SURGICAL-TREATMENT OF HEPATIC AND PULMONARY METASTASES FROM COLORECTAL CANCERS

Background. Selected patients with double hepatic and pulmonary metast ases from colorectal cancer may benefit from operation. Methods. From 1970 to 1995, 239 patients underwent operation fur resection of pulmon ary metastases from colorectal cancer at two French surgical centers. Among these patients, 43 (18%) had previously undergone complete resec tion of hepatic metastases and constitute the subject of this retrospe ctive study. Results. The median interval time between hepatic and pul monary resections was 18 months. Two pneumonectomies, 5 lobectomies, 3 segmentectomies, 6 wedge resections, and 27 metastasectomies were per formed, No postoperative mortality was observed. Two patients had majo r postoperative complications. Seven patients (16%) underwent subseque nt pulmonary resection for recurrences. Twenty-one patients were still alive, 14 free of disease. The median survival from pulmonary resecti on was 19 months and the 5-year probability of survival was 11%. Preth oracotomy carcinoembryonic antigen blood levels and the number of pulm onary resection were found to be significant prognostic factors; the i nterval time between hepatic and pulmonary resection (>36 months) was borderline significant (p = 0.06). Conclusions. Selected patients with combined hepatic and pulmonary metastases from colorectal cancer shou ld be considered for surgical resection. Patients with normal prethora cotomy carcinoembryonic antigen levels and late metachronous pulmonary metastasis, appear to be the best surgical candidates. (Ann Thorac Su rg 1998;66:214-9). (C) 1998 by The Society of Thoracic Surgeons.