the nonresection group ( 6 months; P <.001). The pattern of risk also differed; it peaked at 2 years and then declined in the resection group but was constant in the nonresect ion group. In the resection group, patients with metachronous resections su rvived longer after colorectal resection (median, 70 months) than patients with synchronous (median, 22 months) or mixed resections (median, 31 months ; P <.001), Risk factors for death included older age, multiple liver metas tases, and a short disease-free interval, Conclusions: Younger patients wit h solitary metachronous metastases to the liver, then the lung, and long di sease-free intervals are more likely to benefit from resection of both live r and lung metastases, Patients with risk factors also had better survival with resection than without resection.