Surgical treatment of hepatic and pulmonary metastases from colon cancer

Background. Surgical resection of isolated hepatic or pulmonary metastases secondary to colorectal cancer has been shown to yield acceptable long-term survival. However, results are inconclusive for surgical resection of both hepatic and pulmonary metastases. Methods. We reviewed the records of all patients who underwent surgical res ection of both hepatic and pulmonary metastases from colorectal cancer betw een 1980 and 1998. Results. A total of 58 patients underwent resection of both hepatic and pul monary metastases secondary to colorectal cancer. All patients had local co ntrol of their primary cancer before metastasectomy. There were no operativ e deaths. Morbidity occurred in 12% of patients. Follow-up was complete in all patients, with a median duration of 62 months (range, 6 to 201 months). The 5-and 10-year survivals were 30% and 16%, respectively. A premetastase ctomy carcinoembryonic antigen level greater than 5 ng/mL increased the ris k of early death (p = 0.029). Neither the number of pulmonary lesions nor t he time interval between the primary surgery and the metastasectomy had a s ignificant impact on survival (p 0.67). At 5 years, 55% of patients were fr ee of disease. Four patients had lymph node involvement at the time of pulm onary resection and all 4 patients died within 22 months of their pulmonary metastasectomy. Conclusions. Resection of both hepatic and pulmonary metastases secondary t o colorectal cancer in highly selected patients is safe and results in long -term survival. Thoracic lymph node involvement and elevated carcinoembryon ic antigen levels before pulmonary metastasectomy are associated with reduc ed survival. (C) 2001 by The Society of Thoracic Surgeons.