Simultaneous detection of colorectal carcinoma liver and lung metastases does not warrant resection

BACKGROUND: Recent evidence suggests that metastasectomy is efficacious for selected patients with hepatic and pulmonary metastases from a colorectal primary. The aim of this study was to identify a subgroup of patients who b est benefit from hepatic and pulmonary metastasectomy among those with colo rectal carcinoma metastases. STUDY DESIGN: We analyzed retrospectively a total of 136 patients who under went resection of hepatic or pulmonary metastases of colorectal origin at N iigata University Medical Hospital between 1982 and 2000. The median follow up period was 94 months. Eighty-four patients underwent hepatectomy alone, 25 underwent pulmonary resection alone, and 27 underwent both hepatic and p ulmonary resection. The 27 patients undergoing hepatic and pulmonary resect ion were divided into two groups: 17 patients with sequentially detected he patic and pulmonary metastases and 10 patients with simultaneously detected metastases. Survival time was determined from the date of initial metastas ectomy. Differences in cumulative survival were evaluated using the log-ran k test. Sixteen factors were assessed for their influence on the survival o f the 27 patients undergoing resection of hepatic and pulmonary metastases; univariate and multivariate analyses were used in this evaluation. RESULTS: Patient survival after hepatic and pulmonary resection was compara ble with that after hepatectomy alone (P = 0.536) and that after pulmonary resection alone (p = 0.294). Among the 27 patients undergoing hepatic and p ulmonary resection, the outcomes after resection were significantly better in patients with sequentially detected metastases (cumulative 5-year surviv al of 44%) than in those with simultaneously detected ones (cumulative 5-ye ar survival of 0%) (p < 0.001). On multivariate analysis sequential detecti on of hepatic and pulmonary metastases was the strongest independent favora ble prognostic factor (p < 0.001). CONCLUSIONS: Patients with sequentially detected hepatic and pulmonary meta stases from a colorectal primary are good candidates for aggressive metasta sectomy. Simultaneous detection of these metastases does not warrant resect ion. (J Am Coll Surg 2001;193:153-160. (C) 2001 by the American College of Surgeons).